Reactionary frames about public health are no better than reactionary frames about politics

David Wallace-Wells and Emily Oster have a conversation [gift link] about RFK Jr.’s tenure as HHS secretary, in which they acknowledge that it’s been what they call a worst case scenario, and I would call RFK doing exactly what he said he would do, so predicting that what has happened was going to happen doesn’t exactly make you Nostradamus Jr. or anything.

One part of their conversation that’s worth focusing on is how both of these doubleplusgood left-liberals/standard east coast elite model/NYT op-ed page trim line/ simply buy whole hog into the entire Make America Healthy Again frame, even though they of course disagree with RFK Jr. and the MAGA anti-vax moms etc. about what would be the best path for achieving this apparently non-controversial goal:

If we were serious about literally making America healthy again, we have a tool [GLP-1 drugs] to make an enormous difference. And the culture that’s calling for exactly that — that has made that their slogan, their calling card — is resistant to it because their philosophy is really not about making America healthy again.

I would go back to what you said before, which is if your goal is really to make America healthy again, you should think about the full range of possible ways to do that. . . .And we’re not going to think about some of the avenues that might help a much larger share of people. That feels like you’re not really doing the thing that you said. You’re not making America healthy again.

I don’t doubt for an instant that both of these public intellectuals would reject out of hand the whole idea that, in political terms, we need to make America great again, since that is so obviously a reactionary frame, and just as obviously false from any sort of liberal or progressive perspective. Who thinks America was greater in the 1950s or the 1900s or the 1840s than it is today? White supremacists and big fans of the patriarchy that’s who. Again this is obvious.

But shift the topic to public health, and these liberal-left public intellectuals swallow the exact same reactionary nonsense hook, line, and sinker. What I would ask them is, precisely when was America “healthier” than it is today? Please be specific historically, and be sure to define your terms!

Age adjusted mortality rates per 100K:

2023: 750

2019, i.e. pre-pandemic, 715. Based on preliminary data I expect the 2024 figure will be very close to the 2019 number, which is the current all-time low.

2000: 869

1980: 1,039

1960: 1,339

1930: 1,944

1900: 2,518

I don’t have a Cray supercomputer handy but I think I detect a subtle trend.

Let’s look at the nation’s biggest killer, heart disease, which as we all know is at epidemic levels because of all the obesity and ultra-processed foods and sedentary lifestyles:

In the United States alone, the age-standardized death rate from cardiovascular disease has fallen by three-quarters since 1950. This means that for people of the same age, the annual risk of dying from cardiovascular disease is now just one-quarter what it was in 1950.

Hmmm. But that’s not what I read on TikTok, or heard on Joe Rogan’s podcast!

I could go on, but the general point is that claims that America isn’t “healthy” compared to the always unspecified Golden Age, when everybody got lots of fresh air [from backbreaking labor] and was much thinner [because of chronic malnutrition and food scarcity] is a bunch of totally false and basically fascistic/eugenic adjacent reactionary bullshit.

Obviously there are massive real public health problems in the US in comparison to developed countries, including drug and alcohol addiction and overdoses, suicide, homicide, and car accidents, our catastrophically inefficient health care “system,” and our even more catastrophic economic inequality, but this kind of thing just gets in the way of addressing that, in the way that reactionary nostalgia always does, and is in fact designed to do.

Thank you for your attention to this matter.