RSV and Heart Health
What RFK Jr. Gets Wrong About Chronic Disease
In his confirmation hearing as Secretary of Health and Human Services, Robert F. Kennedy Jr. Argued that U.S. Health-care spending represents a "20 percent tax on the entire economy." Rather than engage in a "divisive debate about who pays," he suggested the nation ask, "Why are health-care costs so high in the first place?"
Kennedy offered his own answer: "chronic disease," to which "90 percent of health-care spending" is devoted. He specifically pointed to rising rates of obesity, diabetes, and cancer, as well as "autoimmune diseases, neurodevelopmental disorders, Alzheimer's, asthma, addiction," and more besides. He blames poor diets and environmental toxins for the rise in chronic disease rates.
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In truth, the growing burden of chronic disease owes mostly to increased affliction by the diseases of old age. In 2019, the year before Covid hit, U.S. Life expectancy was 78.8—a hair's breadth below 2014's all-time high of 78.9, and well up from 47.3 in 1900. This owes much to progress in medical science and increased spending on health care; but it also reflects improvements in urban sanitation, widespread vaccination, and reduced consumption of alcohol and tobacco.
Obesity remains a problem. The U.S. Obesity rate is twice the average for developed countries, which accounts for America's higher rates of heart disease, diabetes, cancer, and stroke. It also explains America's higher death rate from Covid-19.
Though Americans' diets are more varied and fresh than a half-century ago, they also consume more sugars, soda, and processed foods. Kennedy blames these, along with additives and dyes, for much of the nation's ill health, telling Congress that "we shouldn't be giving 60% of the kids in school processed food that is making them sick."
Americans have always eaten a lot. Nineteenth-century Americans consumed over 1,000 calories more per day than the English and French. But it's hard to force Americans to change their diets, as New York mayor Michael Bloomberg discovered when he attempted to ban the sale of supersized sodas. "I don't want to take food away from anybody," Kennedy assured Congress. "If you like a McDonald's cheeseburger or a Diet Coke, which my boss loves, you should be able to get them."
As Secretary of Health and Human Services, Kennedy will lack the power to alter meaningfully Americans' diets. Congressional agriculture committees view farm subsidies, like those supporting high-fructose corn syrup, as their prized possessions. They also control the food stamp and school breakfast programs, the latter of which has been shown to increase obesity. When Congress has delegated authority over dietary guidelines to the executive branch, it has entrusted them to the Secretary of Agriculture. In President Trump's first term, that led to an effort to alter food stamp program nutrition requirements so that they could be satisfied by canned spray cheese and beef jerky.
For the bulk of his career, RFK was an environmental activist committed to clearing rivers of chemical pollutants. In his confirmation hearing, he argued that "human health and environmental injuries are intertwined," noting that the "same chemicals that kill fish make people sick also." He can do little about this at HHS, as the regulation of pesticides is entrusted to the Environmental Protection Agency.
Kennedy's environmentalism seems to have left him with a prejudice that nature inherently means humans well, and that unexplained disease is likely the product of artificial toxins. He has speculated that Wi-Fi causes cancer, that school shootings are caused by antidepressants, that chemicals in the water are responsible for gender identity disorders, and that vaccines cause autism.
To be sure, overmedication is a real problem. America has seen a proliferation of costly drugs with only slight therapeutic benefits, which may unleash a prescription cascade to deal with side effects. RFK Jr.'s skepticism of "unnatural" pharma may therefore be helpful if it leads him to resist attempts to weaken prior-authorization oversight on utilization.
Elsewhere, though, his instincts lead him astray. Kennedy told Congress, "I was raised in a time when we did not have a chronic disease epidemic," and suggested that, since his uncle's presidency, the proportion of children with chronic illnesses had surged from 2 percent to 66 percent.
These seemingly alarming statistics owe much to greatly broadened definitions and increases in the diagnosis of food allergies and behavioral health conditions that no one was tracking when JFK was in the White House. In reality, child health has improved dramatically, and the rate of mortality per 100,000 children has declined from 68.6 in 1962 to 24.9 in 2018.
RFK also claimed, "We spent zero on chronic disease during the Kennedy administration. Today we spend $4.3 trillion a year." The first statistic is clearly false (cancer and heart disease existed in the early 1960s); and much of the second can be explained by increased longevity.
Chronic disease is often a price of medical success and of aging. Improved treatment has turned the most serious medical conditions, such as heart disease, into things that people live with for years instead of dying quickly—and cheaply. Consider: age-adjusted deaths from heart disease fell by 67 percent from 1970 to 2018, while those from strokes declined by 75 percent. Deaths from prostate, colorectal, lung, and stomach cancers have all been halved since 1990.
The more medicine advances, the more work it has to do. Tissues, glands, and bones degenerate over time, and the effectiveness of medical care diminishes with age. The longer medical progress helps people live into old age, the more drawn out the period of bodily decline will be, with intractable and hard-to-cure conditions figuring more prominently.
This burden of chronic disease falls largely on the elderly. Relative to adults aged 35 to 50, those over 80 are nine times more likely to have cancer, ten times more likely to have diabetes, 18 times more likely to have COPD, and 47 times more likely to have a stroke. Whereas Alzheimer's disease afflicts only 2 percent of those aged 65 to 74, it touches 43 percent of those 85 and older.
Environmental toxins and unhealthy lifestyles can certainly precipitate bodily decay, but they are not the main reason for the rising cost of chronic illness. Increased spending on the treatment of chronic medical conditions is the product of a wealthier society with greater longevity. It's an unpleasant problem, but it beats the alternative.
