“Make America healthy again”. We can all get behind this slogan and agree that much more could be done to improve the health of people living in the US. Robert F Kennedy Jr, the US health and human services secretary, recently released a report detailing the challenge of the US’s health. About 90% of it outlines the high rates of obesity, mental health issues and chronic disease, 10% covers vaccine scepticism, and 0% looks at solutions or any discussions of the systemic social and economic issues that drive much of the US’s health problems.
But what surprised me more was a notable omission of the two biggest killers of American children. American children aren’t just unhealthier. They’re more likely to die in the first 19 years of life because of guns – both homicides and suicides – or in a road traffic accident than children in comparable countries. How can an entire report be written without mentioning these factors, and how unique the US is in the burden of disability and death they cause?
Take guns. In 2020, gun injuries overtook car crashes as the leading cause of death in the US for children and adolescents. From 2019 to 2021, there was a 23% increase in gun deaths among Americans of all ages, while gun deaths among children and teens rose 50% in the same period. Per 100,000 people, the US in 2019 had nearly 100 times as many gun homicides as Britain. Even countries such as Canada, which ranks in the world top 10 in civilian gun ownership, has about seven times fewer gun homicides than the US, and about half as many suicides involving guns – both adjusted for population. Outliers on the more positive end include Japan and South Korea, which have close to zero gun-related deaths each year. For the four years between 2020 and 2024, the US averaged almost two mass shootings a day. They’re happening so often that the media often just doesn’t report them any more. It’s not news. It’s just daily life.
Unlike countries such as Britain, Australia, New Zealand, Serbia and Colombia – to pick just a few examples – legislation to regulate firearms, especially handguns, has remained in political gridlock. The result is a growing sense of hopelessness, complacency and even acceptance as children die in shooting after shooting. Getting shot at school is one of the most likely ways for a child to die in the US, yet firearms aren’t mentioned at all in the “Make America healthy again” movement.
The second leading cause of death for American children is road traffic accidents. In 2021, 43,000 people died in the US in road crashes compared to fewer than 3,000 people in Japan. Adjusted for population, the US rate was 12.7 deaths per 100,000 people versus Japan’s 2.24. This difference isn’t random: vehicle size plays a big part. The bestselling motor vehicle in Japan, a class of compact known as a Kei car, weighs about 1,100kg and is 3.3m long. This is compared to the US, where the most popular vehicle (a pickup truck) is 2,900kg and 5.8m long. This impacts on road safety. A study in the Journal of Safety Research found that children are eight times more likely to be killed in a collision with an SUV than they are in a crash with a standard car. This is not only about the size and weight of these cars but also how much vision is restricted, especially for children who might be near the vehicle.
Identifying the main causes of child disability and death is one step. Gun and road traffic deaths in the US are so common they sometimes seem to have faded into the background. But the data shows the difference between the US and other countries is stark, and it is part of the role of public health agencies such as RFK Jr’s to make these issues more visible. Of course, trying to find solutions, especially ones that might be seen to infringe on individual freedoms to own a gun or drive whatever vehicle they like, is much harder. There are policy steps that can be taken, as shown by Japan, Britain and other countries that have prioritised health and wellbeing.
If the US government truly wants to “Make America healthy again”, it must first acknowledge the brutal toll that gun violence and road crashes take on its people, especially children. Without confronting these realities head-on – and without systemic policy change – no vision of a healthier US can succeed. After all, you can only be healthy if you are alive.
-
Prof Devi Sridhar is chair of global public health at the University of Edinburgh, and the author of How Not to Die (Too Soon)