Since taking over as the top US health official in February, Robert F. Kennedy Jr has overseen radical changes that have alarmed many public-health experts. The agency he leads announced that it would cut its workforce by 20,000, and cancelled billions of dollars in federal funding for research and public health. Earlier this month, Kennedy replaced all the members of an influential vaccine advisory committee with hand-picked ones, including some who have expressed scepticism about vaccines. His mission, he says, is to ‘Make America Healthy Again’. “We are the sickest nation in the world,” he said in March, “and we have the highest rate of chronic disease.”
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His diagnosis holds some truth, say public-health specialists and analysts. Relative to other similarly wealthy nations, the United States has the shortest life expectancy despite spending the most on health care. It “has the highest rates of preventable and treatable deaths”, says Reginald Williams, a health-policy specialist at the Commonwealth Fund, a think tank in New York City that publishes regular comparisons of health-care systems around the world. And researchers agree that high rates of chronic disease, including heart disease and obesity, are key contributors to Americans’ higher death rates, as Kennedy emphasizes.
But researchers say that Kennedy — widely known as RFK Jr — has mostly ignored other leading causes of death and ill health, including car accidents, drug overdoses and gun violence. In these areas, the United States “is a really clear outlier”, says Colin Angus, who studies health policy at the University of Sheffield, UK. “But, you know, I don’t see RFK talking about those things.” Kennedy has also promoted medical misinformation and conspiracy theories — particularly with regards to the safety of vaccines.
With Kennedy’s plans for US health beginning to come into focus, Nature has dug into the data to explore how unhealthy America is, how it got there and why many researchers say that some of Kennedy’s proposed solutions are misguided.
Shorter lives
To gauge US health, life expectancy — the average number of years a person is expected to live — is a good place to start. Many analyses show that the United States has lower life expectancy than most similar nations. A comparison by KFF, a non-profit health-policy research organization based in San Francisco, California, shows that US life expectancy at birth in 2023 was 78.4 years. This is 4.1 years shorter than the average of 11 comparably large wealthy countries, including Australia, Germany, Japan and the United Kingdom (see ‘Low expectations’). “The US is just like nothing else. It’s shocking,” says Angus.
Source: Peterson-KFF Health System Tracker
People in the United States also spend fewer of their years in good shape. Healthy life expectancy — the average number of years lived in good health — was 64.4 years in 2021. This ranks below that of almost all other high-income countries, according to data from the Global Burden of Disease study1, a massive epidemiological project to measure health loss.
The gap wasn’t always so wide. Life expectancy in the United States was closer to the average for its peers around 1980 and gradually improved, according to KFF’s analyses. The gains were driven partly by a drop in smoking and increased use of cholesterol-lowering drugs known as statins, which cut deaths from cardiovascular and other chronic diseases, says Thomas Bollyky, who directs the global-health programme at the Council on Foreign Relations, a think tank headquartered in New York City.
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