“We Will Make Americans Healthy Again” Robert F. Kennedy Jr. announced.. A political action committee that promoted Mr. Kennedy, President-elect Donald J. Trump’s pick for Health and Human Services secretary, he says his movement “Revolutionizing health In America.”
But the word “again” conjures up a time in the country’s past when Americans were in better health. Was there really a time when America was healthy?
There is a short answer for historians of medicine.
“No,” said Nancy Tomes, a historian at Stony Brook University.
“It’s hard for me to think of a time when America, with all the real health disparities that characterize our system, was healthy,” said John Harley Warner, a Yale historian.
Dr. Jeremy Green, a historian at Johns Hopkins University, asked: “To what particular era does RFK want to take us back?”
Probably not in the 19th and early 20th centuries.
Rich people smoked cigarettes and cigars, poor people 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, saloons were a big problem. Men were drinking their paychecks. That’s why we had Prohibition.
And, Dr. Costa notes, most American diets in the 19th century were bland.
It is true that agriculture at that time was organic, food was locally produced and not ultra-processed food. But fresh fruits and vegetables were in short supply because they were difficult to ship and because growing seasons were short. For the most part, Dr. Costa said, until the 1930s, “Americans were deprived of dried fruits and vegetables.”
As for protein, Americans were relying on salt 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 time, Dr. Costa said, beef “became a big part of the American diet.”
But although the availability of beef helped diversify the diet, people did not become healthier.
Worked with Dr. Costa. Robert Fogle, University of Chicago economic historian and Nobel laureate, to understand the population health of North Americans around this period. By examining medical records of soldiers of the Union Army. Common conditions, such as hernias, were untreatable – men’s hernias were as large as grapefruits, with trusses. Nineteen percent of these soldiers had heart valve problems by age 60. Today with about 8.5 percent.
Poor nutrition leads to poor health. People were thin, often very thin. In 1900 6.1 percent Union Army veterans were underweight — a risk factor for various diseases and often a marker of poor health — by comparison with 1.6 percent of American adults today. In 1850 Male in his 20s Can expect to live up to about 61 years. Today it is. 74 years.
The beginning of the 20th century saw improvements in public health (clean water, for example, and posters telling parents not to give beer to their children), but disease was rife. There were no antibiotics and very few vaccines. When the 1918 flu swept the country, no one knew the cause—the flu virus was undetected and strange folk remedies were rampant. About 675,000 Americans died.. In 1929, the Great Depression began, and its economic toll over the next decade led to severe malnutrition and health problems.
Health improved in the second half of the 20th century but was worse than today.
Many people are nostalgic for the 1950s and 1960s, seeing those decades as a time of prosperity, when the American pharmaceutical industry took off. new Medical advances: antibiotics, antipsychotics, Medicines for high blood pressure And Vaccines For tetanus, diphtheria, measles and polio.
Despite this progress, those years were terrible for health, Dr. Green said, “lots of heart attacks and strokes.”
Heart disease was rampant in the 1950s with 322 deaths per 100,000 Americans annually From heart disease, double the rate today. By the 1960s, Dr. Greene said, heart disease was responsible for One-third of all deaths in the United States.
In part, this was because almost everyone smoked.
“We were one of the top smoking nations,” said Samuel Preston, an emeritus professor of sociology at the University of Pennsylvania.
Dr. David F. Musto, a Yale medical historian who died in 2010, once said in an interview that although he did not enjoy smoking, the social pressure to smoke was so great when he was in college in the 1950s that “I felt it was my duty to find my own brand.”
Smoking greatly increased the risk of heart disease in the 1950s and 1960s.
Death rates from heart disease have declined in recent decades because smoking is now much less common, and heart disease treatments are more effective. Cholesterol-lowering statins, Introduced in 1987.reduce the risk of heart disease. Bypass surgery and stents, along with other new drugs, have saved lives.
Cancer was the second leading killer in the 1950s, as it is today. But in the 1950s There were 194 deaths from cancer per 100,000 people. Cancer now accounts for 142 deaths per 100,000 people.
Smoking reduction is one of the main reasons, but there has also been a revolution. In the treatment of cancer.
Until the 1990s, cancer was treated with brute force: surgery, radiation and chemotherapy. An array of targeted therapies are now turning or even curing some cancers, which were once fatal, into treatable chronic diseases.
Dr Green said he was not surprised by the idea of a halcyon past when people were healthy.
America has a long history of nostalgia for a past that was better than the present, he said. “History is about erasures – the things we choose not to remember.”
Of course, today is not a health utopia.
Researchers are quick to acknowledge that Americans’ health is not as good as it could be. And they lament the great disparities in health care in this country.
Yet the US spends more on medical care than other countries – on average $12,555 per personWhich is almost double the spending of other rich countries.
But, historians say, the past was actually much worse.
And so, he says, the phrase “make America healthy again” makes no sense.
“As a historian of health, I don’t know what Kennedy is envisioning ‘again,'” Dr. Tomes said. “The idea that once all Americans were healthy is a myth.