Opinion: I am New York City’s doctor. This is how we treat chronic disease.

From the day he was sworn in, U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. has called chronic disease – including diabetes, heart disease and cancer – an urgent crisis in America.

As the doctor for our nation’s largest city, where chronic disease is the leading cause of death, I agree with the diagnosis, but not the treatment. 

Let’s look at what RFK Jr. has actually done as Health Secretary since that day. 

He has fired at least 20,000 employees from the Department of Health and Human Services. Billions of dollars in lifesaving medical research have been cut. Tens of millions of Americans, including millions of New Yorkers, will lose their Medicaid, Medicare, and Supplemental Nutrition Assistance Program (SNAP) benefits because of Republicans’ “One Big Beautiful Bill.” The record-breaking government shutdown multiplied the confusion and loss.

The resulting increase in chronic disease will likely take years off Americans’ lives. 

And that’s just the beginning. The CDC’s National Center for Chronic Disease Prevention and Health Promotion has conducted groundbreaking research and policy work such as helping millions of people control their blood pressure, and preventing $8.2 billion in medical costs in 2023 alone. Yet the most recent White House budget proposes a roughly 50% cut to the CDC’s overall funding – including the near-complete elimination of that research center.

My job is to support all New Yorkers in leading their healthiest lives, no matter their income or neighborhood.  We have the experience and expertise to improve outcomes and even prevent chronic disease entirely. We know what approaches are proven to make a lasting impact.

But the absence of federal support makes reaching those goals much more difficult. It’s my responsibility to consider the health of the city in its entirety – and from that vantage point, it’s very clear that the risk is unfairly distributed.

Recently, I treated a 50-year-old Latino father of two at Kings County Hospital in Brooklyn, where I am a practicing physician. He worked more than eighty hours a week as a mechanic to provide for his family. He smoked two packs of cigarettes a day. He had no health insurance and no time to see his doctor regularly – let alone the time and money to exercise and change his diet. He was struggling just to take his medication for diabetes, which was now uncontrolled. 

When I met him in the ER, he had already been hospitalized three times in three weeks. His heart was pumping at 5% – a healthy heart pumps at 65%. He had severe heart failure, and we needed to act fast.   

My patient’s story is not an isolated one. 

He is one of many across the nation whose lives have been impacted by longstanding inequity and a health care system that has been stretched to its limits. Kennedy is correct when he claims that we invest in a system that leaves people seeking sick care instead of health care. 

When patients come to see me, they sometimes feel ashamed and guilty about their health – but it is not their fault. We cannot blame an individual for their health outcomes while knowing the brokenness of their options.

Kennedy and his Make America Healthy Again initiative are not repairing those options. Look no further than MAHA’s pressure on the food industry to replace artificial sweeteners with cane sugar, even though there’s no significant health difference between them. Sugar is sugar, whether it is natural or not. This could worsen the problems it claims to solve.

Chronic and diet-related diseases, like my patient had, have become normalized – but these conditions should not be the norm for anyone.

We regularly see patterns of health inequity across income, race, zip code and more. In 2023, New Yorkers living in very high-poverty neighborhoods were more than twice as likely to have diabetes than those in wealthier neighborhoods. Black, Latino and Asian and Pacific Islander New Yorkers have higher rates of hypertension than white New Yorkers.

New Yorkers are sick of this inequity – literally. But it doesn’t have to be this way. Government has a responsibility to maintain the health and wellness of its people. Our federal government is abandoning that responsibility. 

Instead, it has eliminated agencies like the federal Office on Smoking and Health, despite the fact that smoking remains a leading cause of death. From 2012 to 2018, more than 16 million smokers attempted to quit. One million people successfully stopped smoking because of the office’s “Tips From Former Smokers” campaign. Yet, the federal administration eliminated this program, in what one of the office’s former directors has called “the greatest gift to the tobacco industry in the last half century.” 

This is just a fraction of the federal administration’s cuts that are contrary to their touted narrative. 

We urgently need a path forward. And we’re not waiting around for that leadership to come from the federal level. 

That’s why, at the New York City Health Department, we recently released a city-wide chronic disease prevention strategy, which outlines how local government can address the root causes of chronic disease. 

The strategy recommends promoting healthy living through nutritious foods and physical activity. But we must also meet people’s material needs. Improving access to basic resources – with direct cash payments, grocery credits and more – has a proven impact on health. And informed conversations around marketing, product design and creative media approaches can increase consumer awareness of the health impacts of the products they buy.  

When people can afford the things they need – housing, health care, the ability to put healthy food on the table – they aren’t waiting to be treated in the ER once they’re in crisis. 

Regardless of race, socioeconomic status or zip code, everyone deserves to thrive and live their longest, healthiest lives. Here in New York City, we are proud to continue to expand, not cut, access to high-quality, evidence-based public health and health care. 

Thanks to those policies, we’re making progress: The average life expectancy for New Yorkers just reached an all-time high of more than 83 years. Yet there is much more work to do. Life expectancy continues to show significant inequities by race and ethnicity.

If RFK Jr. were to truly commit to “practical, cost-effective, and locally driven” solutions, patients like mine would have a much better shot at healthier and longer lives.