Saying "How are you?" now the general response is "I'm fine" or "Oh, I'm fine. How are you?"
However, before 1950 this was a much more strategic saying because people got sick and died much younger as a general rule than now. For example, in 1950 I had whooping cough at age 2 and almost died that year and my best friend in school from age 12 on had polio until he was 6 and could only walk with braces and crutches until he was 6 or 7 years old.
Only with the advent of polio vaccine and shots to treat chicken pox, measles, whooping cough and other things did childhood deaths decline in the western world. So, as you can see, "How are you" back then and before meant also, "Are you well?" "Are you dying?" "Is anyone in you family dying or dead?" etc. Though it also is implied in the question still "How are you?" is a catch all phrase to find out who is alive who is dead and what is happening to you and will it affect me and mine. So "How are you?" in this sense is a very strategic question and only very recently has it become more inane just to mean, "Are you okay?" Because of this many people feel slightly offended to be asked this question even though in the past it was much more strategic and necessary to get enough information so people could survive anything coming their way.
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