Para leer en español, vea esta traducción de El Tiempo Latino.
Independent presidential candidate Robert F. Kennedy Jr. has given children’s health and the “chronic disease epidemic” a prominent role in his campaign. We’ve written about some of Kennedy’s claims on chronic disease in the past, particularly as they pertain to the debunked link between autism and childhood vaccines.
But to what degree are Kennedy’s other claims on chronic disease grounded in science?
Recently, Kennedy repeatedly has said chronic disease in children has dramatically increased, while using statistics with unclear sources and putting forward unsupported narratives on the causes. Diagnoses of a variety of chronic conditions in children have increased in recent decades, but likely not to the extent that Kennedy claims or for the reasons he gives.
“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.”
Kennedy recently has repeated the latter statistic on the campaign trail. In a June 4 interview with USA Today, he listed “ending this chronic disease that is now debilitating 60% of our kids” as one of the “issues at the core of people’s concerns about what’s happening to America today.” He told the paper he had a plan for ending the chronic disease epidemic “overnight.”
On June 12, at the Richard Nixon Presidential Library and Museum, Kennedy spoke of a rise in diabetes and autism in children, before saying, “An entire generation, 60% of these kids — and that’s a conservative estimate — now have autoimmune diseases, neurological diseases, obesity, peanut allergies, food allergies.”
He went on to say that the cause “has to be” an “environmental toxin” while claiming that “NIH will not identify which exposures are contributing or causing this,” referring to the National Institutes of Health. “Once you do that, once NIH does that, you can end them,” he said.
Certain chronic health conditions — including obesity, both Type 1 and Type 2 diabetes, attention-deficit/hyperactivity disorder, autism and food allergies — have been increasingly reported in American children in recent decades. Incidence of asthma has increased globally in the past half century but recently seems to have leveled off in the U.S. and some other countries.
However, there’s no good way to track chronic conditions in U.S. kids over the more than 60-year span Kennedy refers to, given changes in how chronic conditions are diagnosed, tracked and defined. Nor is there a single, standard definition today of what counts as a chronic condition.
We reached out to the Kennedy campaign to ask for the source of his statistics but did not receive an answer. A possible source of Kennedy’s reference to the current statistic is a 2011 study we covered in a previous article, showing that 43% of U.S. kids had at least one of a list of 20 chronic conditions, as reported by their parents in a 2007 survey. This number rose to 54% under a very broad definition that included those who were overweight, obese or were “at risk” for developmental delay. Children’s Health Defense, an organization founded by Kennedy that spreads anti-vaccine content, has cited the 54% figure, and Kennedy uses the same percentage in a video included at the bottom of his campaign’s chronic disease page.
But experts we consulted considered Kennedy’s 60% statistic to likely be an overestimate — and not a “conservative estimate,” as he claims, nor evidence that chronic conditions are “debilitating” a majority of children. Measures of chronic disease that only count children with conditions that limit their activity or require special support have yielded far lower estimates. And as we have previously written, there is evidence that chronic conditions in children are not necessarily permanent.
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.”
Chronic disease can have different definitions, Dr. James Perrin, who studies chronic health conditions in children and adolescents at Harvard Medical School and MassGeneral Hospital for Children, told us via email. It is difficult to place an upper limit on the chronic disease rate, he said, given that one could include very mild conditions, such as relatively minor allergies. But “most analysts,” he said, would say there have been “really huge increases, but not to the level that Mr Kennedy claims.”
In his focus on an “environmental toxin,” Kennedy also provides an incomplete picture of the causes and suspected causes of these trends.
“The patterns and risk factors do really vary by disease,” said Stephanie Eick, an environmental epidemiologist at Emory University’s Rollins School of Public Health. For instance, obesity and Type 2 diabetes come with different risk factors than autism, she said, and there have also been improvements over time in diagnosis that mean fewer children with certain chronic conditions are now being missed.
Eick added via email that Kennedy’s promises of ending the chronic disease epidemic overnight appear overblown. “In my opinion, I do not think it’s possible to stop the chronic disease epidemic overnight,” she said.
And she said the NIH does support research into environmental risk factors for chronic disease, including chemical exposures. For example, the NIH Environmental influences on Child Health Outcomes (ECHO) Program is looking at “the effects of early environmental influences—including, for example, biological, behavioral, psychological, chemical, physical, and social factors—on child health and development,” an NIH spokesperson told us via email.
Kennedy is not alone in mentioning chronic disease as part of his agenda. In video from his website — posted over a year ago but shared widely on social media in July — former President Donald Trump discusses “an unexplained and alarming growth in the prevalence of chronic illnesses and health problems, especially in children” — although, as we’ve said, the growth in diagnoses of chronic conditions is not entirely unexplained and unstudied.
Trump vows to “establish a special presidential commission of independent minds who are not bought and paid for by big pharma” to look into the problem, implying without clear evidence or explanation that pharmaceutical companies’ influence is responsible for impeding progress on childhood chronic disease.
