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America’s Silent Epidemic: The Alarming Rise of Chronic D...

Explore how chronic diseases are reshaping U.S. healthcare and how RPM, telehealth, and prevention offer a path forward.

America’s Silent Epidemic: The Alarming Rise of Chronic Disease

https://www.rand.org/pubs/commentary/2025/03/combating-americas-chronic-disease-epidemic.html

The fact that the chronic disease epidemic persists despite significant expenditures on prevention may indicate that the solution may not lie in more spending on prevention but in “smarter” spending.

https://www.factcheck.org/2024/08/rfk-jr-s-exaggerations-on-chronic-disease-in-children/

Independent presidential candidate Robert F. Kennedy Jr. has given children’s health and the “chronic disease epidemic” a prominent role in his campaign.

“When John F. Kennedy was president, 6% of American kids had a chronic health condition,” reads a page on Kennedy’s campaign website detailing his intention to “end the chronic disease epidemic” in the U.S. “Today it is 60%. Rates of autoimmune disease, diabetes, ADD and ADHD, autism, obesity, asthma, food allergies, and other chronic health conditions have been skyrocketing.”

I can write here some of my ideas ideas on the reasons of this problem, but my ideas can be considered as "pseudoscientific" and "speculative".

8 hours ago, Linkey said:

I can write here some of my ideas ideas on the reasons of this problem,

I’ve only seen assertions that it’s an “epidemic” but no real analysis showing it.

8 hours ago, Linkey said:

but my ideas can be considered as "pseudoscientific" and "speculative".

You can say the same about any writeup that’s citing RFK Jr, who is a quack. Your last link points out that his claims are exaggerated, so why quote him?

Also from the article:

Paul Newacheck, a professor emeritus who studied children’s health policy at the University of California, San Francisco for multiple decades, said it was “unrealistic” to claim that 60% of U.S. children have chronic health conditions. “The big growth areas are obesity and mental/behavioral conditions,” Newacheck told us via email. “But they don’t add up to 60% of kids.”

However, I would agree that wild assumptions without even having the basics right are by definition speculative and as a method not scientific. For a proper scientific inquiry you have to start and end with accurate data and provide evidence for any assertions made. This takes time and effort, something that only few are willing to invest (including RFK Jr. and his foundation).

But one of the big issues associated with a range of chronic diseases is obesity. And the reason for that is not precisely a mystery (though somewhat complex).

Some correlations are more a spur to forming hypotheses that can be feasibly tested. E.g. decrease in children walking to school and activities and rise in obesity and metabolic syndrome. It's facile to say cause and effect, but much harder to control other variables. Same with the oft-mentioned decrease in home-cooked meals. Or increased time per day with electronic media, and less time in the park. Or, or, or.

Not my field, but is one challenge with longitudinal studies that people don't necessarily select just one healthy habit and make just one change? The families that, say, sign up for a Walk Your Kids to School program may also start putting more vegs on the plate, switching from frosted flakes to müsli at breakfast, supporting their kids in extracurricular sports, etc. Maybe one good approach is to study fairly homogenous communities where you have entrenched traditions and then some amenity is withdrawn in a clear-cut way so that you don't have a testing group that self-selected.

1 hour ago, TheVat said:

Not my field, but is one challenge with longitudinal studies that people don't necessarily select just one healthy habit and make just one change?

Yes, or more precisely, not necessarily an issue with longitudinal studies, but with almost all association studies. It is virtually impossible to control for all variables and many factors are not independent.

Generally speaking, creating the "right" cohort is incredibly difficult and it is rare that you can find for example two identical groups of people where the only difference is the variable under investigation. Typically, you need a controlled study in order to really figure it out. But that is typically not feasible for longitudinal study, as folks won't e.g. stay on a specific diet for decades.

Sometimes, you have "natural" experiments, in which something happens that creates good control and test groups. For example, there might be daycare centers having similar composition of kids but offering different diets. Or you can look at before and after of food labeling or banning of certain foods or rapid changes in dietary habits. For that reason, quite a few of the newer papers are looking at China, where there has been a massive change in diet.

But going back to obesity, both factors, physical activity and diet. I think activity was slightly more controversial as it is sometimes difficult to establish the cost of additional expenditure over the basal metabolism, but I think the lit has coalesced around somewhat consistent finding that sedentary lifestyles would indeed require shaving off a few hundred calories to counteract weight gain in children. But the very basics are pretty straightforward, and ultimately it is the excess consumption of calories. Though to reverse obesity, diet is the main part that can lead to weight loss (though exercise is helpful in doing it in a healthy way).

I will write my ideas.

