In the ongoing discourse surrounding American health policy, a striking phrase has emerged: “the sickest generation in American history.” This alarming assertion appears prominently in a recent report issued by a presidential commission led by Health and Human Services Secretary Robert F. Kennedy Jr. The sentiment encapsulates the core message of his Make America Healthy Again (MAHA) movement, claiming that America, particularly its children, represents “the sickest country in the world,” as articulated by Kennedy during a recent Senate hearing.
This narrative hinges on the belief that we are experiencing unprecedented levels of illness and health crises. If true, it would necessitate a complete overhaul of the American healthcare system, something Kennedy is advocating for. However, contrary to this grim portrayal, the evidence suggests a much more optimistic reality: America is not the sickest country in the world, and this generation—our children included—does not represent the sickest generation in American history.
When we examine the data and consider the historical context of American health, the claim that we are in a health crisis appears not only exaggerated but almost absurd. Significant advancements in areas such as vaccines, medical treatments, and environmental health have contributed to a population that is healthier and living longer than previous generations.
This does not imply that Americans are devoid of health challenges or that new health issues, such as rising obesity rates, chronic diseases, and mental health disorders, are not emerging. However, it is crucial to place these contemporary problems in historical perspective to appreciate the progress made over the years. Our society’s tendency toward negativity, exacerbated by the chaos of social media, can lead to a distorted view of reality, prompting us to seek radical solutions that could undermine the very advancements we have achieved.
Nowhere is this more evident than in our perception of American health, and the dangers of adopting an all-or-nothing approach to health policy are particularly concerning. Thus, it’s time for a reality check.
**An Increase in Life Expectancy**
Death is a significant concern in medicine, and on this front, contemporary Americans are faring significantly better than their ancestors. In the late 19th century, during a period when U.S. cities were just beginning to be electrified, the average life expectancy was a mere 40 years—an unsettling fact for those of us who are now in our 40s. However, over the course of the 20th century, life expectancy in the U.S. increased by more than 30 years, primarily due to public health improvements, the introduction of vaccines, antibiotics, and advancements in medical care and environmental health.
According to science writer Steven Johnson, the entire nation has effectively gained “an extra life.” While life expectancy saw a slight decline during the Covid-19 pandemic, it has rebounded, with the average American now expected to live 78.4 years, nearly doubling the lifespan of their great-great-great-grandparents from the 1880s.
**Success Against Infectious Diseases**
One of the most significant factors contributing to our extended life spans has been the successful management of infectious diseases. In 1900, diseases such as pneumonia, tuberculosis, and diarrheal diseases accounted for approximately one-third of all deaths in America, with a staggering percentage of those fatalities occurring in children under five. Tragically, by 1915, one in ten American infants did not survive to their first birthday, a grim statistic that starkly contrasts with contemporary health outcomes.
Thanks to vaccines and medical advancements, current mortality rates from infectious diseases are drastically lower. Conditions like polio, which afflicted thousands of Americans, particularly children, have been virtually eradicated. The emergence of HIV, once a death sentence, has become manageable due to remarkable advancements in treatment. The Covid-19 pandemic underscored our vulnerability to infectious diseases, yet the rapid development of mRNA vaccines saved millions of lives.
As infectious disease deaths have declined, there has been a noticeable increase in deaths due to non-infectious diseases, such as heart disease and cancer. This shift can be interpreted as a sign of progress, as these diseases typically affect individuals later in life. Despite some troubling trends, such as rising cancer rates in younger populations, overall cancer mortality rates have been decreasing for decades, and deaths from heart disease have also significantly declined, largely due to a substantial reduction in smoking.
**Environmental Improvements**
The health of Americans has also benefited from cleaner air and water. The environmental conditions of the 1960s and 70s presented serious health risks, with cities choked by smog and polluted waterways. Thanks to the implementation of the Clean Air Act and other environmental protections, emissions of major air pollutants have plummeted by 78% since 1970. Lead exposure, once commonplace due to leaded gasoline and other sources, has been drastically reduced, resulting in significant public health improvements, particularly for children.
Today, Americans enjoy cleaner environments and safer living conditions, with reduced fatality rates from car accidents and workplace incidents. The strides made in environmental health are undeniable and contribute significantly to the overall well-being of the population.
**Rethinking Health Conditions**
While it is true that certain health conditions, such as autism and ADHD, have seen increased diagnoses in recent years, much of this trend can be attributed to changing diagnostic criteria that allow for earlier detection and support for affected children. The rate of high-support needs autism has not significantly increased over the past three decades, suggesting that we are simply better at identifying and addressing these conditions now than in the past.
Moreover, some experts argue that overdiagnosis is a growing problem in various fields of medicine. As diagnostic tools and criteria evolve, there is potential for mislabeling healthy individuals or those with mild conditions, leading to unnecessary treatments and anxiety.
From obesity and diabetes to youth mental health and drug overdose deaths, the challenges we face are real and concerning. However, it is essential to recognize that we are not living in a uniquely sick era. Our historical context reveals a time when one in ten children did not survive infancy, when HIV was a death sentence, and when air quality was dangerously poor.
Addressing the legitimate health issues we face today requires building upon the remarkable public health achievements of the past, rather than dismantling them in pursuit of radical reforms. The path forward lies in enhancing our existing health systems and ensuring that all Americans benefit from the progress we have made.
