THE US’S CHRONIC DISEASE CRISIS DEMANDS A SMARTER PREVENTION STRATEGY | COLUMN

As policymakers search for ways to reduce health-care spending while improving Americans’ health, the microbiome deserves far greater attention.

The United States spends more on health care than any other nation, yet chronic disease continues to drive enormous human and economic costs. Three in four American adults have at least one chronic condition, and over half have two or more. Collectively, chronic diseases account for roughly 90% of the nation’s health-care spending. Many of these, including cardiovascular disease, diabetes, cancer, autoimmune disorders, neurodegenerative diseases, and obesity, are increasingly being linked to disruption of the gut microbiome.

Yet much of our health-care system remains focused on treating disease after it develops rather than preventing it before it becomes established.

The microbiome, the vast community of bacteria, viruses, fungi, and other microorganisms that live in and on the human body, is increasingly recognized as a critical regulator of human health. The human gut alone contains trillions of microorganisms that interact continuously with the immune system, metabolism, and other physiological processes. Research continues to reveal the influence of these microorganisms on immune function, inflammation, brain health, cancer response, and healthy aging, as well as the complex interactions between our genetics and these microorganisms.

Unlike our genetics, the microbiome changes throughout life in response to diet, medications, and environmental exposures. That makes it one of the few biological systems that may be measurable and modifiable before disease develops. At a time when more than 40% of U.S. adults are living with obesity, and more than 40 million Americans have diabetes, understanding these modifiable biological pathways has become increasingly important.

The question is no longer whether the microbiome matters. It is a question of whether our health-care system is prepared to translate this rapidly advancing science into prevention strategies that improve health and reduce costs.

Importantly, microbiome science is beginning to move beyond discovery. Evidence-based interventions, including probiotics, prebiotics, postbiotics, and, in appropriate clinical settings, fecal microbiota transplantation, demonstrate that the microbiome can be modified to improve health. This is not to suggest simple cures or immediate solutions. The science remains complex, and much remains to be learned. But it does suggest that one of medicine’s most promising frontiers may lie in preventing disease rather than simply treating it.

The microbiome also provides a scientific foundation for growing national discussions about nutrition and “food as medicine.” Diet is among the strongest influences on the microbiome, linking what we eat to immune function, metabolism, chronic disease risk, and long-term health. Human health is also connected to the microbial ecosystems in our soils, food systems, and environment, reinforcing the importance of a One Health approach that recognizes the interconnected health of people, animals, plants, and ecosystems.

The urgency will only grow as America ages. By 2030, more than one in five Americans will be over age 65. Preserving cognitive, cardiovascular, metabolic, immune, and musculoskeletal resilience will become one of the defining public health challenges of the coming decades. The microbiome will be an important contributor to maintaining that resilience throughout life.

Across the country, research institutions are beginning to shift from microbiome discovery toward translation, connecting basic science with prevention, diagnostics, nutrition, and therapeutics. At the University of South Florida Microbiomes Institute, for example, scientists are studying how microbiome science can inform aging, cancer, infectious diseases, immunology, nutrition, and public health, while the USF Future of Food Think Tank is bringing together organizations across Tampa Bay to address food insecurity and strengthen the connection between nutrition, health, and community well-being. Yet nationwide, the infrastructure needed to translate discoveries into scalable clinical and public health solutions has not kept pace with the science itself.

The United States has invested heavily in treating disease, but comparatively less in building the translational infrastructure needed to convert promising prevention science into better health outcomes.

Scientific discovery alone does not improve public health. Translation does. If even a fraction of chronic disease can be delayed, prevented, or better managed through microbiome-informed approaches, the implications for Americans’ health and for the nation’s long-term health-care costs could be substantial.

The microbiome will not solve America’s chronic disease burden on its own. No single scientific field can. But if we are serious about prevention, healthy aging, and reducing the long-term costs of chronic disease, we cannot afford to overlook a biological system that influences so many aspects of human health. Some of the greatest gains in medicine may come not from treating disease earlier, but from understanding how to preserve health before disease begins.

Christian Bréchot, M.D., Ph.D., is a professor of medicine at the University of South Florida (USF), founder and co-director of the USF Microbiomes Institute, and senior associate dean for research in global affairs at the USF Health Morsani College of Medicine. He is the former president of the Institut Pasteur and INSERM, the French National Institute of Health and Medical Research, and has also served as vice president of the Institut Mérieux.

2026-08-04T10:35:04Z