Let’s make America healthy again

Dec. 9, 2016 / By Steve Delaronde

Making America healthy again implies that there once was a time when most Americans were healthier than they are now.  This depends on how we define health and the time period we consider.  For example, the United States has led the world with declines in mortality rates through the last century, particularly through the control of infectious disease.  Life expectancy has continued to increase over the past 25 years from 75.4 in 1990 to 78.8 in 2014, however, compared to 34 developed countries, the U.S. rank for the age standardized death rate changed from 18^th in 1990 to 27^th in 2010.  So Americans may be living longer, but other developed nations are improving faster, and doing it at lower cost.

Health is not only defined by the quantity of life, but by its quality, commonly measured as years lived with disability (YLD).  The number of years lived with disability is increasing for Americans, but that is largely due to population growth and the aging of the U.S. population.  After age adjustment, YLD has only significantly increased for stroke, and actually decreased or stayed the same for the 30 leading diseases and injuries that contribute to YLD.

Some of the factors associated with disease burden for which the United States has demonstrated major improvements include reductions in tobacco smoking, uncontrolled high blood pressure, and new cases of most infectious diseases.  This would suggest that America is healthier than it’s ever been.  But wait.

America’s waistline has been gradually increasing over the past 25 years, from a 23 percent obesity rate in the late 1980s to 38 percent in 2014.  A high body mass index represents the single biggest potential for disease burden reduction in the U.S. and is associated with multiple comorbid conditions including diabetes, cardiovascular disease, stroke and osteoarthritis.  Obesity and dietary health behaviors are the primary reason the U.S. has not made greater advances in improving the overall health of the nation.

By most accounts, America was indeed sicker 30 years ago.  Since then, there have been improvements in reducing smoking rates, treating infectious disease, reducing cancer death rates, and increasing life expectancy.  However, the U.S. has not kept pace with the rest of the developed world.  This can largely be attributed to less than optimal advances in preventing and managing chronic conditions such as diabetes and heart disease, which are related to our health behaviors – especially what and how much we eat.

The U.S. healthcare system has typically ignored the areas of diet, nutrition and weight management.  Resources have instead been focused on technology, procedures, drugs and diagnostics that have less impact on reducing the population’s YLD.  If the United States is to restore its position as one of the healthiest nations in the world, we have to take our nutrition seriously.  This means policy changes that require healthier lunches in public schools, financial incentives for the production and availability of fruits, vegetables and whole grains, disincentives for producing less nutritious processed food, and a shift in healthcare from treating the effects of poor nutrition to promoting healthy nutritional choices.

Steve Delaronde is director of consulting for populations and payment solutions at 3M Health Information Systems.