Kennedy took note, writing on X, “Imitation is the sincerest form of flattery” and that “talk is cheap.”
Recently, Kennedy has indicated a desire to take his chronic disease agenda to a Trump White House, reportedly discussing a deal in which he might endorse Trump in return for a role involving health issues. In a leaked July 14 phone call between the two men, Trump repeated falsehoods about vaccination and health effects on children.
Unsupported Statistics on Childhood Chronic Disease
The source of Kennedy’s statistical claim — that chronic disease in U.S. children increased from 6% during his uncle’s presidency to 60% today — is unclear.
The Kennedy campaign website links to a Centers for Disease Control and Prevention page that states that “more than 40% of school-aged children and adolescents have at least one chronic health condition,” citing data from the 2018 National Survey of Children’s Health.
Christina Bethell, a professor at Johns Hopkins University Bloomberg School of Public Health, told us in an email that she did not know of data that supports Kennedy’s claim of an increase in the chronic condition rate from 6% to 60%.
It’s “all about” how chronic conditions are “defined and measured and I am not aware of any comparable data between 1960 and today,” Bethell said. Bethell is director of the Child and Adolescent Health Measurement Initiative, founded to support the use of data from the NSCH, versions of which have been conducted since 2003. The NSCH, a survey carried out by the federal government, is the source of the 54% figure cited by Children’s Health Defense.
The most recent NSCH data, from 2022, show that per parent reports, around 41% of children under 18 had “current or lifelong health conditions,” when asked about 25 health conditions.
These conditions encompass those called out by Kennedy on his website, as well as multiple others. These include some very specific diagnoses, such as cystic fibrosis or Down syndrome, as well as much broader categories such as allergies.
Obesity is the only condition listed by Kennedy as “skyrocketing” that is not included in the NSCH’s 25-condition list. However, “adding in obesity would not increase the chronic condition list to 60%–many with obesity also have another chronic condition among those that are asked about,” Bethell said.
Bethell was a co-author of the 2011 paper — based on 2007 NSCH data — that is the source of the notion that 54% of U.S. children have chronic conditions. As we explained, this was based on a broad definition that included obesity, overweight and “risk for developmental delay.” Bethell said that adding in both overweight and obesity to the current 25-condition list would raise the health condition rate to around 65% for adolescents (12 to 17 years old), but that it would remain “much lower for young children” and would not rise to 60% for children overall. The “risk for developmental delay” item is no longer part of the NSCH, she said.
The expanded definition of chronic conditions was included in the 2011 paper “just to make a point that the majority of children have some high risk or an actual condition,” Bethell said. “This is still true in the US. My point back then was that most children have needs that point to the importance of prevention, health promotion and integrated health and social services to support them.”
Other ways of measuring chronic conditions give more conservative estimates.
One measure, which is part of the NSCH, seeks to identify children with special health care needs. The 2022 data indicate that around 21% of U.S. children have an ongoing health condition that requires above-routine services.
To give a sense of the rate of chronic conditions dating back to when John F. Kennedy was president, Perrin cited data from the National Health Interview Survey, which for many years asked parents about activity limitations in their children caused by chronic conditions — a relatively narrow definition capturing children whose conditions affected their day-to-day lives.
The NHIS data indicate that activity-limiting chronic conditions in children rose over the decades, from around 2% in the early 1960s to 4% in 1981, 7% in 1992 through 1994 and 8% in 2010. The latest available data, from the 2018 NHIS, suggest that 8% of children and 11% of adolescents had activity-limiting chronic conditions. In 2019, the NHIS questionnaire was redesigned, and so the most recent versions lack “a comparable estimate,” a CDC spokesperson told us in an email.
Chronic Conditions Have Increased for Various Reasons
Kennedy often reduces the causes or suspected causes of chronic disease to a list of specific chemicals and other exposures, implying that the solution is simply eliminating these exposures. But while some of these substances potentially play a partial role in certain diseases, experts painted a different and more complex picture of the causes of childhood chronic disease.
In his Nixon library speech, for instance, Kennedy spoke about the rise in diabetes and autism in children, before continuing: “We know what’s causing it. It has to be an environmental toxin. Genes don’t cause epidemics.” As we’ve discussed, he went on to list autoimmune diseases, neurological diseases, obesity and food allergies as affecting 60% of American children.
“All this happened beginning around 1989,” Kennedy continued. “We know what the suspects are. You know, it’s glyphosate [an herbicide], it’s neonicotinoids [pesticides], it’s atrazine [an herbicide], PFOA flame retardants, cell phone radiation, high fructose corn syrup.”
