Image by Greg Skidmore.

The Senate Finance Committee hearing with Robert F. Kennedy Jr. was explosive. The Secretary of Health and Human Services was accused of “reckless disregard for science and the truth,” and senators from both parties were openly hostile as they questioned him extensively on his vaccine policies, as well as the firing of scientific advisory board members and agency heads and their replacement with ideologically driven anti-vaccine supporters. During that more than three-hour session, he was called a charlatan and a liar, and he returned the insults.

The distrust of his honesty and integrity was palpable. The public health community already mistrusted his views on vaccines and the role of science. There was, however, some modest hope that he would at least follow through on his views on the environmental causes of chronic disease and the food industry’s disastrous impact on obesity and diabetes, as well as other diseases. Sadly, that’s been anything but the case and there’s quite a history behind that reality.

A Long History of Public Health Disasters

In focusing on the environmental causes of disease, Kennedy was building on a public health tradition that saw disease, suffering, and death as, at least in part, a function of the worlds we’ve constructed for ourselves and others over time. Historically, some instances of unnecessary suffering are glaringly obvious. Take, for instance, the exploitation and often premature death of Africans enslaved and transported to the New World under conditions so inhumane that approximately 10% to 20% of them perished during what came to be known as the Middle Passage. And don’t forget the suffering and early deaths of so many who survived and were consigned by Whites to forced labor in the American South, where the average life expectancy of a newborn slave child was less than 22 years, or about half that of a White infant of the same era.

Or, to take another example, in her famous 1906-1907 study Work-Accidents and the Law, Crystal Eastman, the feminist co-founder of the American Civil Liberties Union and a social reformer, wrote of 526 men who were killed in accidents in the steel mills of Pittsburgh and another 509 who suffered serious injuries in — yes! — a single year, arguing that many of those accidents would have been preventable had work conditions been different. As she grimly reported:

“Seven men lost a leg, sixteen men were hopelessly crippled in one or both legs, one lost a foot, two lost half a foot, five lost an arm, three lost a hand, ten lost two or more fingers, two were left with crippled left arms, three with crippled right arms, and two with two useless arms. Eleven lost an eye, and three others had the sight of both eyes damaged. Two men have crippled backs, two received internal injuries, one is partially paralyzed, one feebleminded, and two are stricken with the weakness of old age while still in their prime.”

Some aspects of the inevitable — fatal disease or other devastating genetic and biological conditions — are clearly affected by how societies care for their members. Historically, race, social class, geographic location, gender, age, and immigrant status have all been shown to have a tremendous impact on access to medical care and the quality of that care. The social and economic arrangements Americans created have shaped patterns of disease prevalence, distribution, and recovery over the course of our history.

Most obviously, a system dependent on slavery produced untold suffering and death among those most exploited; a commercial economy involving trade between various regions of the country and the world often lent a significant hand to the transmission of diseases from mosquitoes, rats, and other sources of infection. The development of cities with large immigrant populations gave landlords the opportunity to profit from renting airless tenements without adequate sewerage or pure water, producing epidemics of tuberculosis and cholera, among other diseases of poverty. Similarly, the disfiguring accidents and diseases caused by toxic chemicals were often a reflection of the rampant expansion of a laissez-faire industrial system that put profits above human life. And the Trump administration’s decision to promote the use of coal and ignore the impact of a fossil-fuel-based economy on the climate and on........

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