“We will make Americans healthy again,” Robert F. Kennedy Jr. declared. The political action committee that promoted Kennedy, President-elect Donald J. Trump's nominee for Secretary of Health and Human Services, said his campaign is “sparking a health revolution in America.”
But the word “again” assumes a time in this country's past when Americans were in better health. Was there really a time when America was healthier?
For medical historians, there is a simple answer.
“No,” said Nancy Tomes, a historian at Stony Brook University.
“It's hard to remember a time when America was healthier, with the real health disparities that characterize our system,” said John Harley Warner, a historian at Yale University.
Dr. Jeremy Green, a historian at Johns Hopkins University, asked, “What era is RFK trying to take us back to?”
Probably not from the 19th or early 20th century.
The rich smoked cigarettes and cigars – poor chewing tobacco. Heavy drinking was the norm.
“It was definitely a drinking culture,” says Dora Costa, an economic historian at the University of California, Los Angeles. “Drinking was a big problem and saloons were a big concern. Men were drinking their paychecks. That's why we instituted Prohibition.”
And Costa points out that most Americans in the 19th century had a monotonous diet.
It is true that agriculture back then was organic, food was produced locally, and there were no ultra-processed foods. However, there was a shortage of fresh fruits and vegetables because shipping was difficult and the growing season was very short. Until the 1930s, Dr. Costa said, for the most part, “Americans subsisted on dried fruits and vegetables.”
When it came to protein, Americans relied on cured pork because meat is difficult to preserve, she said. It wasn't until the end of the Civil War that Chicago meatpackers began processing meat and shipping fresh beef across the United States. At that point, beef “became a large part of the American diet,” Dr. Costa said.
But even though the availability of beef helped diversify diets, it did not make people healthier.
Dr. Costa collaborated with economic historian and Nobel Prize winner Robert Vogel of the University of Chicago to understand the health status of Americans living in the North during this period by examining the medical records of Union soldiers. did. Common conditions such as hernias are untreatable, and the man had a hernia the size of a grapefruit pinned down by a truss. Nineteen percent of these soldiers had heart valve problems by age 60, compared to about 8.5 percent today.
Malnutrition led to poor health. People were thin, often too thin. In 1900, 6.1 percent of Union veterans were underweight (a risk factor for a variety of diseases and often an indicator of poor health), compared to 1.6 percent of American adults today. He was underweight. In 1850, a 20-year-old man was expected to live to about 61 years. Today marks the 74th year.
Although public health improved in the early 20th century (for example, with clean water and posters encouraging parents not to give beer to their babies), disease was widespread. There were no antibiotics and very few vaccines. When influenza hit the country in 1918, no one knew what caused it. The influenza virus had not yet been discovered, and strange folk remedies were widespread. Approximately 675,000 Americans died. The Great Depression began in 1929, and the subsequent decade of economic damage created serious nutritional and health problems.
Health conditions improved in the second half of the 20th century, but were still poor compared to today.
Many people are nostalgic for the 1950s and 1960s, the decades when the American pharmaceutical industry introduced new medical advances such as antibiotics, antipsychotics, hypertension drugs, and vaccines for tetanus, diphtheria, measles, and polio. I think of it as an era of prosperity that was created.
Despite these advances, Dr. Green said those years were terrible for health, with “huge numbers of heart attacks and strokes.”
In 1950, heart disease was an epidemic, with 322 deaths per 100,000 Americans per year from cardiovascular disease, twice as many as today. Dr. Green said that by 1960, one-third of all deaths in the United States were due to heart disease.
Partly because almost everyone smoked.
“We were one of the heaviest smokers in the country,” said Samuel Preston, professor emeritus of sociology at the University of Pennsylvania.
Dr. David F. Musto, a medical historian at Yale University who passed away in 2010, once said in an interview that he had never enjoyed smoking, but when he was in college in the 1950s, he became aware of social attitudes toward smoking. He said the pressure was very strong. It was my duty to find my own brand. ”
Smoking significantly increases the risk of heart disease, which was the leading cause of death in the 1950s and 1960s.
Mortality rates from heart disease have declined sharply in recent decades. This is because smoking is now much reduced and treatments for heart disease are more effective. Cholesterol-lowering statins, introduced in 1987, reduced the risk of heart disease. Bypass surgery and stents, as well as other new drugs, have saved lives.
In the 1950s, just as today, cancer was the second leading cause of death. However, in 1950, there were 194 cancer deaths per 100,000 people. Currently, the number of deaths from cancer per 100,000 people is 142.
The decline in smoking is the main reason, but there has also been a revolution in cancer treatment.
Until the 1990s, cancer was treated with aggressive methods such as surgery, radiation, and chemotherapy. Now, a series of targeted therapies are turning some once-deadly cancers into treatable, chronic diseases that are even being cured.
Dr. Green said he was not surprised by the idea of a milder past, when people were healthier.
“America has a long history of nostalgia for a past that was better than the present,” he says. “History is about erasing what we don't want to remember.”
Of course, today is not some kind of health utopia.
Researchers are quick to acknowledge that Americans are not in much better health. And they lament the huge disparities in health care in this country.
But the United States spends more on health care than any other country, averaging $12,555 per person, about twice as much as other wealthy countries.
But historians say the past was actually worse.
Therefore, they say, the phrase “make America healthy again” has no meaning.
“As a health historian, I don't know what Kennedy is imagining 'again',” Tomes says. “The idea that all Americans were once healthy is an illusion.”
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