Chronic Disease Isn’t a Mystery. It’s a Policy Failure

The rising rates of chronic disease aren’t a failure of scientific research, they’re a failure of political priorities.

Source: National Heart, Lung, and Blood Institute (NHLBI), NIH.

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Over the weekend, I read a piece by a journalist essentially blaming the NIH, the nation’s major medical research agency, for making little progress in preventing chronic disease. The insinuation being that research scientists have no idea what causes chronic disease, and that this failure lies squarely with research scientists and institutions like the NIH.

And unfortunately, this narrative is not just coming from individual journalists. It’s embedded in official messaging. Take the Make America Healthy Again (MAHA) executive order released last month, which calls for a commission to “investigate the causes of chronic disease.” On the surface, that might sound reasonable, until you read what they’re really saying.

“Despite substantial investments in health research, rates of chronic disease continue to rise. The American people deserve answers. A full investigation is needed to evaluate whether current institutions are too heavily influenced by corporate or ideological interests that have skewed research outcomes.”

I agree that the American people deserve answers. And we have them. This framing insinuates that we don’t already understand the causes of chronic disease. Or worse, that science itself has failed us because it’s “skewed.” But as someone with a PhD that was focused on chronic disease prevention, I can tell you that’s not just inaccurate, it’s dangerously misleading.

We do know what’s driving the most common chronic diseases in the US. And we’ve known much of it for decades. The problem isn’t the science. It’s the political unwillingness to support and implement science-based policy.

What We Actually Know

Let me be clear: we are not in the dark when it comes to the causes of chronic disease. We’re not guessing. We’re not “waiting on more data.” We’ve had strong, consistent evidence for decades.

My PhD was in chronic disease prevention, specifically focusing on cardiometabolic diseases like cardiovascular disease and type 2 diabetes. I was part of a PhD program titled Physical Activity, Nutrition, and Wellness (It’s true…my diploma actually says wellness). I worked in a department alongside researchers studying everything from nutrition science and exercise physiology to sleep, stress, and behavior change. Our entire field was dedicated to understanding the root causes of chronic disease and, just as importantly, how to reduce risk.

One of the most influential studies in this space, and one that deeply shaped my own work, is the Diabetes Prevention Program (DPP). This NIH-funded clinical trial followed 3,234 adults with prediabetes over the course of three years to compare the effects of a structured lifestyle change program, the diabetes drug metformin, and a placebo.

The results were incredibly encouraging:

• Participants in the lifestyle intervention group, who were coached to lose a modest amount of weight through healthier eating and regular physical activity, reduced their risk of developing type 2 diabetes by 58%.

• For participants over the age of 60, the risk reduction was even higher: 71%.

• Notably, lifestyle changes outperformed metformin, one of the leading medications used to manage or delay diabetes.

These findings changed public health practice. The results of this study led to the launch of the CDC’s National Diabetes Prevention Program, which now offers evidence-based lifestyle change programs across the country. These programs are so effective, and so cost-saving in the long run, that Medicare and many private insurers cover them.

This is how science should work: identify a problem, rigorously test a solution, and scale what works.

The DPP also inspired aspects of my own research, which focused on small, evidence-based strategies that could help people reduce their risk of cardiometabolic disease. Because often with chronic disease prevention, the challenge isn’t figuring out what to do, it’s creating environments where people can actually do them.

There are already well-established public health goals, like those outlined by Healthy People 2030, the Office of Disease Prevention and Health Promotion, and numerous NIH-funded initiatives, that spell out the changes needed to improve population health.

Here’s what the science tells us, clearly and consistently, about reducing risk for the most prevalent chronic conditions:

• Eat a diet rich in whole foods: fruits, vegetables, whole grains, healthful fats, and a variety of proteins

• Aim for 25–38 grams of fiber per day

• Limit added sugar to less than 10% of daily calories

• Maintain a healthy weight and practice portion control

• Get at least 150 minutes of moderate to vigorous physical activity per week

• Prioritize sleep, stress management, and mental well-being

• Avoid tobacco use and limit alcohol consumption

• Engage in preventive healthcare and regular screenings

That’s just the foundation. And we have thousands of studies to support each recommendation.

