This story was reported and written by our media partner Capital News Service.
Zephyr Conrad is a fourth-year college student who has dealt with chronic anxiety and depression for as long as they can remember.
“I take medication for it, which doesn’t erase the fact that I have anxiety and depression, but it lessens the symptoms and gives me longer periods of good mental health,” Conrad said.
Conrad studies psychology at Virginia Commonwealth University. They have tried for the past eight months to get an official Ehlers-Danlos syndrome diagnosis, a chronic illness that affects a body’s connective tissues, or essentially makes tendons and ligaments “stretchy,” according to Conrad. Some doctors said the expensive diagnosis is not worth it because the disease is not curable.
The new Make America Healthy Again Commission created by President Donald Trump aims to address a “growing health crisis.” It will examine the increase and root causes of chronic diseases, which could include medical treatments, government policies, environmental factors and corporate influence.
Childhood chronic diseases are a focus of the commission. An estimated 30 million children had in 2022 at least one health condition, such as allergies, asthma, or an autoimmune disease, according to the executive order. Over 3.4 million children are now on medication for Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder, with a diagnosis rate that continues to rise.
The commission will recommend major reforms in research, health care delivery, food safety and public policy. It aims to improve the lives of people like Conrad, but some experts say the increase in chronic disease is mostly due to longer life expectancy and earlier diagnosis rates.
The potential impact of the commission remains unclear. By late May, the commission will submit an assessment of childhood chronic diseases to the president, and by August it will construct a strategy to improve the health of American children.
Federal Health Cuts Could Undermine Make America Healthy Again Commission Goals
The U.S. Department of Health and Human Services Secretary, Robert F. Kennedy, who also chairs the commission, has initiated big changes that could impact MAHA’s work.
HHS announced on March 27 it will downsize from 82,000 employees to 62,000 employees, and decrease the number of regional offices and divisions Americans can access.
These cuts will hit Virginia. Half of the Virginia Department of Health's $1.3 billion budget last year was funded by the federal government, according to the Richmond Times Dispatch. The federal cuts could result in a loss of over $200 million and over 500 contract positions employees.
Kennedy sees HHS as a bloated bureaucracy that needs to be more efficient. The HHS budget grew by 38% and staffing by 17% under the Biden administration.
The Trump administration proposed an estimated one-third cut to the HHS’s discretionary budget, or $40 billion, according to the Washington Post.
HHS will create an Administration for a Healthy America, or AHA, as part of the downsizing and restructuring. Five separate HHS agencies, from workplace safety to substance use and mental health services, will be consolidated into AHA.
Chronic Disease Management at Center of Debate
Former speechwriter and Domestic Policy Council chief Vince Haley is executive director of the commission. Aside from the Centers for Disease Control and Prevention and National Institute of Health, departments that are not leading chronic disease experts will join the commission.
Chronic diseases are defined by the CDC as conditions that last for more than a year and require ongoing medical attention. An estimated 60% of Americans have at least one chronic disease and 25% of U.S. adults have a mental health condition. Many illnesses are caused by health habits such as poor nutrition, smoking or alcohol abuse. But there are also social determinants such as poverty, unhealthy environments and lack of access to quality education and jobs, the CDC states.
Katie Lorig, a professor at Stanford University School of Medicine, helped launch Chronic Disease Self-Management Programs, which host workshops and provides resources to help people manage symptoms.
“We pay for medication, we pay for surgery, we pay for all kinds of things, which are in fact necessary for chronic illnesses,” Lorig said.
But people need help to manage chronic illnesses. Some are preventable through behavioral changes, but genetics are not going to change regardless of lifestyle changes, according to Lorig.
“Unless we are looking to expand the lifespan infinitely, we are probably never going to get rid of chronic conditions,” Lorig said. “We can improve quality of life and that's probably the most important thing.”
The commission highlights the overuse of prescription medication linked to these diagnoses, stating that it poses a dire threat to Americans.
“Medications are absolutely necessary to manage chronic illness,” Lorig said.
Mental Health Advocates Push for Representation
No mental health representative currently sits on the commission, according to Mental Health America’s director of policy and advocacy Caren Howard.
Ideally, all HHS agencies would integrate the Substance Abuse and Mental Health Services Administration's principles and ideas, because “there is no health, without mental health,” she said.
The stated mission of SAMHSA, an agency that AHA will absorb, is to drive public health initiatives to support individuals with mental and substance use disorders.
“I think the right person for the job will prioritize and balance the voices of people with mental health conditions, along with all of the other stakeholders and players in the health policy space and health care space,” Howard said.
The cuts within HHS mean there will be fewer people to do the same work that really needs to be done, according to Howard.
“I think there will be a lot less progress over the next few years in terms of the ability for the agency to address concerns quickly,” Howard said.
Virginia Professor Signs Open Letter of Concern
The commission's approach imitates some of the broader goals outlined in the Heritage Foundation's Project 2025 plan. This was a conservative policy agenda prepared for the presidential transition.
Both the commission and Project 2025 emphasize increased transparency in health data, redirected research funding to focus on root causes of illness, and skepticism towards the current medical system's reliance on pharmaceuticals to treat chronic and mental health conditions.
Scientists and professors across America wrote an open letter to the public about how the Trump administration’s cuts have already impacted scientific research as a whole. But many fear exposure and repercussion, with several health care and political experts in Virginia expressing hesitancy and turning down an interview.
“The administration is slashing funding for scientific agencies, terminating grants to scientists, defunding their laboratories and hampering international scientific collaboration, which is forcing institutions to pause research, including studies of new disease treatments,” the letter stated.
Steven H. Woolf, director emeritus and senior adviser at VCU Center on Society and Health, was one of the estimated 2,000 individuals who signed the letter.
“There's going to be a damaging effect from this that will harm the health of Americans, which is a bit ironic given the fact that the administration is pushing this slogan about making America healthy again,” Woolf said.
The long term impact will be the cost of lives through limited health care access, and America will not remain the world leader in research, according to Woolf.
“The most important policies to address chronic disease are not in the health space,” Woolf said.
Virginia should address chronic disease by dealing with poverty gaps, education and affordable housing, according to Woolf.
“Dealing with those social conditions that so many Virginians are struggling with would do more to reduce the burden of chronic disease than adding another wing onto the hospital,” Woolf said.
Although Conrad was not diagnosed with depression and anxiety until they were older, they can look back now and see the signs in their childhood.
People could lose access to health care for diagnosis, medication and support if scientists are prevented from studying and treating certain chronic diseases. Conrad worries there will be an increase in self-harm if people feel more helpless.
“Because when people don't have access to care that can help them with these issues, that's what often ends up happening, both with physical and mental health,” Conrad said.
Capital News Service is a program of Virginia Commonwealth University’s Robertson School of Media and Culture. Students in the program provide state government coverage for a variety of media outlets in Virginia.
