Introduction
The United States faces a significant health crisis, as highlighted by Robert F. Kennedy Jr.’s “Make America Healthy Again” (MAHA) initiative. Kennedy, now leading the Department of Health and Human Services (HHS), has called the U.S. “the sickest nation in the world,” pointing to alarming statistics on life expectancy, chronic diseases, and preventable deaths. This article provides a comprehensive health check for the U.S., comparing its health outcomes to those of similar high-income nations. By examining data on life expectancy, causes of death, healthcare spending, and proposed solutions, we aim to understand the depth of the crisis and evaluate whether Kennedy’s policies can deliver on the promise to improve American health.
Purpose of the Analysis
This analysis seeks to measure the health of the United States using key metrics such as life expectancy, mortality rates, and healthcare expenditure. It explores the primary drivers of poor health outcomes, including chronic diseases, substance misuse, gun violence, and car crashes, while comparing U.S. performance to peer nations. Additionally, it critically examines Kennedy’s MAHA initiative, alongside alternative solutions proposed by public health experts, to assess their potential to address America’s health challenges.
Measuring America’s Health: Life Expectancy
Life expectancy is a fundamental indicator of a nation’s health. According to a 2023 analysis by the Kaiser Family Foundation (KFF), the average life expectancy at birth in the U.S. was 78.4 years, approximately four years shorter than the average of 82.5 years in 11 comparable wealthy nations, including Australia, France, Japan, and Sweden. This gap has widened over time, despite earlier improvements driven by reduced smoking rates and the adoption of cholesterol-lowering statins. However, U.S. life expectancy plateaued in the 2010s, while peer nations continued to see gains.
Historical Trends in Life Expectancy
In 1980, U.S. life expectancy was comparable to peer nations, averaging 73.7 years versus 74.6 years. Over the subsequent decades, other high-income countries saw more rapid improvements, with Japan reaching an average life expectancy of 80 years by 1996, a milestone achieved by all peer nations by 2012. In contrast, U.S. life expectancy stagnated, dropping to 77.0 years in 2020 due to the COVID-19 pandemic—a decline nearly four times larger than the average 0.4-year drop in peer nations. By 2023, the U.S. had only partially recovered to 78.4 years, while peer nations averaged 82.2 years.
Impact of Young Adult Mortality
A significant driver of the U.S.’s lower life expectancy is the high death rate among younger people, particularly those aged 15 to 49. KFF data shows that the U.S. death rate for this age group is up to three times higher than in comparable countries. Because deaths at younger ages result in more years of life lost, they disproportionately impact overall life expectancy. For example, a recent calculation suggests that one in 20 U.S. five-year-olds will die before age 45, compared to one in 50 in the United Kingdom and one in 100 in Switzerland. This stark disparity underscores the urgency of addressing premature mortality in the U.S.
Causes of Death: Chronic Diseases and Beyond
To understand why U.S. life expectancy lags, it’s essential to examine the leading causes of death. Chronic conditions dominate, but other factors like substance misuse, gun violence, and car crashes also play significant roles, particularly among younger populations.
Chronic Diseases: A Major Contributor
Kennedy has emphasized that the U.S. has “the highest rate of chronic disease” globally, a claim supported by KFF data. Chronic conditions—cardiovascular disease, cancer, stroke, and respiratory diseases—account for four of the top five causes of death in the U.S. Americans are approximately twice as likely to die from cardiovascular disease before age 70 compared to peers in similar countries. Additionally, the U.S. has the highest age-standardized cancer incidence rate globally, with an 88% increase in cancer cases from 1990 to 2021, the largest among evaluated countries. These conditions drive about 32% of the premature death gap between the U.S. and peer nations, highlighting systemic failures in prevention and management.
Cardiovascular Disease
Cardiovascular disease remains the leading cause of death in the U.S., with Americans 2.5 times more likely to die from it than citizens of peer nations. Risk factors such as obesity, poor diet, and sedentary lifestyles contribute significantly. Despite advancements in medical interventions, the U.S. struggles with consistent prevention and early treatment, partly due to barriers in healthcare access.
