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This "miasmist approach" to public health starts from a belief, not a basis of fact or empiricism. There are certainly circumstances in which malnutrition makes someone more susceptible to infectious disease, but what evidence is there that this is a significant contributor to infectious disease in countries like the US? What evidence is there that an otherwise healthy immune system could be "boosted" with proper nutrition and elimination of environmental toxins to the point that it would have a meaningful impact on infectious disease?

No one's against nutritional public health measures or elimination of environmental toxins to improve public health. The fact is lifestyle interventions are ALWAYS first-line recommendations by medical doctors for things like obesity, but Americans are stressed out, overworked, inactive, eating garbage food, and have clamored for easy solutions like taking a pill for a long time rather than making lifestyle changes. There's been no neglect of "living a healthy life", it's just that Americans don't want to do it because it requires lifting a finger. There are many positive public health impacts HHS and the Trump admin could have, but they are talking out of both sides of their mouth when they claim "MAHA" while cutting food access entitlements, rolling back environmental regulations for clean air and water, and of course "drill baby drill". RFK Jr. made a deal with the devil to be HHS secretary.

There's endless studies looking at the relationship between exercise and just about everything. It can do everything from substantially reduce your risk of cancer [1] to dramatically reducing your risk of getting a cold [2] and resulting in equally dramatically less severe symptoms if you do catch one.

And nobody really knows why this is, though there are plentiful hypotheses. And exercise is just one aspect of living healthy, though a very important one. You find similar strong associations between 'clean' eating and all other sorts of aspects of a living a healthy life.

Not only does it have effects but rather dramatic ones. I'd think most people would probably see this in their daily lives as healthfulness has dramatic effects on both physical and psychological wellbeing.

[1] - https://www.cancer.gov/about-cancer/causes-prevention/risk/o...

[2] - https://www.bbc.com/news/health-11664660

Also, excuse the double reply, but there are simple solutions to also help push society in the right direction. For instance requiring employers over 'x' employees (let's say 1000) to provide free access to a specified minimal set of exercise equipment and grant employees at least 'x' hours per week of paid exercise time which must be spent within this area exercising at a reasonable intensity (in other words not taking an hour break to go play on your phone in the gym).

Other things would be to offer a 100% tax credit for things like gym memberships. If this actually incentivized people, then it'd probably pay for itself through better health outcomes for society. It could also be paid for by adding a health tax, such as already exists on cigarettes, to e.g. highly processed foods, candy, and cola.

Similarly, the FDA should have some sort of an accreditation that restaurants and other food services can apply for that confirms some standard of minimal healthfulness of their food. This accreditation would be extremely critical since, in general, just dumping salt and sugar into food makes it more addictive, which increases margins, so when you go for health - you do so at profit loss. Such an accreditation could help combat this by giving people something to look for.

I'm going to reply here to both comments.

I didn't contest the relationship between regular exercise and health. The questions I raised were: what evidence is there that [malnutrition] is a significant contributor to infectious disease in countries like the US? What evidence is there that an otherwise healthy immune system could be "boosted" with proper nutrition and elimination of environmental toxins to the point that it would have a meaningful impact on infectious disease?

I agree with all of these solutions for encouraging regular exercise, and I'm open to the solutions for encouraging healthier nutrition.

The most clear example of this in the US is obesity. It correlates extremely negatively with basically every disease in existence, in every single way (susceptibility, severity, outcomes, recovery, etc) and is driven by malnutrition.

Solutions are not difficult to find for this specific manifestation of malnutrition. The primary issue is crap foods and cola which enable one to consume far more calories than you'd even be able to if eating a comparable amount of healthy food. For instance 2400 calories is 15 100g (cooked size) chicken breast servings. Or it's less than 2 McDonalds Big Breakfasts.

