Health and Human Services Secretary Robert F. Kennedy Jr. has claimed that 5G causes cancer. He has alleged that vaccines are part of a vast pharmaceutical industry conspiracy. He’s questioned the safety of fluoridated water, food dyes, and weed killers. Some of his claims are demonstrably false, others speculative, and a few—like the health effects of food additives and ultra-processed diets—deserve a careful look. But set aside the conspiracies for a moment, and Kennedy is onto a real issue: Americans are dying younger not because of poor doctors or bad hospitals, but because of the way they live.
For all the nation’s medical innovation and spending (both lead the world), U.S. life expectancy currently trails nearly every other wealthy country. An American born today can expect to live about 78.4 years, compared to 81.1 in the United Kingdom, 83.1 in France, and 84.1 in Japan. And the gap isn’t because of less access to care or lower-quality doctors—on measures of medical treatment from cancer to acute hospital care Americans fare much better than the rest of the world.
And serious research from dozens of sources confirms this. A landmark report from the National Academy of Sciences found that Americans die younger than people in peer nations not because of inadequate medical care, but because they suffer more from what is called “adverse health-related behaviors.” A 2023 study from the Bloomberg American Health Initiative drilled deeper and found that the bulk of the U.S.-U.K. life expectancy gap is explained by just four factors: cardiovascular disease (resulting from obesity and work stress), drug overdoses, car accidents, and gun deaths (overwhelmingly suicides)—all of which are lifestyle- or environment-related, not failings of the health care system. Even where Americans already have made a lifestyle change for the better, they’ve generally done so later than their counterparts in other wealthy countries. Thus, even though American smoking rates today are about average for rich places, the damage resulting from historically higher rates of smoking continues to impact mortality figures.
Unhealthy lifestyles impact people at every level of society. Sources ranging from the Journal of the American Medical Association to the Annual Review of Public Health have reported that even wealthy Americans have worse health, shorter lives, and higher rates of chronic disease than wealthy people in places like Switzerland, the U.K., and Canada. Whether young or old, Americans can have great doctors, access to every high-tech treatment, great health insurance coverage, and plenty of money and still get sick and die younger.
Particularly if America is to take its creed of “freedom” seriously, however, passing laws which limit behaviors that many see as personal choices poses huge challenges. Accusations of nanny statism very easily—and logically—follow attempts to deprive Americans of their firearms and efforts to intervene in their food choices. The best option, then, is harm reduction.
On core public health issues like obesity, smoking, and drug use, both new technologies and a well-developed body of harm reduction evidence offer tremendous promise.
Obesity, more than any other single factor, drives America’s burden of chronic disease and early death. But years of finger-wagging—eat less, move more, eat this, not that—have coincided with huge increases in obesity. Dieting to lose weight almost always fails. Recommendations for healthy eating change every few years. A better approach focuses on helping people manage weight realistically. That’s where GLP-1 medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) come in. These drugs help people lose significant weight, control type 2 diabetes, lower cardiovascular risk, and have shown promise in treating a range of substance use disorders.
Right now, however, demand outpaces supply. With brand-name versions of these medications costing over $1,000 a month and insurance often declining to cover them for weight loss, many patients have turned to compounded versions, often priced at $200 to $500 a month. But now that the Food and Drug Administration (FDA) has curtailed compounding, it risks cutting off a lifeline—sometimes an actual lifeline—for people who benefit mightily from these drugs.
Public health officials have a role here, not just in safety but in ensuring access. That means guarding against monopolies, assuring that “product hopping” that keeps drugs under intellectual property protection doesn’t reduce access, investigating ways to increase insurance coverage, resisting a blanket crackdown on compounding, and moving quickly to approve generic versions once patents expire. (At least one GLP-1 is already out of patent and approved in generic form.) Making safer weight management tools available is classic harm reduction—and exactly what good health policy should encourage.
The same logic applies to smoking: About 11.5 percent of American adults smoke—nearly all knowing it’s dangerous, many not even wanting to quit. Although many public health measures including indoor smoking bans, higher taxes, education campaigns, and sales limitations have contributed to a big decline in smoking, these measures seem to have reached the limits of their effectiveness. The better path is harm reduction: encouraging smokers to switch to far safer alternatives like vapes, nicotine pouches, heated tobacco, and moist snus. These products eliminate combustion and dramatically reduce health risks. Countries like Sweden, with a smoking rate just over 5 percent, have nearly eliminated smoking by embracing these alternatives.
Tobacco companies almost all say they want to phase out combustibles, and there’s little reason to doubt them since alternative products are more profitable anyway. Regulators should take them up on it by easing approval pathways for safer products (approving a modified risk tobacco product at the FDA currently takes years and millions of dollars), allowing tobacco companies to use established brands for lower-risk products, resisting flavor bans, and taxing products according to risk. If stricter rules on cigarettes such as caps on nicotine (which could potentially make cigarettes less addictive) or menthol bans (which would end the use of a minty flavor in cigarettes) make sense at all, they should apply largely to combustibles, not the alternatives. The goal shouldn’t be government-mandated abstinence. Instead, it’s helping people who want to use nicotine move to less deadly alternatives.