Cancer and Other Chronic Conditions
Cancer is another major killer, with the U.S. reporting nearly double the cancer incidence rate of the next-highest country in 2021. Chronic respiratory diseases and kidney disease also contribute disproportionately to premature deaths, with Americans nearly four times more likely to die from kidney disease than peers in similar nations. These trends point to gaps in screening, early diagnosis, and lifestyle interventions.
Other Leading Causes of Death
Beyond chronic diseases, the U.S. stands out for high death rates from external causes, particularly among those aged 15 to 49. These include substance misuse, car crashes, suicide, and homicide, which collectively account for a significant portion of the life expectancy gap.
Substance Misuse and the Opioid Crisis
The opioid crisis is a major driver of premature mortality in the U.S., with deaths from substance misuse far exceeding rates in peer nations. The CDC reports that drug overdoses, primarily from opioids, contribute significantly to the high death rate among young adults. This crisis reflects a combination of over-prescription, lack of access to addiction treatment, and socioeconomic factors.
Gun Violence: A Public Health Crisis
Gun violence is a uniquely American issue, with firearms accounting for about 80% of homicides and 55% of suicides. In 2024, former U.S. Surgeon General Vivek Murthy declared gun violence a public health crisis due to its impact on mortality, particularly among youth. The U.S. has significantly higher rates of gun-related deaths than peer nations, where stricter gun laws and lower firearm ownership prevail.
Car Crashes
Car crashes are another major contributor, driven by the U.S.’s car-centric culture, larger vehicles, and higher mileage per capita. Unintentional injuries, including car accidents, are the leading cause of death for U.S. children, further dragging down life expectancy.
Suicide and Mental Health
Suicide rates are elevated in the U.S., with mental health challenges exacerbated by limited access to care. About one in five U.S. adults lives with a mental illness, and funding cuts to mental health programs have hindered efforts to address this crisis, particularly among youth.
Healthcare Spending: High Costs, Poor Outcomes
Despite its health challenges, the U.S. spends disproportionately on healthcare. In 2023, per capita healthcare spending reached approximately $13,000, nearly double the $7,000 average in comparable wealthy nations. This translates to about 18% of U.S. GDP, compared to an average of 10-12% in peer countries. Yet, these high expenditures have not translated into better health outcomes, raising questions about efficiency and allocation.
Lack of Universal Health Coverage
The U.S. is the only high-income country without universal health insurance, with 8% of its population (approximately 26 million people) uninsured in 2023. High costs and lack of coverage create barriers to early diagnosis and treatment, contributing to higher rates of chronic conditions and preventable deaths. For example, KFF’s 2023 Survey of Consumer Experiences with Health Insurance found that 18% of insured adults with chronic conditions delayed or skipped prescriptions due to cost, compared to 9% without chronic conditions.
Administrative and Preventive Spending
The U.S. spends significantly on administrative costs for its complex public-private healthcare system, which includes Medicare, Medicaid, and private insurance. Preventive care spending, while higher than in peer nations, has not yielded proportional benefits. For instance, preventive care spending doubled from $343 per capita in 2019 to $741 in 2020 due to the COVID-19 response but fell to $589 in 2021, reflecting inconsistent investment.
Kennedy’s Make America Healthy Again Initiative
As HHS Secretary, Robert F. Kennedy Jr. has made chronic disease prevention the cornerstone of his MAHA initiative. His plan emphasizes shifting the healthcare system from treatment to prevention, targeting nutrition, physical activity, and environmental factors. Key proposals include:
- Promoting Healthy Lifestyles: Encouraging community-based programs to improve diet and increase physical activity.
- Expanding Preventive Screenings: Enhancing access to early detection for chronic conditions.
- Reducing Industry Influence: Addressing conflicts of interest in healthcare and food industries, such as pharmaceutical fees to the FDA and lobbying by Big Food.
- Rural Healthcare Investments: Supporting student loan forgiveness and telehealth to increase provider numbers in underserved areas.
