America is facing a dual crisis of physical and mental health. Rising chronic illness, obesity, and deaths of despair demand urgent attention. It’s time to Make America Healthy Again.
As a physician, the most interesting part of this second Trump administration—of MAGA 2.0—is the MAHA (Make America Healthy Again) component. Such a focus is sorely needed, as Americans’ health has clearly deteriorated over the past few decades.
A useful overall metric is longevity. In my first 50 years, life expectancy rose from just under 70 years to nearly 79 years by 2010. This was driven largely by improvements in public health, advances in medical care, and declining smoking rates. However, beginning around 2014, life expectancy stagnated and then began to decline, due in large part to rising rates of chronic illness and so-called “deaths of despair,” including drug overdoses (especially opioids), suicides, and alcohol-related disease.
With the arrival of COVID-19 in 2020, American longevity declined even further and has yet to recover to pre-pandemic levels. Drivers of increased mortality include not only the novel coronavirus but also the aforementioned deaths of despair, alongside the growing burden of chronic conditions such as obesity, diabetes, hypertension, and cardiovascular disease.
The obesity rate when I was born in 1960 was about 13 percent. By 2020, 42 percent of Americans were obese. Childhood obesity has increased four- to five-fold since my youth. Driven largely by these rising obesity rates, we’ve seen commensurate increases in hypertension, diabetes, and cardiovascular disease.
Comparing rates of mental illness over time is more difficult due to the stigma that surrounded it in earlier eras and evolving diagnostic criteria. Still, it seems abundantly clear that we are now facing a mental health crisis on par with our physical health crisis. Americans today have a lifetime incidence of depression of 20–25 percent and anxiety of around 30 percent. Our youth have been particularly affected, with rates of anxiety and depression among teens and young adults having doubled over the past decade. Nearly 30 percent of teen girls have seriously considered suicide.
“Deaths of despair” was not a recognized concept in 1960, but deaths from drug overdoses, suicide, and alcohol-related disease were relatively uncommon. By the 2020s, overdose deaths had risen to over 100,000 per year. Suicide deaths have increased by about 35 percent in recent decades, with 49,500 recorded in 2022—the highest number on record. Alcohol-related deaths have also nearly doubled, now contributing to an estimated 140,000 deaths annually.
By any of the above metrics, we are not doing well. Turning the clock back to 1960—at least in terms of health outcomes—would be a welcome change. There are many factors that must be reviewed and addressed. Some are not directly medical, such as economic and social disparities, but others fall squarely into the health bucket, including the quality of our food supply, the adequacy of our public health system, and the effectiveness of our healthcare delivery.
So yes, I welcome a renewed focus on health through initiatives like MAHA. If the primary goal of our federal government is to protect Americans, then it is long past time to address these pressing problems. One significant hurdle this new effort will face is the lack of public trust in the scientific endeavors necessary for real progress. To a considerable degree, I sympathize with that skepticism—which I will explore further in future installments.
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