All of us want to live long healthy lives, but what if the lives aren’t really healthy?
A study in the Journal of Gerontology concluded that our increasing national life expectancy – which is still low compared to the rest of the developed world – has not increased lately. More disturbing is that the number of years of life affected by illness is growing.
A 20-year-old man in 1998 could expect to live to be 65 on average before he developed heart disease, cancer, or diabetes. A 20-year-old man in 2006 can expect one of these diseases to appear by age 63.8. For a 20-year-old woman, the change is 69.2 to 68 years of age.
The study also found that the number of people who report a lack of mobility has increased, the average age of a first heart attack has not changed, and that rates of diabetes have soared.
I believe the increasing diabetes rates are explained both by the fattening of America and the change in the definition of the disease about 10 years ago – the fasting blood sugar level required to make the diagnosis was lowered from 140 to 126 mg/dL. The observation that the average age of a first heart attack hasn’t changed is testimony to the tiny effect statins have on primary prevention being cancelled out by sedentary lives in an obese population.
Another study in Health Affairs predicts that the obesity epidemic will have a bigger impact on future death rates and health expenditures than earlier predictions. They forecast even higher rates of diabetes, high blood pressure, and heart disease. I suspect if they’re right, we can also expect higher rates of cancer, arthritis, and a general lack of functionality from a nation being out of shape.
Critics of the U.S. healthcare system often point to the disparity in the overall life expectancy between American and the rest of the developed world as evidence that our system doesn’t work well. With the conclusions reached by these studies, I wonder if we shouldn’t worry even less about the length of our lives and worry more about having a reasonable quality of life for the years we have.
The healthcare industry will seize on these findings and claim we need more screening and treatment of chronic diseases as the solution. Obesity is a public health problem that has medical consequences, not a medical problem. This distinction is important because it informs how resources should be used to maximize population health. The healthcare industry wants more blood tests to be ordered with pills to follow. Better solutions include interventions such as requiring buildings to have more accessible stairs, agricultural subsidies (if we’re going to subsidize anything) that make fruits and vegetables more affordable, safe neighborhoods where children walk to school, and plenty of physical education and recess once they get to school. We could also consider fast food taxes, soda taxes, and other similar disincentives to less healthy choices.
It looks like the vast majority of forecasts predict America’s life expectancy will decrease from the growing obesity rate. Don’t let the healthcare industry convince you that the solution is more healthcare industry.