“We will make Americans healthy again,” said Robert Kennedy Jr. A political action committee that promoted Mr. Kennedy, President-elect Donald J. Trump for secretary of health and human services, says his movement is “sparking a health revolution in America.”
But the word “again” presupposes a time in the country’s past when Americans were in better health. Was there ever 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.
John Harley Warner, a historian at Yale, said: “It’s hard for me to think of a time when America, with all the real health inequalities that characterize our system, was healthier.”
Dr. Jeremy Green, a historian at Johns Hopkins University, asked, “What specific era does RFK want to take us back to?”
Probably not 19th and early 20th century.
The rich smoked cigarettes and cigars, 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. “Booze was a huge problem, saloons were a huge concern. The men drank their wages. That’s why we had the ban.”
And, notes Dr. Costa, American diets for most of the 19th century were monotonous.
It is true that agriculture at that time was organic, food was produced locally and there was no over-processed food. But fresh fruits and vegetables were in short supply because they were difficult to ship and because growing seasons were so short. For the most part, Dr. Costa said, until the 1930s, “Americans lived on dried fruits and vegetables.”
For protein, Americans relied on cured pork, he said, because the meat was difficult to preserve. It wasn’t until after the Civil War that meatpackers in Chicago began processing meat and shipping fresh beef around the country. At that point, Dr. Costa said, beef “became a big part of the American diet.”
But although the availability of beef helped to diversify the diet, people did not become healthier.
Dr. Costa worked with Robert Fogel, the University of Chicago economic historian and Nobel laureate, to understand the health of a population of Americans living in the North during this period by examining the medical records of Union Army soldiers. Common conditions such as hernias were incurable – men had hernias as large as grapefruits, which they held in trusses. Nineteen percent of those soldiers had heart valve problems by age 60, compared with about 8.5 percent today.
Poor nutrition led to poor 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 an indicator of poor health — compared to 1.6 percent of U.S. adults today. In 1850, men at the age of 20 could live about 61 years. Today marks 74 years.
The early 20th century saw improvements in public health (eg cleaner water and posters advising parents not to give beer to their babies), but disease was rampant. There were no antibiotics and very few vaccines. When the 1918 flu swept the nation, no one knew the cause—the flu virus hadn’t been discovered, and strange folk remedies were rampant. About 675,000 Americans died. In 1929, the Great Depression began and its economic effects over the next decade led to severe nutritional and health problems.
Health improved in the second half of the 20th century, but was poor compared to today.
Many people are nostalgic for the 1950s and 1960s, seeing those decades as a time of prosperity, when the American pharmaceutical industry ran out of steam. new medical advances: antibiotics, antipsychotics, drugs 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 “tremendous numbers of heart attacks and strokes.”
Heart disease was rampant in 1950, with 322 deaths per 100,000 Americans per year from cardiovascular disease, double the rate today. By 1960, Dr. Green said, heart disease was responsible for one-third of all deaths in America.
In part, this was because almost everyone smoked.
“We were among the countries that smoke the most,” said Samuel Preston, professor emeritus of sociology at the University of Pennsylvania.
Dr. David F. Musto, a medical historian at Yale who died in 2010, once said in an interview that although he never liked smoking, the social pressure to smoke when he was in college in the 1950s was so great that “I felt it was my duty to find my brand”.
Smoking greatly increases the risk of heart disease, the leading killer in the 1950s and 1960s.
Death rates from heart disease have plummeted in recent decades because smoking is much less common now and treatment for heart disease is much more effective. Cholesterol-lowering statins, introduced in 1987, reduced the risk of heart disease. Other new drugs as well as bypass surgery and stents have also saved lives.
Cancer was the second leading killer in the 1950s, as it is today. But in 1950, there were 194 cancer deaths per 100,000 people. There are now 142 cancer deaths per 100,000 people.
The reduction in smoking is the main reason, but there has also been a revolution in cancer treatment.
Until the 1990s, cancer was treated with brute force: surgery, radiation and chemotherapy. Now, a number of targeted therapies are turning some once-deadly cancers into treatable chronic diseases or even curing you.
Dr Green said he was not surprised by the idea of the kingfisher’s past when humans 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 choose not to remember.”
Today is not some kind of health utopia, of course.
Researchers are quick to acknowledge that Americans’ health isn’t as good as it could be. And they lament the vast disparities in health care in this country.
However, the US spends more on medical care than other countries – an average of $12,555 per capita, which is about twice what other rich countries spend.
But, historians say, the past was actually much worse.
And so, they say, the phrase “Make America Healthy Again” is meaningless.
“As a health historian, I don’t know what ‘again’ Kennedy is imagining,” said Dr. Toms. “The idea that once upon a time everyone Americans were healthy is a fantasy.”
