Is this the “sickest generation” in American history? Not even close.

If you’ve been paying any attention to the fractious debate over American health policy, you’ve probably heard this phrase: “the sickest generation in American history.” The words can be found in the third sentence of a major report released in May by a presidential commission led by Health and Human Services Secretary Robert F. Kennedy Jr., but the line itself essentially sums up the ethos of his Make America Healthy Again (MAHA) movement. America, and especially its children, is “the sickest country in the world,” as Kennedy himself told senators in a hearing earlier this month.

This idea — that we are sicker than we’ve ever been — underpins the radicalism of the MAHA agenda. If it’s true, then what choice do we have but to blow up the American health care system and remake it from top to bottom? Which is exactly what Kennedy aims to do.

Well, I’m here with some good news: It is not true. America is not, in fact, the sickest country in the world, and this generation — our kids included — is far from the sickest generation in American history. Once you gather the evidence, and once you realize the actual state of American health for much of the country’s history, it’s so not true that to ponder the question as it’s stated feels almost absurd. Decades of progress in everything from vaccines and drugs to cleaner air and water have made Americans far healthier and longer-lived than their ancestors.

Does this mean that Americans are as healthy as they could be, or that we aren’t seeing significant new health problems arise alongside that progress, like the growth of obesity, the spread of chronic diseases, and the rise of diagnosed mental illness? No. But one of the goals of this newsletter is to help put the very real problems of the present into perspective by understanding how far we’ve come from a much darker past. Our negativity bias, turbocharged by the maelstrom of social media, tempts us to catastrophize our present moment. In turn, we lunge for revolutionary solutions that risk destroying the foundation of the progress we’ve made.

Nowhere is that more the case than in our attitude toward American health, and nowhere are the risks of the blow-it-all-up approach more dangerous. So here’s a reality check.

We’ve gained an extra life

Death isn’t the only enemy of medicine, but it is the last one. On that final score, today’s Americans are better off on average than virtually any who came before them.

In the late 19th century, even as US cities were first being wired for electricity, life expectancy in the US was just 40 years — a sobering thought for someone like myself who is currently 47. Over the course of the 20th century alone, the average lifespan of Americans increased by more than 30 years. And nearly all of those gains came from improvements in public health, like the introduction of vaccines and antibiotics, improvements in cardiovascular care, safer roads and workplaces, and a cleaner environment and food supply. (MAHA decries the state of American food, but if you want to know what the unregulated system looked like at the turn of the 20th century, just read Upton Sinclair’s stomach-turning classic The Jungle.)

The science writer Steven Johnson has a brilliant description for this phenomenon: it’s as if Americans across the board gained “an extra life.” And while the long-term increase in US life expectancy reversed slightly during the Covid pandemic, it has since recovered. Today the average American can expect to live 78.4 years, or nearly twice as long as their great-great-great-grandparent born in the 1880s.

We’ve been winning the war on infectious disease, heart attacks, and cancer

One of the biggest factors behind all that extra life is medicine’s success against infectious disease. In 1900, pneumonia, tuberculosis, and diarrheal disease caused roughly one-third of all American deaths — and 30 percent of those deaths were in children under 5. In fact, as of 1915, an unimaginable one in 10 babies in the US died before their first birthday, just in case you still think today’s children are the sickest ever. That is worse than Afghanistan suffers now. As late as the 1950s, some 16,000 Americans a year — most of them children — were stricken with paralytic polio.

Today, just a fraction of Americans die from infectious disease. Diseases like polio are a thing of the past thanks to vaccines, and the more recent contagion of HIV — which killed nearly half a million Americans between the early 1980s and the late 1990s — has now become a manageable condition thanks to amazing advances in antiviral treatments. One of the reasons the Covid pandemic was so overwhelming was that Americans had lost any experience with a widespread new infectious disease, and even there, estimates are that mRNA vaccines developed at lightning speed prevented millions of deaths.

As deaths from infectious disease dropped over the last century, Americans have increasingly begun to die from noninfectious diseases like heart attacks and cancer. In a way, this was a sign of health success — these diseases strike later in life, and living longer meant more Americans were reaching the age where cancer and cardiovascular disease become a threat. But despite some concerning data like the rise of some cancers in younger people, overall deaths from cancer have been consistently falling for decades, while heart attacks are far less fatal now than they were 50 years ago. One big reason for both trends: Smoking is way, way down. Fire up an episode of Mad Men and tell me those guys are healthier than we are today.

We cleaned up our environment

The haze wasn’t just tobacco smoke. Take a look at Los Angeles circa 1979:

America in the 1960s and ’70s was a highly polluted place, where environmental hazards directly harmed human health. Cars still ran on leaded gasoline, burning 200,000 tons of highly neurotoxic lead each year, with the result that an estimated half of US children at the time were exposed to adverse levels. Smog blanketed our cities, and water supplies received far less treatment. Polluted rivers literally caught on fire!

Today, water and air in America are far cleaner. Cumulative emissions of six major air pollutants like sulfur dioxide and nitrogen dioxide fell 78 percent between 1970, the baseline year for the monumental Clean Air Act, and 2023. Ambient levels of lead fell 99 percent between 1980 and 2005, and have kept falling since. That last bit is especially important — lead is highly toxic to children, leading to lower IQs and other developmental problems. The fact that children today have blood levels that are on average 96 percent lower than children in the late 1970s is an astounding improvement in public health. (Though not so great for me, given that I was a child in the late 1970s.)

One other way in which the safety of our environment has improved: Both vehicles and workplaces are less dangerous than they used to be. The per-mile fatality rate, though still too high, is about quarter what it was in 1970, while the car crash death rate for children under 13 has fallen 81 percent since 1975. Total workplace deaths have fallen by about 60 percent since 1970, even as the size of the American workforce has increased.

We may not be as sick as we think we are

What about the health conditions in children, like autism and ADHD, that have really spiked in recent decades? As my Vox colleague Dylan Scott wrote this year, much of that apparent increase represents liberalizing diagnostic criteria, which have broadened to encompass many more children. The rate of US children with high-support needs autism, for instance, has only marginally grown over the past 30 years. In short, we’re diagnosing more kids who previously would have been missed. That’s a good thing if it gets them needed support earlier, but it does not back up the thesis that this generation of children is uniquely sick.

In fact, some doctors now believe that medicine has a broader problem of overdiagnosis in everything from mental health to certain kinds of cancer, both because of social changes in how health is viewed and improved testing methods picking up milder forms of disease that would have gone undetected in the past. “The bottom line is if you screen healthy people for an illness, any illness, be it cancer or high blood pressure, diabetes, then you will be picking up borderline cases and overtreating them,” Dr. Suzanne O’Sullivan, the author of The Age of Diagnosis: How Our Obsession With Medical Labels Is Making Us Sicker, told Vox in May.

From obesity and diabetes to youth mental health and drug overdose deaths, there is no shortage of ways in which we really are sick — and getting sicker. But I challenge anyone to go back to a time when one in every 10 American children died before the age of one, or when HIV was a clear death sentence, or when urban air was choked with smog, and tell me that we live in a uniquely sick time.

The way to address the very real health challenges we face today is not, as so much of MAHA wants, to destroy the foundation of the public health achievements we enjoy today, but rather to build on them.

A version of this story originally appeared in the Good News newsletter. Sign up here!