Amish Health Paradox: Rapid Population Growth, Distinct Disease Profiles, and the Complex Realities Behind Vaccine Narratives

The Amish population in North America is not a fading cultural relic but one of the fastest-growing demographic groups in the United States, with profound implications for public health, healthcare financing, and medical research. According to Cory Anderson, a postdoctoral researcher in population health and demography at Penn State University's Population Research Institute (search)Search term, the Amish population currently stands at approximately 400,000, up from roughly 250,000 in 2010. With a total fertility rate (TFR) of 6.1 children per woman and a retention rate of 85%, preliminary population projections suggest the Amish could number close to 2 million by 2075. "So public health is going to have to talk about the Amish more and more, especially if their health profiles are going to continue to differ from non-Amish populations," Anderson said on the STAT "First Opinion Podcast."

The demographic momentum is striking. Braxton Mitchell, professor of medicine and vice chair for research in the division of endocrinology, diabetes (search)Search disease, and nutrition at the University of Maryland School of MedicineView company profile, noted that the Amish population doubles in size approximately every 20 years. In Lancaster County, Pennsylvania, where Mitchell conducts his research, the average number of children in an Amish family is about seven, with some families reaching 18 to 20 children. Anderson's database, built from Amish Population Registries covering approximately 55,000 households, documented one woman who had 21 children.

Vaccination and Autism (search)Search disease: Separating Fact from Political Narrative

The renewed public interest in Amish health stems in part from claims made by President Trump at a September press conference, where he repeated a common assertion among vaccine critics: that the Amish do not vaccinate and do not get autism (search)Search disease. Both Mitchell and Anderson firmly reject the premise.

"Absolutely, they do," Mitchell said when asked whether Amish people develop autism (search)Search disease, though he emphasized that no reliable prevalence data exist. "We don't have any good numbers on what the percentage, what the proportions are." He noted that studying autism in the Amish population would be scientifically valuable, given their distinct lifestyle factors. "We know genetics is a huge risk factor, but there's a lot speculation that there could be lifestyle factors as well. Vaccination is not one of them."

The diagnostic landscape further complicates any comparison. Mitchell explained that autism (search)Search disease diagnostic criteria have broadened considerably over the past two to three decades, and many screening mechanisms rely on school-based health experts—a structure largely absent in Amish parochial school systems. "There aren't health experts in the school systems, there's not really an opportunity to look for and make recommendations about health conditions there," he said.

On vaccination itself, the picture is far from monolithic. "In Lancaster, many do, many don't. There's no directive from the church bishops about this issue, so families just choose what they want," Mitchell explained. He recounted one Amish liaison at their clinic who reported that among her six siblings, three had their children vaccinated and three did not—"and she said that's probably par for the course."

Anderson noted that research from the New Leaf Center (search)Search term in Wayne County, Ohio, found that Amish vaccination practices were "somewhat a la carte," with families selectively accepting certain vaccines. However, some stricter Amish groups largely abstain from vaccination as a collective practice. "If they were to start doing it, it could create a bit of what they might call a 'chiss,' or a fuss, because someone's doing things that we haven't done," Anderson said.

Both researchers observed that COVID-19 vaccineView drug details skepticism has carried over into broader childhood vaccine hesitancy among the Amish. Mitchell attributed this largely to government skepticism rather than religious doctrine. "I think there was a big disservice because there was the big movement to belittle vaccines and promote the view that this was government overreach. And I think this was a view that many Amish are very sympathetic to." Anderson's research found that the presence of Amish populations in U.S. counties predicted lower COVID-19 vaccination rates, a pattern he links to institutional distrust and the politicization of public health measures.

Distinct Disease Profiles and Research Opportunities

The Amish population presents a unique scientific opportunity due to its genetic structure as a founder population. The Lancaster Old Order Amish, the group Mitchell studies, descended from approximately 500 to 600 original settlers who arrived from the German-Swiss border region in the early 1700s. Today, roughly 43,000 Amish in Lancaster County are essentially all descendants of those founders, resulting in limited genetic diversity that facilitates the identification of genetic contributions to disease.

"We thought that looking at adults and some of the more common diseases that we might be able to pick out genetic components of diseases like diabetes (search)Search disease, osteoporosis (search)Search disease, and we've expanded the sets of disorders that we've been looking at over the years," Mitchell said.

Anderson's synthesis of the published literature on Amish health revealed a complex pattern: lower rates of certain cancers and asthma (search)Search disease alongside higher rates of other malignancies. "There are just things going on among the Amish that give them a bit of resilience and some things that make them a little bit more vulnerable," he said. The lower asthma rates have generated particular interest, with some research suggesting that exposure to barn dust may play a protective role.

Mitchell emphasized that the Amish are valuable to study not only for genetic reasons but also for their distinct lifestyle. "We can learn an awful lot about some of the common conditions that the population suffers from. Looking at groups with different lifestyles, because we know lifestyles are really important for heart disease risk, diabetes (search)Search disease risk, hypertension (search)Search disease, etc."

The Economics of Amish Healthcare

Perhaps the most distinctive aspect of Amish health is how care is financed. "In our community, they pay out of pocket. Amish do not like to sign up for government benefits," Mitchell said. This creates unique challenges for researchers. Mitchell described a study involving coronary artery calcification imaging where incidental findings posed ethical dilemmas: "In the real world, we would provide this for patients and they would go use their insurance, go get it looked at and, 99 out of 100 times it would be a normal variation, nothing to worry about. But if we were to do this in the Amish, we have to think about, 'Well, what message do we want to deliver knowing that they are paying out-of-pocket for follow-up care?'"

The Lancaster community has established its own Amish aid program, pooling resources and negotiating "Amish-friendly rates" with local providers. Anderson described a spectrum of approaches: more progressive Amish settlements have created programs resembling insurance with premiums and deductibles, while stricter groups rely on traditional alms—church deacons or committees collecting funds to cover large medical bills.

Anderson illustrated the stakes with a real-world scenario: a child with leukemia (search)Search disease whose treatment results in a $3 million hospital bill. With no insurance and a principled refusal of government assistance, families may face liens on their property. "The Amish will say, 'We will pay what we can our entire life. We will pay what we can,' but this bill is never going to get paid," Anderson said. He noted that the Amish are unlikely to sue for malpractice, meaning hospitals may not need to absorb the defensive medicine costs built into such bills.

The Clinic for Special Children (search)Search term in Lancaster has emerged as a model for addressing rare genetic disorders prevalent in these communities. The clinic, supported by community fundraising auctions raising hundreds of thousands of dollars annually, has developed affordable screening chips that test for multiple disorders simultaneously. For certain conditions involving nutritional enzyme defects, early detection allows dietary interventions starting almost at day one, preventing severe neurological damage.

"As this population continues to grow and move into new areas across the U.S. and Canada, especially rural areas, we're going to see some transformation going on across North America," Anderson said. With projections of a tripling population by 2075 even under conservative assumptions, the intersection of Amish health practices, genetic research, and healthcare financing will demand increasing attention from the medical and public health communities.