This isn’t a knowledge gap. It’s not a scientific failure. It’s a policy failure.

The Real Barriers

So if we know how to reduce chronic disease, and if we have decades of research, national guidelines, and successful programs to look to, why are so many Americans still struggling with chronic disease?

Because the reality is that we are not set up to succeed.

We live in a country where making the healthy choice is often the hardest choice. Where everything from our food system to our work culture to our built environment makes it difficult to follow evidence-based recommendations, no matter how motivated someone might be.

Let’s just look at a few basics:

• Over 90% of Americans don’t eat enough vegetables

• Nearly 95% don’t get enough fiber

• Over 50% consume too much added sugar

• About 70% eat more calories than they need

• 80% don’t meet physical activity guidelines

That’s not a willpower problem. That’s a systems problem.

We’ve built a food environment that’s designed for profit, not for public health. Our shelves are dominated by ultraprocessed foods because they’re cheap to produce, easy to distribute, and heavily marketed. We’ve essentially allowed industry to shape the food landscape, and we’re now living with the consequences.

We’ve built cities around cars, not people, significantly limiting opportunities for incidental activity and making walking, biking, or accessing green spaces difficult or even unsafe in many areas.

We have a labor system that overworks people, offers limited paid time off, and leaves millions juggling multiple jobs just to survive, leaving little time, energy, or resources to cook meals, get enough sleep, or go to a doctor.

And then there are the broader social and economic conditions that directly impact health, including food insecurity, lack of access to preventive care, inadequate mental health services, environmental pollution, unsafe neighborhoods, and income inequality.

We like to talk about health as if it’s all personal responsibility. But personal choices are made within systems - systems that either support health or make it nearly impossible.

Let’s take a common example: A single mom working two jobs because her full-time job doesn’t pay a living wage. She has little control over her schedule, no paid time off, and limited access to affordable food. She’s exhausted. She might know what the guidelines say about diet and exercise, but the system around her makes it nearly impossible to follow them. That’s not a personal failure. That’s a policy failure.

This is the reality for millions of Americans. Until we acknowledge that, and address the systemic conditions people are living in, we will never meaningfully reduce chronic disease rates, no matter how much science we have.

How We Got Here

The chronic disease crisis in the US is not a mystery. It’s the predictable result of decades of policy decisions that put corporate profit above public health.

Since the 1980s, U.S. policy has steadily moved toward deregulation, disinvestment in public health infrastructure, and a growing alignment between corporate interests and political power. These choices didn’t just shape our food system, they shaped every pillar of public health:

• Nutrition: Policies favored industrial agriculture and food manufacturing, enabling the rise of ultraprocessed foods while dismantling local food systems. Lobbying efforts also weakened food labeling laws and marketing regulations, particularly those protecting children and vulnerable communities.

• Physical Activity: Urban planning and transportation policies prioritized highways and suburban development, making it harder to walk, bike, or access public spaces. Physical activity was engineered out of daily life, and many communities were left without safe parks or recreation areas.

• Healthcare Access: Despite gains under the Affordable Care Act, decades of underfunding and a system rooted in privatization have left millions without affordable, preventive care. Employer-based insurance still excludes many of the most vulnerable, and even those with coverage often face high out-of-pocket costs that make early intervention and chronic disease management difficult.

• Environmental Health: Corporations have lobbied successfully to roll back environmental protections, resulting in increased exposure to pollutants, toxins, and unsafe drinking water, which disproportionately impacts low-income and marginalized communities.

• Mental Health & Stress: An economy driven by shareholder profits, stagnant wages, and job insecurity has led to chronic stress, overwork, and burnout. At the same time, we’ve underfunded mental health services and social support systems that could ease the burden.

• Sleep & Work Culture: Labor policies have enabled an overwork culture with minimal paid leave, unpredictable schedules, and little protection for workers. This has direct consequences for sleep, stress, and overall health.

These conditions didn’t happen by accident. They were the result of political choices that repeatedly put the interests of large industries ahead of the health of the people.