- Opioid Crisis Response: Expanding addiction treatment and promoting non-opioid pain management.
Kennedy’s supporters, including MAHA influencers like Calley Means, argue that these reforms address root causes of poor health, such as ultra-processed foods and over-reliance on medications. However, critics highlight significant gaps in the MAHA agenda, including its omission of gun violence, substance misuse (beyond opioids), and infectious diseases like measles, which have surged due to vaccine hesitancy.
Controversial Actions and Cuts
Kennedy’s tenure has been marked by controversial moves, including the layoff of 10,000 HHS employees and the termination of billions in grants for pandemic preparedness, cancer research, and chronic disease prevention. A sweeping spending bill signed in July 2025 is projected to result in 12 million people losing health insurance by 2034, primarily due to Medicaid cuts. Critics argue these actions undermine public health infrastructure and could exacerbate the health crisis.
Vaccine Policy Concerns
Kennedy’s history of vaccine skepticism has raised alarms, particularly after he replaced all members of the CDC’s vaccine advisory committee with critics of immunization and cut $1.1 billion in funding for vaccination programs. These moves coincide with a growing measles outbreak, prompting fears of increased preventable diseases.
MAHA Report Criticisms
The MAHA Commission’s first report, released in May 2025, cited hundreds of studies but was criticized for including non-existent or misinterpreted research, particularly on children’s health issues like screen time and medication use. The White House has promised to address these errors, but the report’s credibility has been questioned.
Alternative Solutions from Public Health Experts
Public health researchers and organizations like the American Public Health Association (APHA) argue that Kennedy’s approach overlooks critical drivers of poor health and propose alternative strategies:
Expanding Health Coverage
Experts advocate for expanding, rather than cutting, health insurance coverage to ensure access to early diagnosis and treatment. Medicaid, which covers 50% of U.S. children and 63% of nursing home residents, is seen as vital for vulnerable populations. Reversing proposed cuts could prevent millions from losing coverage.
Increasing Preventive Care Investment
Boosting spending on disease prevention, including screenings and public health campaigns, could reduce chronic disease rates. For example, CDC data suggests that top-performing health systems could prevent 30–50% of complications from heart attacks, strokes, and cancer through better prevention.
Addressing Social Determinants
Tackling social determinants like poverty, housing, and education is crucial. For instance, addressing childhood poverty could reduce obesity rates, which are 70% higher among low-income children. Programs like universal free school lunches, weakened during Trump’s first term, could improve nutrition outcomes.
Combating Gun Violence and Substance Misuse
Reducing gun deaths requires addressing the public health crisis of firearm access, potentially through stricter regulations. Similarly, combating the opioid crisis demands increased funding for addiction treatment and mental health services, areas currently facing cuts.
Strengthening Public Health Infrastructure
Restoring funding for agencies like the CDC and NIH is essential for research, disease tracking, and pandemic preparedness. Rebuilding trust in health institutions, undermined by layoffs and misinformation, is also critical.
Challenges and Political Realities
The U.S. health crisis is deeply intertwined with social, economic, and political factors, making quick fixes unlikely. Kennedy’s MAHA initiative faces resistance from both industry stakeholders and public health experts. Pharmaceutical executives and farmers have expressed concerns about his policies, while Republican-led deregulation efforts may conflict with health-focused reforms. Additionally, partisan divides complicate solutions, with 72% of Republicans supporting HHS cuts compared to 89% of Democrats opposing them, according to a KFF poll from April 2025.
Balancing Cost-Cutting and Health Gains
Kennedy’s cost-cutting measures, justified by the U.S.’s high healthcare spending, risk undermining programs critical to health improvement. For example, cuts to Meals on Wheels and smoking prevention programs could exacerbate chronic disease rates. Balancing efficiency with investment in prevention will be a key challenge.
Navigating Public Trust
Kennedy’s vaccine skepticism and controversial appointments, such as Mehmet Oz to lead CMS, have eroded trust among some health professionals. Restoring confidence requires transparent, science-based policymaking, which Kennedy’s critics argue is lacking.
