WHEN ROBERT F. KENNEDY JR. was named secretary of health and human services, a certain kind of voter was thrilled. Some were Democrats, some were Republicans, and others were independents, but they were united in their belief that the nation was beset by a health disaster that could be laid at the feet of the government and experts.
Calley Means, a former Republican lobbyist and now an official at the Department of Health and Human Services (and the brother of surgeon general nominee Casey Means), spoke for this constituency when he explained that he supported Kennedy because “The public health–expert class has given us a public health collapse. We are on the verge of, at best, a health crisis and, at worst, a societal collapse with 20 percent of GDP going to health expenditures. [We’re] getting sicker, fatter, more depressed, more infertile for every dollar we spend.”
Fomenting suspicion about vaccines and food additives while pushing miracle diets (Kennedy’s includes no candy but plenty of fast food, as Joe Perticone points out) has made many an influencer wealthy and famous. Heck, it made one a cabinet secretary. Though these obsessives have always been with us, the Trump moment has given them new power because their conspiracy-mindedness fits seamlessly into the MAGA analysis of the world: You are not responsible for anything that has gone awry in your life. It’s the work of sinister elites who’ve betrayed you. They’ve shipped your job overseas, halved your neighbor’s salary through bad trade deals, stolen elections, and picked your pocket to support failed forever wars. In that spirit, the notions that vaccines cause autism, that antidepressants cause school shootings, and that COVID-19 spares Jews and Asians seem to demand a fair hearing. It’s a “Burn the Witches” level of analysis.
In the early days of Trump 2.0, even reasonable adults who should know better told reporters that it might be good to have Kennedy as our chief public health officer because, after all, we do have a serious problem with chronic health conditions like type 2 diabetes, heart disease, and obesity. GOP senators praised his focus on chronic diseases and predicted that he would bring a “fresh perspective” to health care.
But the reality is that most of what causes chronic medical conditions in America is almost entirely outside the remit of government. Obesity, lack of exercise, smoking, drinking, and poor diet all contribute mightily to chronic poor health—and they are behaviors that are extremely difficult to change. By contrast, government is indispensable in certain crucial areas—prevention and treatment of infectious diseases, promoting research on new drugs, and funding scientific studies on best practices. In all of those, Kennedy is not only failing to do his job well; he is doing the exact opposite of what he should.
It isn’t popular for politicians or activists to acknowledge, but most chronic conditions that afflict Americans are the result of personal choices. Please don’t get me wrong: People get cancer and Parkinson’s and ALS and lots of other ailments due to simple bad luck. But chronic conditions like type 2 diabetes, obesity, and heart disease are closely linked to behavior. It’s possible to do everything right and still get these diseases, but it’s much more common for people who have unhealthy habits to succumb. Even cancer rates can be affected by eating habits: consuming lots of fruits and vegetables has been shown to be protective against several forms of cancer. Again, this is not to blame people for their diseases or to suggest in any way that they don’t deserve treatment and care. Neither is it to suggest that what people eat is entirely a function of what they choose, as opposed to what is available to them at an affordable price. But as a matter of epidemiology, it’s important to be clear-eyed about what we can control and what we can’t. There are plenty of wealthy Americans who could easily make healthier choices and don’t.
People who are obese have a 28 percent higher risk of heart disease than do people of normal weight. Carrying excessive extra pounds also increases cancer rates, stillbirths, preeclampsia, strokes, arthritis, type 2 diabetes, kidney disease, infertility, gout, and mental health challenges.
Sitting for most of every day also does not conduce to good health.
We Americans (and, to be fair, many people around the globe) do a lot of that. A British study found that adults who watch six or more hours of TV a day had twice the all-cause mortality of those who watched two hours or less.
Everyone knows that the best path to good health is eating healthy foods, getting a decent amount of exercise, avoiding cigarettes, drinking alcohol in small amounts (no more than 1 drink per day for women, 2 for men), and maintaining a healthy body weight. A study in the journal Circulation found that women who followed these recommendations lived an average of 14 years longer than those who did not, and men lived an extra 12. But take a guess at how many American adults actually follow all five of those recommendations? According to a University of Oregon analysis, only 2.7 percent.
So, yes, we are plagued by diabetes, heart disease, strokes, and cancer. But it’s not because we use food dyes (though by all means, remove food dyes, we don’t need them), or because drug companies have conspired to keep us sick, or because WiFi is frying our brains, or due to fluoride in water (though in some jurisdictions, levels may be a bit too high). The only way to grapple with these conditions is to change our behavior—and that’s hard.
Meanwhile, what is not hard, or shouldn’t be, is to hire a government that does the basics of public health, like empanel experts to advise on the composition of the yearly flu vaccine, or provide guidance on which vaccines are needed for children and at what ages, or fund research on vaccines to prevent future pandemics. On all of these fronts, Kennedy has done the opposite, disbanding advisory committees of academics and physicians, canceling funding for mRNA vaccine research, changing the recommendation for COVID vaccines for pregnant women and babies, and creating a panel stacked with frauds to “reexamine” the non-existent link between the MMR vaccine and autism.
You can take this to the bank: Kennedy’s crusade will not overcome our chronic disease problem. But it is very probable, if he is not stopped, that former plagues like measles will make a big comeback; that we will be far less prepared to cope with the next epidemic because we cut research on the miracle of mRNA technology; that rates of vaccine hesitancy will continue to rise; and that trust in government professionalism will be shattered.
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