Why Kennedy Sees an Epidemic of Chronic Disease Among Children

Robert F. Kennedy Jr., now President-elect Donald J. Trump’s pick to lead the Department of Health and Human Services, has for years called attention to what he considers an “epidemic” of chronic disease that has left America’s children among the sickest in the developed world.

Mr. Kennedy blames environmental toxins and a broken food system. But he also points to some of the most widely acclaimed advances of the last century: fluoridated water and vaccines that have nearly eradicated diseases like polio.

Most child health experts are adamantly opposed to scaling back fluoridation or immunizations, saying such changes would harm health and trigger outbreaks of deadly infectious diseases.

But many do not reject Mr. Kennedy’s primary diagnosis: There is a child health crisis in America.

“On this particular point he’s right,” said Dr. Philip Landrigan, a pediatrician and epidemiologist who directs the Program for Global Public Health and the Common Good at Boston College.

Even as infectious diseases and child mortality plummeted in the 20th century, he added: “There is no question noncommunicable diseases in children are up. I disagree with him that vaccines are the cause.”

Many scientists like Dr. Landrigan acknowledge that there are disturbing trends in childhood health in the United States, and they welcome Mr. Kennedy’s focus on foods and chemicals in the environment.

At the same time, they say, the solutions are not as simple as Mr. Kennedy has sometimes suggested. “It’s very clear that there’s no single one factor that’s driving increases in all of these noncommunicable diseases across the board,” Dr. Landrigan said.

A spokeswoman for Mr. Kennedy did not respond to requests for an interview.

Chronic disease affects the majority of American adults: 60 percent have at least one condition, like high blood pressure or diabetes, and 42 percent have more than one, according to a widely cited RAND Corporation study.

Childhood is usually the healthiest period of life. Yet some 40 percent of children also have a chronic health condition, according to the National Survey of Children’s Health. An earlier study found the figure was higher among adolescents, and when overweight and obesity are included.

It can be difficult to track the prevalence of a chronic illness over time because definitions and survey tools have evolved. Some increases in conditions like autism disorders, or anxiety and depression, reflect enhanced awareness and improved diagnosis.

Among the illnesses that have grown more common among children are obesity and overweight, respiratory diseases like asthma, mental health problems, and neurodevelopmental conditions, a broad category that includes both the autism spectrum and attention deficit disorders.

About 20 percent of children aged 6 to 11 were obese in 2018, according to the Centers for Disease Control and Prevention, up from 4 percent in the early 1960s. Overall, more than one in three children are overweight or obese, according to a new study.

One in 36 children is diagnosed with an autism spectrum disorder now, up from one in 150 two decades ago. One in four has a seasonal allergy, a food allergy or eczema. Rates of Type 2 diabetes, linked to obesity, and Type 1 diabetes have been rising among people aged 19 and under each year.

Anxiety and depression among teens ages 12 to 17 rose steadily between 2016 and 2023, and suicide rates among those 10 to 24 years of age also increased, to 11 per 100,000 in 2021 from 6.8 per 100,000 in 2007. (Some researchers have cited social media as one possible cause.)

And the incidence of childhood cancer, while still rare, has been creeping up by a fraction of a percent every year since 1975.

“If R.F.K. Jr. is concerned about chronic disease in America, that’s a good thing, because chronic diseases are real and there are things you can do to address them,” said Dr. Richard Besser, a pediatrician who is chief executive of the Robert Wood Johnson Foundation and the former acting director of the C.D.C.

“But if the new administration wants to take on chronic disease in a big way, you want it to be based on good evidence and on what we know works,” he said.

Critics have attacked Mr. Kennedy because he doesn’t always provide a reference or include appropriate caveats about the data. But researchers say the trends overall are unmistakable.

“You can split hairs about what’s going up, and what’s not going up but going on a long time,” said Christina Bethell, a professor at Johns Hopkins University’s schools of medicine and public health, who is the founding director of the national Child and Adolescent Health Measurement Initiative.

“But we need to focus on this,” she added. “We’ve ignored the well-being of our children for a long time.”

A healthy childhood lays the foundation for a healthy adulthood, she and other scientists noted. Children outgrow some conditions, but others can become lifelong burdens that grow more severe with age.