Not difficult to find? Maybe, maybe not. Effective public health solutions for obesity for which there is political will to implement them seem difficult to find to me. At the individual level, if you can manage to cut out ultra-processed food, exercise a few times a week, and get any comorbid medical conditions treated you're probably in the clear. All that is to say, it is relatively easy to identify at least some of the determinants of obesity for solutions.

I don't agree there at all. Our society has become so screwed up with unhealthful practices that there's low hanging fruit all over the place. For instance don't offer soft drinks, junk food, "sports drinks", etc. at public schools or allow vending machines for such. Offer water, milk, naturally non-caffeinated teas, and so on. Vending snacks could include things like wasabi peas and other extremely low calorie + high flavor type items.

Another thing is to remove the ability to purchase junk foods and cola with government food assistance. There's an extreme inverse correlation between obesity and income (hah.. imagine people of a couple hundred years ago hearing that) and so steps like this could actually have a tremendously positive overall impact on overall social health and wellbeing. This is even more true when you consider that twinkies and cokes are being bought on strictly limited budgets which means that much less money (and now more) for healthy foods.

I thought we were talking about public health interventions. How would "don't offer soft drinks, junk food, etc." be implemented? Are you going to propose a law or regulation that bans offering those things?

There's merit to the government food assistance (SNAP in the US) idea, though if you're trying to ban "junk food" from SNAP you're going to run into definition issues. Banning things like Twinkies and cola from SNAP is one thing, but "junk food" may also include ready-made ultra-processed food depending on your definition, and that may be the only type of food typical SNAP recipients can use (e.g. homeless who do not have access to cooking, people who live in food deserts). There is also a valid concern about micromanaging the food people eat, because SNAP recipients are normal humans and we tend to give normal humans leeway to indulge in a treat every now and then.

A lot of the malnutrition of students is driven by money. For instance Coca Cola has contracts with a massive chunk of all US school districts. And schools are obviously signing those with complete disregard for the health of their student in exchange for money. But because money is the motivation, this can just as easily be fixed by executive order (amongst a million other ways). Cut Federal funding to schools that sell soft drinks or other sorts of unhealthy products to children and Coke will disappear pretty much overnight.

Food deserts are largely irrelevant. Things like rice, beans, canned goods, and other such products are widely available and provide sufficient nutrition. There is also online food ordering (from Amazon etc) that allows payment with things like SNAP. And the sort of products we're talking about are not "treats", and should not be seen that way. They are highly addictive and harmful trash that, in the future will almost certainly be completely banned, certainly in anything like their current formulations.

I remember thinking it couldn't be true when the local schools first put in soda machines. Yes, banning the sale of soda and junk food in taxpayer-funded schools is an obvious, easy way to improve health. It would get major pushback from school boards which would cry about the lost funds, but they're always doing that anyway.

You can force exercise by doing periodic checks the way we do with disease or addiction. If your score is below some point you require a different kind of healthcare with a different price tag. If stats don't improve there should be special hospitals

You can force minimal exercise by doing periodic checks the way we do with disease or addiction. If your score is below some point you require a different kind of healthcare with a different price tag. If stats don't improve there should be special hospitals (with public funding)

Rather than have the stores and restaurants pay for changes they can be required and tax funded. Do it gradually.

The economy will thank you later.

I know I'm coming to the discussion late, but actually there is good evidence that improvements in nutrition, working conditions, and sanitation are a big factor in improving resistance to infectious diseases.

Look at "The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century", by Mckinlay and McKinley (1977). I know it's an old paper, but it has some fascinating and, to me, very persuasive time series. Those plots show mortality from various infectious diseases over the 20th century.

Example: death rates (per 1000) from scarlet fever dropped from 0.1 in 1900 to effectively 0 in 1940. There is NO VACCINE for scarlet fever.

Example: death rates from measles (lately very much in the news) dropped from 0.12 in 1900 to 0 in 1960 (a vaccine for measles was introduced in 1960).

