A new study of Americans’ well-being and longevity found that we are living longer, but we are living longer with more illness. Christopher Murray and colleagues at the University of Washington have been researching the specific ailments that are plaguing the U.S. population as well as the link between lifestyle choices, public policy, and wellness. As healthcare reform struggles to advance, Murray documents that although we are living longer, overall we are less healthy as a nation and the statistics vary greatly depending on where you live. 

The new study was published on July 10, 2013 in the online journal of JAMA. The study includes data on the status of population health from 34 countries from 1990-2010. According to researchers, overall population health improved in the U.S. during this period, including an increase in life expectancy. However, illness and chronic disability now account for almost half of the health burden in the U.S. and improvements have not kept pace with overall population health in other wealthy nations.

“The United States spends the most per capita on health care across all countries, lacks universal health coverage, and lags behind other high-income countries for life expectancy and many other health outcome measures. High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socioeconomic groups, and race and ethnicity groups,” according to background information from the article.

The researchers assert, “With increasing focus on population health outcomes that can be achieved through better public health, multisectoral action, and medical care, it is critical to determine which diseases, injuries, and risk factors are related to the greatest losses of health and how these risk factors and health outcomes are changing over time.”

American life expectancy rose from 75.2 years in 1990 to 78.2 years in 2010. However, this improvement is undermined by two major problems. First, although women live longer than men, their life expectancy is rising more slowly. Secondly, both sexes have a lower life expectancy than their peers in other wealthy countries. The chasm between Americans’ health and other wealthy nations has been widening since the 1980s.

Heart disease remains the leading cause of death in the United States. Major depressive disorder now ranks fifth as a disablity, up from seventh, and diabetes jumped to eighth from ninth. In an alarming surge, drug disorders saw a more dramatic rise (10th from 17th), as did Alzheimer’s disease (12th from 25th) and chronic kidney disease (17th from 27th).

Daily lifestyle choices make the difference between illness and well-being. 

The number one cause of disease is now linked to a poor diet. Americans aren’t eating enough fruits, vegetables, olive oil, nuts, low-fat dairy and lean meats—instead we are consuming an abundance of junk food that is loaded with trans fats, sodium and gulping sugary drinks. Smoking is the second leading driver of disease, followed by a general association of high body mass index (a measure of obesity which is now classified as a disease), high blood pressure, high blood-sugar levels. A lack of exercise is considered another major driving force in our nation’s poor health.

Dr. Murray and his colleagues report that the gap between life expectancies in the wealthiest and poorest countries has widened since 1985. In the richest counties in America—such as Marin County, California and Fairfax County, Virginia—the life expectancies rival those of Switzerland and Japan. However, at least one of every nine counties in America has a life expectancy lower than Nicaragua's. Parts of West Virginia and Mississippi fare worse than Bangladesh and Algeria.

Interestingly, changes in a county’s household income, being educated and having insurance coverage didn’t completely explain the changes in a county’s average life expectancy. This suggests that shifts in behavioral drivers of disease—such as diet, exercise and obesity—are the most important predictors of wellness. For this reason, Michelle Obama has made combating childhood obesity through changes in diet and exercise her top priority as First Lady through the "Let’s Move! Active Schools" initiative.  

Conclusion: Eat Less, Exercise More, and Get an Education

What can individuals and policy makers do to reverse the trend of increased illness as we age? There is no silver bullet that could provide a nationwide solution, but making healthy lifestyle choices like exercising more, eating less, getting an education and remaining a non-smoker all make a huge difference.

“The leading risk factors related to disability-adjusted life-years were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use,” Christopher Murray says. With an increase in life expectancy and the number of years lived with disability for the average American, “individuals in the United States are living longer but are not necessarily in good health.”

Americans consume nearly 4,000 calories a day on average—more than anyone else in the world. This wasn't always the case. Over the past two decades the consumption of processed and calorically dense foods have caused obesity to skyrocket in the United States in comparison to other countries. Unfortunately—with the globalization of an American fast food diet—the obesity epidemic is becoming an international problem.

Education is key to improving one's odds of staying healthy into old age. Dr. David Kindig, a population health specialist at the University of Wisconsin, Madison, says these types of studies shouldn't be ignored. Kindig believes that some clues about what to do combat these health crisis come from a state-by-state analysis of U.S. health disparities that he and his colleagues do every year.

"Some of the healthiest states—say, like Minnesota—actually spend less on health care," Kindig says. "And presumably that allows them to spend more on some of the other determinants of health." Education is one of those determinants. Kindig says it would be a mistake to cut spending on schools since education and health are tightly linked—and cuts there will just show up later in poorer health.

Murray and colleagues at University of Washington conclude, “In many cases, the best investments for improving population health would likely be public health programs and multisectoral action to address risks such as physical inactivity, diet, ambient particulate pollution, and alcohol and tobacco consumption.” 

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