The same applies to opioid policy: Opioid deaths remain very high, claiming almost 55,000 American lives in 2024 (though this is a large decrease from 2023). The overwhelming majority of opioid users—even including a great many of those who meet the diagnostic criteria for substance use disorder—are seeking genuine pain relief rather than a high. Because opioid overdoses tend to impact relatively young people—many victims are in their 30s and 40s—such deaths alone reduce average American life expectancy by a full year. Medication-assisted treatment (MAT) with drugs like buprenorphine (which reduces cravings) and methadone (which prevents withdrawal symptoms) can cut overdose risk by more than 50 percent, but regulatory and cultural hurdles still limit access. France—when it let general physicians prescribe buprenorphine starting in the 1990s—saw overdose deaths drop by nearly 80 percent over four years, and increasing access to drugs like this is already helping reduce opioid deaths in America. Despite a swing towards “tough on crime” policies, the U.S. should continue removing barriers to MAT and support other proven harm-reduction strategies: widespread naloxone distribution, syringe access, and drug-checking equipment such as fentanyl test strips all of which reduce overdose deaths without increasing drug use.
But treatment is only part of the solution. Prevention matters, especially for the millions of Americans living with chronic pain. That’s one reason why the FDA should speed the approval of non-addictive painkillers currently in trial phases (AT-121 and SR-17018 are two), which show early promise in providing strong relief without triggering addiction or respiratory depression. (The latter is the proximate cause of almost all opioid-related deaths). These drugs could help patients manage pain safely and avoid exposure to opioids altogether—and so deserve a very fast track to market if they’re effective. Harm reduction should cut off the crisis upstream by giving people better options to manage pain.
It’s not just about drugs, diet, or even things within the purview of public health officials. In other areas that fall outside of public health, ideas analogous to harm reduction offer great promise.
Even road safety could benefit. More than 40,000 Americans die in car crashes each year—and 94 percent of those deaths stem from human error. That’s why fully self-driving cars offer such promise. A 2024 study found that one company’s fully autonomous level vehicles had 85 percent fewer injury crashes than human drivers on the same streets. And this is with technology still classified as experimental. Critics might worry about edge-case failures, but the math is clear: Delaying the rollout of good-enough autonomous vehicles (AV) means accepting tens of thousands of deaths. The law doesn’t require perfection from human drivers. Regulators shouldn’t demand it from software that’s already better.
If the federal government is serious about saving lives, it should treat AV deployment as a priority just as Transportation Secretary Sean Duffy has promised. Harm reduction belongs on the highway.
And when it comes to suicide, the challenge is even deeper than it is elsewhere. Dealing with firearm-related suicides is uniquely difficult—and if one is honest, it only tangentially involves guns themselves. America’s suicide rate has soared in the 21st century and likely reached a new high in 2024. Because suicide attempts with a firearm are fatal up to 90 percent of the time—compared to just 1 to 4 percent for cutting or overdose—guns make suicide attempts far more lethal. But they obviously do not cause suicide themselves: Japan, where civilian gun ownership is generally illegal, has a higher suicide rate than the U.S.
Still, some targeted interventions around guns could make sense. Extreme Risk Protection Orders, better known as red flag laws, allow courts to temporarily remove firearms from people in crisis. They include due process, and in places like Indiana and Connecticut, they’ve been linked to a 7 to 14 percent reduction in firearm suicides. But laws may not even be necessary. Safe-storage initiatives and short-term gun storage programs that offer no-questions asked turn-ins—especially in pro-Second Amendment states like Utah and Montana—offer a voluntary path that seems promising. These efforts don’t require new mandates. Just different norms.
But broader strategies are essential since guns themselves aren’t the root problem. Mobile crisis teams—mental health responders who defuse emergencies without police—can prevent escalation and tragedy. Crisis stabilization centers, offering 24- to 72-hour care, provide safe, effective alternatives for people in acute distress. Add in peer support and public education, and America could begin to build a system that sees suicidality as a treatable health challenge rather than a moral failing—or worse, a problem that we simply can’t fix.
The bottom line is this: From obesity to opioids to automobiles, the answer isn’t prohibition. It’s harm reduction policy that works with American life as it is and accepts that freedom usually wins the day.
Americans enjoy the buffet at Golden Corral, SIG Sauer P365 handguns, and Ford F-150s. Trying to control these things through bans or scolding will backfire. But there’s another way. Through harm reduction, policymakers can help people make safer choices without asking them to abandon freedom or pleasure. These aren’t revolutionary ideas—they’re practical, proven, and can save tens of thousands of lives a year. Secretary Kennedy is wrong about 5G and quite a lot else. But he is right that America’s health crisis results from lifestyle factors. And if the country wants to fix it, the way forward isn’t prohibition or panic. It’s policies that make living American life—imperfect, risk-filled, and free—just a little bit less deadly.
