Long-term public health gains undercut claim that U.S. is 'the sickest generation'

A presidential commission report released in May and the Make America Healthy Again movement led by Health and Human Services Secretary Robert F. Kennedy Jr. have asserted that the United States — and especially its children — are living in the “sickest generation in American history.” A review of long-term public health and mortality data shows a different picture: Americans today live far longer and face far lower risks from infectious disease, environmental toxins and many acute causes of death than people did for much of the country’s history.

Life expectancy in the United States has increased dramatically over the last century and a half. In the late 19th century, average life expectancy in the U.S. was roughly 40 years. Over the 20th century, Americans gained more than 30 years of expected life, a shift often attributed to public-health measures such as vaccines, antibiotics, cleaner water and food supplies, and safer roads and workplaces. After a Covid-era decline, life expectancy has recovered; the average American can now expect to live about 78.4 years.

In the early 1900s, infectious diseases accounted for a far higher share of deaths than they do today. Around 1900, pneumonia, tuberculosis and diarrheal illnesses caused roughly one-third of U.S. deaths, and by 1915 about one in 10 American infants died before their first birthday. Polio epidemics in the mid-20th century left as many as 16,000 people a year with paralytic disease. Widespread vaccination campaigns transformed the outlook: diseases such as polio all but disappeared, and the advent of effective antiviral therapies turned HIV from a near-certain death sentence in the 1980s and 1990s into a manageable chronic condition for many patients. Rapid development of mRNA vaccines during the COVID-19 pandemic is estimated to have prevented millions of deaths worldwide.

As deaths from acute infectious disease receded, chronic conditions such as heart disease and cancer became the dominant causes of mortality. That shift is partly a marker of success: people are living long enough for those illnesses to emerge. Even so, long-term trends show progress. Cancer death rates have been declining for decades, and deaths from heart attacks are far less likely to be fatal today than 50 years ago, a development tied to better treatments and, importantly, a large reduction in smoking rates.

Environmental and safety improvements have also contributed to population health gains. Air and water quality in the United States are substantially better than in the mid-20th century. Cumulative emissions of six major air pollutants fell about 78 percent between 1970 and 2023, and ambient lead levels dropped roughly 99 percent between 1980 and 2005 and have continued to fall. Childhood blood lead levels are on average about 96 percent lower than in the late 1970s. Motor-vehicle safety and workplace protections have reduced injury and death: the per-mile fatality rate for drivers is about one-quarter of its 1970 level, the car crash death rate for children under 13 has dropped about 81 percent since 1975, and total workplace deaths have fallen approximately 60 percent since 1970 even as the American workforce has grown.

At the same time, several modern problems have worsened or become more visible, complicating claims that Americans are healthier in every respect. Rates of obesity and type 2 diabetes have risen, drug overdose deaths increased sharply in the 21st century, and more children are diagnosed with conditions such as autism and attention-deficit/hyperactivity disorder. Experts caution that some of the apparent increase in neurodevelopmental and mental-health diagnoses stems from broader diagnostic criteria and increased screening rather than a true surge in severe illness. "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," said Dr. Suzanne O’Sullivan, author of The Age of Diagnosis: How Our Obsession With Medical Labels Is Making Us Sicker.

Public-health scholars and clinicians say the appropriate response to contemporary health challenges is to build on the foundations that produced long-term gains rather than dismantle them. Vaccination programs, environmental protections, and safety regulations are cited as examples of policies that reduced mortality and disability across populations. Critics of sweeping proposals to remake the health system argue those changes risk eroding elements of public health that have demonstrably reduced deaths from infectious disease, exposure to toxins and preventable injuries.

The debate over whether the current generation is uniquely sick reflects both real and perceived trends: some conditions have become more prevalent or more visible, while many former drivers of high mortality have been curtailed. Measured against historical baselines for infant mortality, infectious disease, environmental exposures and accidental death, the United States has made substantial progress in population health. Policymakers and clinicians face the task of addressing pressing modern problems—rising chronic disease, mental-health needs, and overdose deaths—without sacrificing the public-health infrastructure and scientific advances that underpin longer, healthier lives.