Chris Pope is a senior fellow at the Manhattan Institute.
Photo by Kayla Bartkowski/Getty Images
Inflammaging: Chronic Inflammation's Impact On Age-Related Diseases
As the global population ages, age-related diseases such as cardiovascular disorders, neurodegeneration, type 2 diabetes, and certain cancers are becoming increasingly prevalent. A growing body of evidence points to "inflammaging"—a state of persistent, low-grade inflammation associated with aging—as a key contributor to this rise in chronic conditions. Despite its prevalence, the complex mechanisms linking inflammaging to the initiation and progression of age-related diseases remain incompletely understood and represent a compelling area for further investigation.
This Research Topic aims to comprehensively investigate the biological processes and molecular pathways underlying inflammaging, and to assess how chronic, systemic inflammation acts as a catalyst for the onset and progression of age-related pathologies. We seek to explore intricate signaling networks such as NF-κB and JAK-STAT pathways, age-related changes in both innate and adaptive immune system function, alterations in cytokine and chemokine profiles, the accumulation of senescent cells, and mitochondrial dysfunction. The project further aims to analyze the interaction between genetic predispositions, environmental exposures, epigenetic modifications, and lifestyle factors that collectively modulate the inflammaging process. An additional focus will be on evaluating a variety of interventions—including lifestyle modifications, pharmacological agents, and dietary approaches—that might reduce systemic inflammation and mitigate its detrimental impacts on health during aging.
A better understanding of inflammaging holds the potential to offer novel insights for the development of innovative diagnostic and therapeutic strategies, thereby enabling healthcare professionals to more effectively prevent, diagnose, and manage the diseases that disproportionately affect elderly populations. Ultimately, knowledge gained in this area may inform tailored interventions that improve quality of life, promote healthy aging, and reduce the healthcare and socioeconomic burdens associated with chronic age-related diseases.
We welcome article submissions on topics including, but not limited to:
1. Molecular and cellular mechanisms driving inflammaging2. The role of the immune system in chronic inflammation with aging3. Linkages between inflammaging and specific age-related diseases (e.G., Alzheimer's, cardiovascular disease, diabetes, cancer)4. Biomarkers for detecting and monitoring inflammaging5. The influence of genetics, epigenetics, and environmental factors on inflammaging6. Interventions and therapies targeting inflammaging (e.G., diet, exercise, pharmacology, nutraceuticals)7. The gut microbiome and its relationship to systemic inflammation and aging8. The impact of lifestyle factors (e.G., sleep, stress, physical activity) on inflammaging
Article types and feesThis Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:
Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.
Keywords: Inflammaging, Chronic Inflammation, Age-Related Diseases, Immunosenescence, Cellular Senescence
Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
Immunising The Elderly Is Crucial In Disease Prevention, Say Experts
The session was part of the 'Healthy India, Happy India' initiative aimed at promoting health and wellnessImage used for representational purpose only FilePhoto Credit: Reuters
Vaccination is a crucial yet often overlooked health measure for the elderly in India. Despite the absence of a dedicated national immunisation schedule for vaccinations among the elderly in the country, doctors stress the need for proactive administration of vaccines to protect older adults from preventable diseases.
In response, elder care also extends beyond vaccination to include physical activity, nutrition, mental health support, and chronic disease management, doctors said at the webinar "Prevention of Illness: Immunising the Elderly" organised by Naruvi Hospitals, Vellore in collaboration with The Hindu on Sunday, as part of the 'Healthy India, Happy India' webinar series. This is the sixth in a series of 15 webinars aimed at promoting health awareness and disease prevention, and it featured four subject experts.
Kurien Thomas, senior consultant, physician, and clinical epidemiologist, Naruvi Hospitals, Vellore introduced the importance of immunising the elderly. Dr. Thomas emphasised the importance of the pneumococcal, Hib, and hepatitis vaccines in elder care, and pointed out that 50% of severe pneumonia cases occur in the elderly, making vaccination a life-saving measure. Pneumonia remains a major health burden, with 156 million cases globally and 800,000 deaths annually in India.
Dilip Mathai, senior consultant in infectious diseases, Naruvi Hospitals, presented an overview of different vaccines and guidelines for immunisation of the elderly. Dr. Mathai also addressed vaccine hesitancy, citing a survey that found 60% of adults believed there were better ways to protect their health than vaccination, while 43% felt they were not at risk of falling ill.
Soumendra Nath Haldar, Assistant Professor, Department of Infectious Diseases and Advanced Microbiology, School of Tropical Medicine, Kolkata spoke on vaccines for food and waterborne diseases. He stressed the need for vaccine clinics to provide immunisation for these diseases. He also explained the importance of proper storage, and cost-effective administration of vaccines.
Vasant C. Nagvekar, infectious diseases consultant, H. N. Reliance Foundation Hospital and Research Centre, and the Lilavati Hospital, Mumbai explained the need for more vital vaccines in healthcare for the elderly. He emphasised the necessity of annual influenza vaccines, shingles (herpes zoster), varicella zoster (chickenpox), coronavirus, and H5N1 (avian flu) vaccines for ageing adults.
The experts also addressed cost barriers, and called for better health insurance coverage to prioritise immunisation in the elderly. The presentations concluded with an interactive Q&A session, where the panel addressed queries from the audience on accessibility, efficacy, and affordability of vaccines for adults and the elderly.
The webinar is available at https://www.Youtube.Com/watch?V=SjuhtZUyB9k
Published - March 16, 2025 08:05 pm IST
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