A similar trend exists for many other infectious diseases: huge drops in mortality PRECEDE the introduction of vaccines or antibiotics for the disease. Surely we can't credit vaccines with such a drop in death rates. I don't see how anybody could come to such a conclusion.

No one is contesting the role of nutrition, working conditions, and sanitation in infectious diseases generally. What I asked was: what evidence is there that this is a significant contributor to infectious disease in countries like the US? (I should clarify that I'm referring to present-day US, because we're discussing in context of MAHA which is present-day US)

Yes, measles death rates had dropped precipitously (fortunately), however incidence (new cases) had only dropped a little. It wasn't until the vaccine was introduced that incidence dropped to nearly zero[1]. Yours is a common anti-vaxx talking point, and one that seems to neglect that death is not the only negative outcome from measles. It's understandable to take the talking point at face value when it appears to be scientifically-supported, though this is a good example of how a talking point uses a cherry-picked fact and reframes the issue for a presupposed conclusion (that vaccines are unsafe or ineffective), because the origin of that talking point had no interest in comprehensively informing people but converting them to believers.

[1] https://ourworldindata.org/grapher/measles-cases-and-death-r...

Yes, the measles vaccine is effective. It reduces cases of measles. But the paper in question says that deaths were reduced to almost zero before the vaccine was introduced. The graph that you linked to shows the same thing.

For me the paper shows not just that good sanitation and nutrition help reduce deaths from many infections diseases, but that they are the primary agent in that reduction. I thought it was a very cool paper, although you don’t seem moved in the same way as me.

When I was a child, my parents weren’t upset when I got measles (I was, because it meant missing a trip to the seashore). It meant that you were going to be miserable for a week, but would be immune afterwards. So I became one more case, but not one more death.

I mean, that good sanitation reduced infectious disease incidence and mortality was something I was already aware of so I've already been "moved" so to speak. As for nutrition, the paper cites one researcher who concludes nutrition was a major factor, and it probably was a factor, though the magnitude of its impact is not firmly established by that one researcher.

His logic, rationale, and evidence are worthless when his evidence is fabricated and/or cherry-picked and his logic and rationale stem from a pre-drawn conclusion incompatible with the existing evidence.

If he wants to focus on encouraging Americans to live more healthily, that doesn't need to come at the expense of vaccines. Further, he wouldn't be focused on areas of questionable or marginal value like food dyes, but on junk food as a whole. And if you want to focus on junk food, the place to start is economics: junk food is cheap in both time and money, and a financially-struggling population lacks both.

Nothing is arbitrary, this doesn't make it a debate though. You can have a statement at best if he states the reasons.

About the healthy life stuff, yes most of the rest of the world already practice this without wedging war on modern science and have plenty of regulations in place to protect the citizens. Additionally, a lot of countries have some form of centralized healthcare structure that has has preventive healthcare.

Maybe RFK wants to make USA like EU using BS to avoid being called socialist.

Also, I previously said that I like the spirit of it: https://news.ycombinator.com/item?id=44134479

Something I find extremely interesting is life expectancy. If you look back to the upper classes of old their life expectancy was extremely similar to those of today. So for instance in modern history, of the 15 key Founding Fathers, 7 lived to at least 80 years old: John Adams, John Quincy Adams, Samuel Adams, Jefferson, Madison, Franklin, John Jay. John Adams himself lived to 90.

The youngest to die were Hamilton who died in a duel, and John Hancock who died of gout of an undocumented cause - it can be caused by excessive alcohol consumption. All the others lived into their 60s and 70s. So their overall life expectancy was pretty much the same as we have today. And this was long before vaccines or even us knowing that surgeons washing their hands before surgery was a good thing to do. It's the same as you go back further into history. A study [1] of all men of renown in Ancient Greece was 71.3, and that was from thousands of years ago!

The most primitive medical technology, antibiotics in particular, could have likely expanded these lives well beyond current day. So the idea here is not to just add more regulations to medicine or have people go to the hospital even more for preventative care but to start living healthier lives in general. Less crap food, more time outdoors, more exercise, less obesity, and so on. And these are things that the government should have been pushing all along.