In an interview with Phil McGraw, known as Dr. Phil, Kennedy mentioned a similar list of substances as causes for chronic disease. “It’s not rocket science,” Kennedy said in a podcast episode posted July 9. “It’s glyphosate, which is the active ingredient in Roundup. It’s neonicotinoid pesticides, it’s atrazine, it’s PFOAs — the forever chemicals that are in all of our child’s pajamas, they’re in our furniture.” He went on to mention high fructose corn syrup and “a thousand ingredients in our food that are banned in Europe,” concluding that “we’re mass poisoning an entire generation of kids.”
Some exposures Kennedy mentions may be linked to specific conditions under specific circumstances, but they do not tell the full story of why diagnoses of childhood chronic conditions have increased. And cell phone radiation has not been linked to health effects, according to the U.S. Food and Drug Administration.
Bethell said there are risks “we know are HIGHLY associated with having health conditions – social risks (poverty, food insecurity, discrimination, unsafe neighborhoods) and family/relational risks (adverse childhood experiences, parents that are mentally unwell and not coping well, etc).”
Eick, the environmental epidemiologist from Emory, emphasized the variety of environmental factors that can be risk factors for disease — including specific chemical exposures but also changes in physical activity, diet, poverty, and changes in diagnosis. “I do think that there is a role for chemicals in some of these things, however I think that chemicals are really not the only risk factors here and it’s really in combination with a lot of these other things,” she said.
For instance, obesity in U.S. children has increased “dramatically” since the Kennedy presidency, from around 4% in the 1960s to around 20% in 2020, Izzuddin Aris, an epidemiologist at Harvard Pilgrim Health Care Institute, told us in an email. The increase has been especially pronounced in school-aged children, he said.
“The causes of childhood obesity are complex and multifactorial, including social, behavioral, environmental, and genetic factors operating across the life course,” he said.
These causes could include some environmental exposures Kennedy mentions. For example, research from Aris and others has indicated a link between prenatal exposure to PFAS — including PFOA — and obesity. But for the most part, there’s little evidence that the specific culprits Kennedy highlights are driving an increase in childhood chronic disease.
Dietary components can also play a role in obesity. For instance, Aris and colleagues have done work linking obesity risk in children to overconsumption of sugar-sweetened beverages or non-nutritive sweeteners during pregnancy. Eick mentioned more generally the role of eating more processed foods and reduced physical activity, as children spend more time on phones and tablets and less time outside.
Aris’s work has also shown evidence linking obesity in children to “residence in disadvantaged neighborhood environments that lack access to health care services or have higher rates of crime and unemployment.”
“However, I am not aware of any evidence that has linked glyphosate, neonicotinoids, atrazine, or cell phone radiation with child obesity risk,” he said.
Other environmental influences may be implicated in food allergy. One factor is timing of early-life dietary exposures. For many years, experts told parents to avoid feeding their babies peanuts and other potential allergens in order to prevent food allergy. Then evidence emerged that delaying exposure to peanuts and other foods could lead to an increased risk of food allergy. Today, parents are recommended to introduce peanuts and other potentially allergenic foods starting at four to six months of age, when other foods are introduced.
Understanding the rise in mental and behavioral conditions involves still other considerations, Newacheck said. “Clearly some is due to greater awareness on the part of parents, health care providers and schools, such that we are counting conditions that were always present but previously underreported,” he said. “Some would argue the increased availability of public funds/programs for enhanced services over the past half century has contributed to rising numbers of cases. Some of the increase is likely to be environmental or genetic,” he continued, meaning that changing environmental factors could interact with genes to cause disease. “But how much isn’t clear.”
For instance, as we have written previously, there has been an increase in recorded cases of autism in younger generations. But changes in awareness and diagnosis of the condition have played a major role in its growing prevalence.
Known autism risk factors, such as an increase in children born to older parents and an increase in children born with complications who survive, have likely contributed to a small increase in autism.
A CDC spokesperson told us via email that an increase in ADHD awareness “over the past few decades,” especially in girls, also has contributed to a rise in the condition in children and adolescents.
There are some possible environmental exposures associated with neurodevelopmental conditions such as autism and ADHD.
For example, Eick said, there’s some evidence “pesticides are risk factors for neurodevelopmental outcomes in kids, so things like ADHD, but again, I think that’s really only in populations that have extremely high levels of exposure,” adding that this is not “a major risk factor on the population level.”
Researchers also expressed confusion about Kennedy’s reference to the year 1989 as a turning point in the chronic disease epidemic. “I can’t think of anything special about the year 1989,” Eick said.
Aris said, “there is nothing special about the year 1989 in relation to child obesity.”
In other contexts, Kennedy has more specifically referred to 1989 as a turning point in the prevalence of autism. But as we’ve discussed previously, the idea that this year marked the beginning of the “autism epidemic” is also unsupported by the data.
Update, Aug. 23: Independent presidential candidate Robert F. Kennedy Jr. suspended his campaign on Aug. 23 and encouraged his supporters in key swing states to vote for former President Donald Trump.
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