Chronic disease is not the only problem: A recent study found that deaths in people under age 20 started to rise in 2020 after a long period of decline, because of an increase in firearm injuries, homicides, drug overdoses, car accidents and suicides.

“The United States is the only industrialized country where we’ve been having rising mortality among working-age adults, and it really starts at age 15,” said Dr. James Perrin, a professor of pediatrics at Harvard Medical School and former director of pediatrics at Mass General Hospital for Children.

“That’s really scary, and it partly reflects that fact that we’re producing lots of relatively unhealthy young Americans.”

One consequence: “We’re dealing with an economy increasingly facing an inadequate number of working-age adults and frontline workers,” Dr. Perrin said.

Fluoride, Vaccines and Food

Mr. Kennedy has already signaled some priorities should he be confirmed as H.H.S. secretary.

Even before the election, he said that Mr. Trump would advise “all U.S. water systems to remove fluoride from the water” on the day he is inaugurated. (The federal government does not have direct authority over local and municipal water systems.)

Fluoridated water is credited with vastly improving dental and oral health, which can have an impact on overall well-being. But skeptics have seized on a recent National Toxicology Program report that found that fluoride levels exceeding World Health Organization guidelines of 1.5 milligrams per liter of drinking water are associated with slightly lower I.Q.s in children.

The level recommended by the Public Health Service is set at 0.7 milligrams per liter of water, less than half the W.H.O. standard.

Mr. Kennedy also said he would also warn the public about what he believed to be the potential side effects and risks of vaccines, which, along with improved sanitation and water, dramatically lowered infant and child mortality during the 20th century.

In past interviews, he has said that he wants to subject vaccines to the same rigorous randomized clinical trials that are used to test drugs, and to require mandatory reporting of their side effects and complications and track their long-term effects.

“My position is that if you want a vaccine, you ought to be able to get a vaccine,” Mr. Kennedy said in a recent interview. “But you ought to know the safety profile and the risk profile and the efficacy of that vaccine.”

Scientists say the alleged links between vaccines and autism have been thoroughly debunked, and many have denounced his ideas as dangerous, warning that discouraging use of vaccines will lead to epidemics that kill children and babies.

Making immunizations optional for school attendance in some states will lead to piecemeal uptake of vaccination, they fear, weakening population-wide protection against infectious diseases and leaving communities vulnerable to outbreaks.

Yet Mr. Kennedy’s declarations of war against processed food, unsafe pesticides and man-made chemicals have been welcomed by scientists like Dr. Landrigan.

A mounting body of evidence has linked early-life exposure to chemicals such as phthalates, brominated flame retardants and certain insecticides, along with toxins like lead and mercury, to impaired cognitive function, lower I.Q.s and neurodevelopmental disorders.

“If he looks at evidence that toxic chemicals are important drivers of the epidemic of noncommunicable diseases, then that paves the way for improving chemical legislation in this country, which is really a mess,” Dr. Landrigan said.

“The fundamental problem is that chemicals are still presumed innocent until proven guilty,” he added, “which means they can be brought onto the market with little or no premarket testing.”

Chemicals like phthalates and bisphenols in plastics, known as endocrine disrupters — substances in food, personal care products and the environment that can mimic or block hormones and throw the body’s hormones out of kilter — have been linked to an increased risk for metabolic disorders and obesity, said Tracey Woodruff, director of the Program on Reproductive Health and the Environment at the University of California, San Francisco.

“Corporations have had undue influence on science and on the regulatory process,” Dr. Woodruff said.

“Federal agencies have not used the most up-to-date science. They have allowed polluted science,” she added. “They have not removed financial conflicts of interest from the scientific review process.”

But she, like other scientists, expressed skepticism that Mr. Kennedy would be allowed free rein to rid government agencies of corporate influence in the incoming Trump administration.

Mr. Kennedy could begin to make a difference by getting processed foods out of school lunches, which help feed millions of American children, and adding more fruits and vegetables, Dr. Besser suggested.

“That would address one of the biggest drivers of poor child health in America, which is poverty,” Dr. Besser said.