If RFK's Making America Healthy Again, When Was Then?

What era in our public health past is he seeking to resurrect?

Trump’s MAGA nostalgia may be repugnant, but it is definable. He longs for the halcyon days of unbridled racism, unchecked robber barons, military expansionism, and institutional misogyny. Not quite sure where his royalty fetish fits in, but we can at least see the hellhole he wants to guide us down. RFK Jr’s embrace of Trump, however, has left us with the absurd, bastard catchphrase, Make America Healthy Again. But where is Bobby taking us? What was the time in our public health history he wants to resurrect?

Infectious Disease

I think we can rule out the 19^th century when the leading causes of death in the US were all infectious and frequently killed children. Not a good look.

Leading Causes of death in 1850:

Epidemiology and the germ theory sparked the introduction of sanitation and clean drinking water, which dramatically changed that picture, but it took time. It took until 1950 for antibiotics and further improvements in sanitation to make infectious disease a minor cause of death in the US.

That is also a favorite time for Mr. Natural, before the scourge of vaccines. But I’m not convinced he really wants us getting polio. I don’t think he even likes measles as much as he pretends. But he hates the vaccines that stopped them. So, let’s put a pin in the 1950’s.

Cardiovascular Disease and Cancer

Perhaps RFK Jr. wants to take us back to better times for cardiovascular disease and cancer, currently the top two causes of death in the US. Unfortunately, that was definitely not the 1950’s. Deaths from both causes have been in steady decline for decades. This is primarily due to improved treatment, improved screening and secondary prevention (such as drugs to lower cholesterol and blood pressure), and reductions in cigarette consumption.

Age-Adjusted Death Rates* from Cancer,† by U.S. Census Region§ and Year — United States, 1970–2013

In fact, controlling infectious diseases and improved treatment for non-infectious diseases have combined to produce a steady increase in life expectancy in the US for almost 200 years. But that creates a problem. Getting a disease and not dying from it is the definition of a chronic disease. In other words, these public health and medical successes have helped create the “chronic disease epidemic” that RFK Jr. finds so annoying.

Guns and Obesity

There must be some ways in which Americans are less healthy. I can find at least two. First, our habit of shooting each other and ourselves has been getting steadily worse, more than doubling over the past 50 years. But guns are the third rail of GOP politics, so let’s pretend that’s not happening. The CDC has cut back on efforts to track gun injuries, opioid overdoses, and sexual assault. Apparently, the Trump administration’s idea of radical transparency is to make problems disappear by not looking at them.

Which brings us to the core of Captain Abs. Obesity. The one health issue that has been getting irrefutably, undeniably worse in the US. It encapsulates two of RFK jr.’s favorite obsessions, diet and exercise. Making American Healthy Again seems to be all about making us thin and chiseled again. This is not a new idea. In fact, it was his uncle who gave the President’s Council on Physical Fitness its name over 60 years ago. It was Obama, who added nutrition to create The President’s Council on Physical Fitness and Nutrition, the agency in HHS most directly charged with promoting exercise and nutrition. But it was last reauthorized in 2023 by Joe Biden. It is currently scheduled to cease operations in September.

Let’s see what President Fitness and Mr. French Fries can do to make us healthier. I’m not holding my breath.