"A cured patient is a lost client" (c). The second point is that modern medicine lacks a holistic approach to health: when a patient comes with a problem, it's solved, but then another problem arises (for a doctor of a different specialization), then another, and so on—so doctors unconsciously help each other make money.

31 minutes ago, Linkey said:

I will write my ideas.

"A cured patient is a lost client" (c). The second point is that modern medicine lacks a holistic approach to health: when a patient comes with a problem, it's solved, but then another problem arises (for a doctor of a different specialization), then another, and so on—so doctors unconsciously help each other make money.

This is part of a general conspiracy theory that assumes that there are financial imperatives to keep folks unhealthy. As in this case, there is never any evidence provided, which makes discussions rather meaningless. However, I will add one piece information that hopefully will get you thinking more broadly. In countries with single-payer systems, doctors don't make money by attracting more patients. I.e. a sicker population just means a higher workload for higher pay. But in those systems, the generally practice is often not that different to for-profit systems like the US. What do you make of that?

47 minutes ago, Linkey said:

I will write my ideas.

"A cured patient is a lost client" (c). The second point is that modern medicine lacks a holistic approach to health: when a patient comes with a problem, it's solved, but then another problem arises (for a doctor of a different specialization), then another, and so on—so doctors unconsciously help each other make money.

Your first statement makes no sense. No doctor, whether in private practice or a public health service, will prosper if he or she fails to treat patients effectively. So that's just a silly conspiracy theory.

There could be however be some truth in what you go on to say about medicine becoming so specialised that there may be not enough attention to knock-on effects and treatment of the whole patient. In theory, family doctors, or general practitioners, have this role but certainly in the UK today they can become too overloaded to do that effectively, unless the patient proactively seeks them out for an overview of their condition.

The third point is the one @CharonY has already made: doctors are not paid per person treated, so collectively making the population less well would not make them more money. So this again is just a baseless conspiracy theory.

The fact of the matter is that life expectancy in western countries has increased greatly in the last 50 years or so. That would not be so if your ideas were true.

The issue with these arguments is that there can be a grain of truth somewhere, but folks just than wildly extrapolate from there without stopping to gather evidence or think a bit about it. The fundamental criticism that medicine often is not sufficiently holistic is actually somewhat valid. But the reason is not some silly conspiracy, but rather that it is immensely complicated and much, if not most of the underlying biological determinants of health are simply not well understood.

Just take a look at the vast literature regarding nutrition- while over decades some knowledge has crystallized, a lot is still uncertain, or does only apply to some folks or is hard to replicate. Add to that socio-economic determinants of health it is something that simply put no medical doctor or even groups of MDs can realistically cover. Even in a research context, if going sufficiently deep, each person could conceivably be a research project on their own, owing to individual genetic make-up as well (and perhaps more importantly) developmental history. Things encountered in childhood or even prenatal could have significant impact on health risks further down the line. But figuring those out is immensely complicated and it is unknown how much we can can realistically generalize.

When postgenomics techniques were introduced, many of us had the notion that personalized medicine was on the horizon. However, within a few years the concept mostly got rebranded towards precision medicine, that tries to move away from the personalized aspect. I suspect with AI it will survive a while longer. However, at the given state I personally believe that it will still crash headlong into the issue of limited biological understanding. With AI we will just get to the point a bit faster.

What most medical systems are is therefore the result of whatever best practices we can derive, at a given cost we are willing to pay, which is compatible with the system (e.g. single-payer, public funded, mixed or private) and also is likely to be used by the population.

For example, high sugar food is unhealthy. I don't think that the literature is very ambigous about that. However, addressing that goes beyond the office of an MD. But there are also studies that have shown that in low-income communities, providing money is surprisingly effective in addressing health issues. Again, a practice that is not usually associated with medical treatment, yet rather effectively improved health measures.

Again, this is all to say that health (and associated biology) is vastly more complicated than those youtubers and other folks make it out to be and folks should rather spend time learning the basics than wildly speculate about things they know little about. I understand that this is far less attractive and in today's attention economy won't get you clicks. But it is the only way to actually learn something.

3 hours ago, Linkey said:

I will write my ideas.

"A cured patient is a lost client" (c). The second point is that modern medicine lacks a holistic approach to health: when a patient comes with a problem, it's solved, but then another problem arises (for a doctor of a different specialization), then another, and so on—so doctors unconsciously help each other make money.

As exchemist notes, this is a conspiracy theory. Where’s the evidence?

3 hours ago, exchemist said:

doctors are not paid per person treated

*offer not valid in the USA

But when you’re booked solid, and patients need to book a couple of months ahead of time, there’s no incentive to make more sick people.