Robert F. Kennedy Jr., the health secretary, often says that when his uncle was president in the early 1960s, Americans were much healthier than they are now. People were thinner and had lower rates of chronic disease, he recalls. Fewer children had autism, allergies or autoimmune diseases.
On Thursday, the Trump administration plans to release a report, with a particular emphasis on children’s health, premised on the idea that we’ve fallen far since this golden era.
But were Americans really healthier back then?
The U.S. population was much younger in the 1960s, at the tail end of the Baby Boom, which complicates comparisons. Only 12.4 percent of the population was 65 or older in 1963, compared with 17.7 percent now. Rates of chronic diseases generally increase with age.
But Americans must be doing something right: Life expectancy has increased. A child born today can expect to live almost a decade longer than a child born in 1960. That’s partly because advances in medical care mean that conditions that were deadly decades ago can be kept in check for longer now.
“If R.F.K. Jr. makes the statement that more people are dying of chronic diseases now than in Jack Kennedy’s era, that’s undoubtedly true — we’ve got twice as many people, and a much larger chunk are old folks who have much higher chronic disease rates,” said Kenneth Warner, dean emeritus of the University of Michigan School of Public Health.
“Does that mean we’re doing worse than back then?” he added. “Absolutely not.”
Americans have put on the pounds over the decades, as Mr. Kennedy often notes. Diabetes and obesity are on the rise even among adolescents. On the other hand, the country has cut back dramatically on smoking, a habit that once contributed to huge numbers of deaths in the United States.
Only 12 percent of adults smoke now, down from 42 percent in 1965. The landmark Surgeon General’s report describing the harms of smoking was issued in 1964, when more than half of all adult men smoked.
Partly as a result, the two leading causes of death, heart disease and cancer, have fallen. Death rates attributable to heart disease dropped 71 percent from 1960 to 2019, and rates of death because of stroke have also declined, Dr. Warner said.
Mr. Kennedy has suggested that cancer is on the rise, and President Trump’s executive order establishing the Make America Healthy Again Commission, which put together the new report, contained some somber but erroneous cancer statistics.
The order said that age-standardized cancer rates had nearly doubled between 1990 and 2021 in the United States. In fact, rates have been gradually declining over the past 30 years, according to the National Cancer Institute.
The order also asserted that the United States had the highest incidence rate of cancer among 204 countries. That is incorrect: The nation does not even rank in the top five, unless non-melanoma skin cancers are included, in which case the United States ranks fourth after Australia, New Zealand and Denmark. (These skin cancers are very common and not usually life-threatening.)
But it is true that rates of certain malignancies, particularly breast cancer and colorectal cancer, are rising among younger Americans. Rates of some childhood cancers have also increased.
And yes, Americans could be faring better. Average life expectancy is lower than in the European Union. After a pandemic dip, life expectancy inched back up to 78.4 years in 2023, a few years behind the average 81.4 years in the E.U.
Many of those countries offer national health insurance that covers citizens from cradle to grave. Universal access to health care may account for some of the difference.
Mr. Kennedy is correct that the average American has gained weight — lots of it. The rates of people who were overweight and obese started rising in the 1970s and took off in the 1980s. From the 1960s to now, obesity rates have tripled, reaching almost 40 percent.
“When you look at chronic disease, you’re going to see that the diseases largely driven by cigarette smoking have declined since J.F.K. was president,” said Dr. JoAnn Manson, a professor of medicine at Harvard Medical School.
“But the chronic conditions driven by obesity or diet or sedentary lifestyle have increased,” she said, “including cardiometabolic diseases like Type 2 diabetes.”
That’s partly why progress toward improved health has stalled, she said.
More jobs involved physical activity in 1960. According to the American Heart Association, physically active jobs account for just 20 percent of the work force now, down from half in 1960.
Americans also eat more meals in restaurants, where diners often don’t always know what went into the entree. According to the Agriculture Department, the percent of calories consumed outside the home rose almost 74 percent between the late 1970s and 2017-2018.
Six in 10 Americans have at least one chronic disease, and four in 10 have two chronic conditions or more, a higher rate than in the European Union, Canada or Australia, said Nour Makarem, an assistant professor of epidemiology and co-leader of the chronic disease unit at the Columbia University Mailman School of Public Health.
“We end up spending more on health care as a share of the economy as a result,” Dr. Makarem said. “We have among the highest number of hospitalizations from preventable causes, and a high rate of preventable or avoidable deaths, many from chronic diseases.”
Like certain cancers, obesity and diabetes are occurring at younger ages, she added.
Mr. Kennedy has pointed to unhealthy diets, pesticides, food coloring and seed oils as the culprits. Recently he has also begun targeting sugar-sweetened beverages, which experts like Dr. Manson agree are closely linked to the development of Type 2 diabetes, even apart from weight gain.
Yet the apparent increase in chronic disease rates is also driven to some extent by earlier detection, said Kate Lorig, professor emerita of public health at Stanford University School of Medicine.
“In the past, people often didn’t even know they had chronic conditions,” Dr. Lorig said. “We are diagnosing a lot more things, and we are diagnosing them a lot earlier.”
Patients have their blood pressure taken at almost any encounter with a health provider, for example. And the threshold for treatment has been lowered over the years.
A 1965 report recommended referrals for patients only when their systolic pressure exceeded 160. By 2017, treatment was recommended at a systolic pressure of 130 and diastolic pressure of 80.
That doesn’t mean that high blood pressure is more common, only that doctors have changed the definition of it. Obesity — of great concern because it increases the risk for many other chronic illnesses — wasn’t even defined as a disease until 2013.
Demographics and social conditions also are playing a role.
A study that compared patients in the United States with those in England and Wales reported that Americans were less likely to die of cancer and slightly less likely to die of Covid in 2023.
But the cardiovascular death rate was 38 percent higher in the United States. The overdose death rate was more than three times higher, deaths from car accidents were six times higher and the firearm death rate was 133 times higher.
Many of these trends were documented by federal scientists who were dismissed in recent mass layoffs. The chronic disease prevention center at the Centers for Disease Control and Prevention was eliminated. Employees studying how to prevent gun violence were fired. The C.D.C.’s Office on Smoking and Health was shuttered.
Socioeconomic disparities are more extreme in the United States than in many other industrialized nations. The widening gap contributes to poor health among some Americans, Dr. Makarem said.
“We need to tackle persistent poverty, to invest in education and to improve the spaces that people live in to make them more walkable and to make sure there is access to healthy, affordable food,” she said. “It requires an integrated approach.”
Roni Caryn Rabin is a Times health reporter focused on maternal and child health, racial and economic disparities in health care, and the influence of money on medicine.
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