And now, the current administration is doubling down on that same approach:

• Rolling back EPA regulations, and ushering in the “greatest era of deregulation in US history",” allowing more air and water pollution

• Attempting to cut billions in healthcare and nutrition assistance, including deep cuts to Medicaid and SNAP in the most recent budget proposal, primarily to fund tax breaks that overwhelmingly benefit the wealthiest Americans

• Slashing $1 billion in funding for local food purchasing programs, undermining farm-to-school efforts and food bank partnerships that support local agriculture and increase access to fresh, nutritious food in underserved communities

• Undermining evidence-based health initiatives, even the most successful ones

Remember the Diabetes Prevention Program (DPP), the clinical trial that showed lifestyle changes could prevent or delay type 2 diabetes, which led to the creation of the national DPP infrastructure, and was collecting long-term data on outcomes like Alzheimer’s?

The Trump administration just cut its funding, claiming the study was “no longer necessary.”

That’s what it looks like when decades of valuable science are discarded, not because they failed, but because supporting them doesn’t align with certain political or economic agendas.

We are not failing because the science is unclear. We are failing because we’ve refused to support science-based public health through policy.

The “Lack of Science” Narrative Is a Distraction

Let’s be really clear: the claim that we don’t know what causes chronic disease isn’t just wrong, it’s strategic.

It’s an absurd thing to say. But they’re banking on most people not knowing about the actual research.

The rhetoric is part of a larger effort to erode trust in science and public health institutions, which I wrote about here. If people can be convinced that science has failed, then there’s no pressure to act on the solutions it’s already provided. Instead of holding policymakers and our economic system accountable, the blame is shifted to scientists and doctors, people who have spent their careers trying to solve these problems and help people.

And while this narrative is spreading, it’s conveniently paired with another harmful idea that health is purely a matter of personal responsibility.

But health behaviors don’t happen in a vacuum. They’re shaped by the environments we live in, the policies that govern our access to resources, and the structural conditions that limit choice.

Let’s take a few examples:

• A full-time job that doesn’t pay enough to afford fresh, nutritious food

• A food desert where the nearest grocery store is miles away, but fast food is on every corner

• A neighborhood with no sidewalks, bike lanes, or safe parks to be active

• A healthcare system where even basic preventive care is unaffordable or inaccessible

• A family that can’t prioritize sleep, stress management, or physical activity - because they’re just trying to survive

Yes, personal choices matter. But we’ve put far too much weight on the individual and not nearly enough on the systems that shape those choices.

When the dominant narrative becomes “people just need to take responsibility,” it conveniently lets those in power off the hook. It distracts from the fact that our environment is actively making people sick. And that fixing it would require political will, policy change, and a shift in national priorities.

This is why the “lack of science” claim is so damaging. It undermines the public’s trust in real solutions. It blames individuals instead of systems. And it keeps us from demanding the changes we actually need to improve health at scale.

Let’s Focus

We don’t need a commission to “investigate the causes of chronic disease.” We already largely know them.

We have decades of research, national guidelines, clinical trials, and successful public health programs that clearly show what works to prevent and manage chronic disease. What we don’t have is the political will to act on that knowledge.

The article I read over the weekend blaming scientists and the NIH for failing to prevent chronic disease completely misses the point. The problem isn’t that science has failed. It’s that policymakers have ignored the solutions science has already delivered.

Instead of investing in proven programs, we’re cutting them. Instead of supporting public health infrastructure, we’re undermining it. And instead of holding systems accountable, we’re told to blame individuals. Or worse, to question the science itself.

Yes, personal responsibility matters. But behavior is shaped by policy, environment, and access. People can’t “choose better” in a system that makes health so hard to reach.

And honestly, the American people don’t need performative slogans or a commission to investigate what many of us have been studying for decades. They need leaders willing to act on the science we already have. And a public health system built to support health, not protect corporate interests.

Because the problem isn’t bad research. It’s bad policy. And that’s what needs to change.

Author’s note: When I talk about chronic disease here, I’m referring specifically to the leading causes of chronic disease and chronic disease-related deaths in the US, including heart disease, type 2 diabetes, some cancers, and respiratory conditions, where prevention is often possible. These are also the conditions most often cited in national chronic disease statistics.

That’s different from people living with chronic illnesses like autoimmune conditions, chronic pain, or disabilities, which deserve care, understanding, and support, but are often conflated in these conversations.