[1] - https://pubmed.ncbi.nlm.nih.gov/18359748/

Yes and no. The largest advances in life expectancy were in solving child mortality issues. In other words, when you hear things like "2000 years ago, the life expectancy was 25 years old", those averages are highly skewed by the large number of people who didn't make it to their 10th birthday. Meanwhile those who *did* make it that far tended to live not much less long than we do now.

In other words, for most of human history, once you hit a certain point you were about as likely to live as long as any other point. Obviously not considering outlier circumstances like periods of war or novel disease.

It's only been in recent decades where we're really starting to push beyond that, at least in the most developed of nations. This is due to growing ability to solve the issues that arise from living too long.

I completely agree with the initial part of your post. Childhood mortality reductions explain nearly all of the dramatic increases in life expectancy over time, and also is one of the best examples of how averages mislead. Some people have this impression of the past where people somehow just dropped dead at e.g. age 40 when in reality it was more like half were dropping dead before 10 and half were dropping dead after 70 resulting in an average age of mortality of around 40.

But I'm not sure I'm aware of any evidence for the latter part. Max life expectancy doesn't seem to be changing much at all, even over millennia (though obviously claims from long ago are impossible to objectively verify). This is far from an exhaustive search but the first thing that came to mind was to search for the longest lived people. [1] Of the 100 oldest women and 100 oldest men to have ever lived, only 4 of each are still alive today, and the most common nationality (and in fact the only nationality with more than 1 represented) is Brazil with 2 of the oldest men and 1 of the oldest women.

If we were pushing the bounds max life expectancy, then you'd generally expect to see a significant number of people breaking those records and - accordingly - still alive. In many ways it's kind of surprising that we're not even if we weren't making progress, since the total sample size of 'verified' peoples is increasing dramatically over time, so more people should be living longer (even if there is no change in max life expectancy) by chance/outlierdome alone. This to me is suggestive that we indeed be going in the opposite direction, though that's some extremely weak evidence of course.

[1] - https://en.wikipedia.org/wiki/List_of_the_verified_oldest_pe...

The thing to look at is the shift of life expectancy at an older age, e.g. 65, and how that shifts over time. For instance: the UN has a dataset [1] demonstrating an improvement from roughly 12 years to roughly 16 years (i.e. total age 77 to 81) from 1950 to 2010.

[1] https://www.un.org/en/development/desa/population/publicatio...

Ah perhaps I misunderstood you. You're arguing that more people are reaching our 'expiration date' rather than that date meaningfully changing. That definitely seems true, but I think there's some very clear causal factors in play there (which that article doesn't hit on). Both smoking and drinking are on the decline which is going to send life expectancy at older ages way up.

And the various observations the article does make have similarly straight forward explanations. For instance gains have not been seen to the same degree in Eastern Europe where alcoholism, especially in the windows of time considered, was chronic. It also mentions dramatic gains in Asia but yet again you had things like China's Great Leap Forward and the Indonesian Genocide in the time frame studied where you were seeing deaths by the tens of millions. It's akin to saying that global life expectancy increased dramatically after 1945, which is certainly true.

Regulations are usually about the absolute minimum, if you look at EU you can see that there are large discrepancies between countries despite being under the same regulations. You can't regulate your way into prosperity.

IMHO it's the culture that matters and distrust into science and institutions breeds bad culture.

Those things matter, but you are falling prey to selection bias. I would suggest looking into tue children, siblings, and perhaps wives / mothers of those founding fathers to get the full picture. Your physical fitness and diet play a crucial role. But without modern medicine and specifically vaccines, we rely on the age old technique of have many children, the strong / lucky ones survive. When people desire a natural state, i think thats fine, so long as they appreciate it means literally more people you know die young, including some of your children. Thats how nature has always worked.