“We will make Americans healthy again.” Robert F. Kennedy Jr. announced. The political action committee that promoted Mr. Kennedy, President-elect Donald J. Trump’s pick for Secretary of Health and Human Services, says his movement “Igniting a health revolution In America.”
But the word “again” assumes a period in the country’s past when Americans were healthier. Was there really a time when America was healthier?
For historians of medicine, there is a short answer.
“No,” said Nancy Tomes, a historian at Stony Brook University.
“It’s hard for me to think of a time when America, for all the real health inequalities that characterize our system, was healthier,” said John Harley Warner, a historian at Yale University.
Dr. Jeremy Green, a historian at Johns Hopkins University, asked: “What specific era does Robert Kennedy want to take us back to?”
Maybe not in the 19th and early 20th centuries.
The rich smoked cigarettes and cigars, and the poor chewed tobacco. Heavy drinking was the norm.
“It was definitely a drinking culture,” said 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 were banned.”
Dr. Costa points out that American diets were monotonous for most of the nineteenth century.
It is true that agriculture at that time was organic, food was produced locally and there were no ultra-processed foods. But there was a shortage of fresh fruits and vegetables because they were difficult to ship and because growing seasons were very short. For the most part, until the 1930s, “Americans lived on dried fruits and vegetables,” Dr. Costa said.
As for protein, Americans rely on salt pork, because the meat is difficult to preserve. Only after the Civil War did Chicago meat processors begin processing meat and shipping fresh beef across the country. At that point, Dr. Costa said, beef “had become a major part of the American diet.”
But although the availability of beef has helped diversify diets, people have not become healthier.
Dr. Costa worked with Robert Vogel, an economic historian at the University of Chicago and Nobel Prize winner, to understand the health of the American population living in the North around this period. By examining medical records Union Army soldiers. Common conditions, such as hernias, were untreatable, with men having hernias the size of grapefruit, fixed with stents. 19% of these soldiers suffered from heart valve problems by the time they reached the age of sixty with about 8.5 percent today.
Malnutrition led to deteriorating health. People were thin, often very thin. In 1900, 6.1 percent of Union Army veterans were underweight — a risk factor for various diseases and often a sign of ill health — compared By 1.6 percent of adults in the United States today. In 1850, Males aged 20 He can expect to live to around 61 years old. Today it is 74 years old.
The beginning of the twentieth century saw improvements in public health (clean water, for example, and posters advising parents not to give their children beer), but disease was rampant. There were no antibiotics and very few vaccines. When the 1918 influenza struck the nation, no one knew why, as the influenza virus had not been discovered and exotic folk remedies were rampant. About 675,000 Americans died. In 1929, the Great Depression began, and its economic losses over the next decade led to severe nutritional and health problems.
Health improved in the second half of the twentieth century but was poor compared to what it is today.
Many people are nostalgic for the 1950s and 1960s, seeing those decades as a boom period, when the American pharmaceutical industry pumped up its production capacity. new Medical advances: antibiotics, antipsychotics, Medications for high blood pressure and Vaccines For tetanus, diphtheria, measles and polio.
Despite this progress, those years were terrible for health, Dr. Green said, with “a tremendous amount of heart attacks and strokes.”
Heart disease was rampant in 1950, A rate of 322 deaths per 100,000 Americans per year of cardiovascular disease, double the rate today. By 1960, Dr. Green said, heart disease was to blame A third of all deaths in America.
This was partly because almost everyone was smoker.
“We were among the countries that smoked the most,” said Samuel Preston, professor emeritus of sociology at the University of Pennsylvania.
Dr. David Mostow, a historian of medicine at Yale University, who died in 2010, once said in an interview that although he never enjoyed smoking, the social pressure to smoke when he was in college in the 1950s was great. So much so that I felt it was my duty to find my brand.
Smoking greatly increases the risk of heart disease, which was the leading cause of death in the 1950s and 1960s.
Death rates from heart disease have declined in recent decades because smoking is now less common and treatment for heart disease is more effective. cholesterol-lowering statins, It was introduced in 1987Reducing the risk of heart disease. Other new medications, as well as bypass surgery and stents, have also saved lives.
Cancer was the second leading cause of death in the 1950s, as it is today. But in 1950, There were 194 cancer deaths Per 100,000 people. Now there are 142 cancer deaths per 100,000 people.
The decline in smoking is the main reason, but there is also a revolution In cancer treatment.
Until the 1990s, cancer was treated with brute force: surgery, radiation, and chemotherapy. Now a range of targeted therapies are turning some once-deadly cancers into treatable or even curable chronic diseases.
Dr Green said he was not surprised by the idea of a golden past when people were healthier.
“There is a long history in America of nostalgia for a past that was better than the present,” he said. “History is about erasure, the things we don’t choose to remember.”
Today is not some kind of health utopia, of course.
Researchers are quick to acknowledge that Americans’ health is not as good as it could be. They bemoan the huge disparities in health care in this country.
However, the United States spends more on medical care than other countries – on average $12,555 per personThis is equivalent to twice what other rich countries spend.
But historians say the past was actually much worse.
So they say “Make America Healthy Again” is meaningless.
“As a health historian, I don’t know what Kennedy imagines again,” Dr. Tomes said. “The idea that once upon a time “It is a fantasy for Americans to be healthy.”