Does public health *need* MAHA?

It’s a little more complicated than that

Last week, our friend Dr. Craig Spencer sparked an ongoing volatile discussion with his Atlantic article “Public Health Needs MAHA.” Some have come out in strong dissent, others are cheering, and others are simply lamenting that we find ourselves in such a divided world to begin with.

We will dare to dip our toes in these controversial waters, too. Does public health need MAHA?

We think in some ways yes, and in other ways, no.

MAHA leaders versus the everyday MAHA supporter

The vitriol in this debate mostly comes from one collapsed distinction: the leadership of MAHA is not necessarily the same as the people who support it.

Say “MAHA” and most people picture RFK Jr. Fair enough, as he coined the term and holds most of the power. And, yes, some MAHA followers treat Kennedy as something close to a saint.

But talk to the grassroots, and it’s not a monolith. They’re Republicans, Democrats, and Independents. People who distrust vaccines and vaccine supporters. It’s a wide, eclectic coalition. The data backs this too: 4 in 10 Americans support the movement—that’s a lot of people! But according to polls, vaccines and medical choice (the issues most tied to Kennedy personally) are cited by only 4% as their reason for supporting the movement. For many, the motivations are much broader.

Many MAHA supporters are signing up for the idea that “something needs to change” with health in this country. They’re asking good-faith questions about corporate influence on our health systems, health care costs, nutrition, chemicals, and clean air and water. These are all questions that plenty of public health professionals recognize as legitimate and also care about very deeply.

Blurring the lines between the leadership and grassroots does real damage in two important ways:

1. It hands the 4 in 10 exactly the narrative already fed—that the health ecosystem doesn’t listen, doesn’t care, and paints every critic with the same brush.

2. It gives the actual bad actor more power. RFK Jr. has done irreparable damage and can’t be trusted.

What the MAHA movement gets right

A healthy population is something the public health field was literally built on, and many of these topics are things we have dedicated our lives to. Yet the MAHA movement has captivated nearly half the country in a way the public health establishment has failed to achieve.

So that means MAHA is doing something right. Some of it may be timing (after a Covid-19 pandemic and deep frustration and mistrust with institutions). The movement also does three other things really well:

1. It gives a new, louder voice to system failures.

While MAHA is not a monolith, one theme stays consistent across their stories: the system failed them. For some, it was the system that flooded their communities with opioids and then walked away. For others, it was the system that let their business collapse during Covid with no safety net in sight. For others still, it was the system that failed to help them manage a complex chronic illness, bouncing them from physician to physician without any real answers.

And in many ways, our health ecosystems are failing Americans. Why are medical bills so incomprehensible? Why do some kids get a healthy school lunch and others don’t? Why do an epidemiologist and a MD/PhD student have to start newsletters in the middle of the biggest public health emergency in a century, just so people can get straight information?

Because the systems failed. This deep-seated frustration driving many Americans to search for solutions elsewhere needs to be recognized.

2. MAHA has brilliant comms central to their efforts.

MAHA figured out something most health institutions still have not: the information landscape changed. It’s participatory now, not top-down; influence runs through many nodes in a community, not one institution; and storytelling and telling audiences “what you really think” moves people more than data dumps do. MAHA goes where audiences are listening, using podcasts, social media, and memes in ways most health institutions would scoff at—but it works.

3. They are very good at organizing.

A MAHA meeting feels like a rally: energy, speakers, music, and most importantly, an action for everyone. Someone’s writing the next policy brief, someone’s seeding a narrative, someone knows the next legislative deadline, someone’s sending the text messages for a campaign. None of this is new (ask the civil rights movement), but MAHA knows it works and has capitalized on it.

What MAHA gets wrong

This list could be much longer, and this newsletter has spent a lot of time covering it, but here are a few things:

1. Poor use of scientific evidence. This is the fundamental problem with many MAHA policies: the hype outpaces the science, and experts are often villainized for pointing this out.

2. MAHA leadership has traded real solutions for cheap wins. For example, instead of taking on the powerful food industry and passing real reforms, it has celebrated french fries made of beef tallow and taken out artificial dyes from still very sugary children’s cereal. These changes won’t move the needle on America’s diet.

3. MAHA leadership has tried to dismantle vaccine access in the U.S. While many MAHA supporters emphasize other issues, the effort to change vaccine policy has become MAHA’s signature effort. This is not surprising given RFK Jr.’s extensive track record campaigning against vaccines.

4. It has rallied behind the wrong leader. RFK Jr. has a decades-long track record of villifying doctors, scientists, and public health workers, well before he became HHS secretary. He is known for his decades-long work sowing distrust in vaccines as well as life-saving treatments like antiretroviral therapy for HIV. This is not a serious person who can move the needle on health in the U.S, and he has already done serious damage.

Public health needs more than defense

Defending the evidence is absolutely necessary so health in the U.S. doesn’t move further backward. The public health establishment is very good at defense. The problem is this defense often sounds like defending the status quo, which has failed many people.

Public health needs to offer an alternative to RFK Jr.’s MAHA—one that is rooted in evidence, truly listens to and addresses people’s frustrations, and has innovative solutions and the courage to change the systems.

How do we get there?

1. Find common ground. Do you know what most people care most about? The abysmal cost of healthcare. Start there.

2. Fight for the human loudly. Too often, communications and engagement center on science with a capital S, funding mechanisms, or the CDC/FDA/NIH. Not the person. So the public doesn’t see themselves in it. Instead, they see people fighting for the very powerful systems that they feel negatively impact their health and well-being. Let the public feel and hear that you see their frustrations, you get it, and you’re fighting for them within the system.

3. Recognize when pro-science messages are alienating people. Facts absolutely matter, but angrily venting only alienates people further. Our friend Elisabeth Marnik recently wrote a New York Times article about her experience growing up unvaccinated and how listening and empathetic conversation are the only ways to reach people that really work (a position backed by communication science). Her comments section was full of hateful comments from pro-vaccine individuals attacking her for daring to suggest we approach vaccine-hesitant individuals with empathy. It is possible to both stand firm behind scientific evidence and empathize with people who don’t trust it.

4. Lean into politics smartly. Often, public health has shied away from politics: Don’t touch it, lest you get burned. But this fails to recognize that the third rail is what fuels the train: who is elected determines our budgets, our priorities, and our authority. Being political means being very savvy in strategy on both sides of the aisle, knowing your audience, and recognizing that political capital is as scarce as financial resources and needs to be allocated accordingly.

Bottom line

So does public health need MAHA? That’s not really the right question. Public health has a responsibility not to dismiss 40% of the country who feel heard by this movement and are frustrated that the system has failed them. And it has a responsibility to stick to the evidence and recognize MAHA leadership for what it is: a danger to our nation’s health. Both can, and should, be done.

Love, YLE and KP

A big thanks to Craig Spencer, who had the courage to put his neck out there to start a much-needed discussion at such a critical moment—one that is determining the identity of an entire field.

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Kristen Panthagani, MD, PhD is completing an emergency medicine residency and research fellowship focusing on health literacy and communication. In her free time, she writes the newsletters You Can Know Things debunking health myths and rumors and The Public Health Roundup. Views expressed belong to KP, not her employer.

Your Local Epidemiologist (YLE) comprises a team of experts, ranging from physicians to immunologists to epidemiologists to nutritionists, working together with one goal: to “translate” ever-evolving public health science so that people are well-equipped to make evidence-based decisions. The YLE suite of newsletters reaches over 475,000 people across more than 132 countries. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below: