The following report helps illustrate my motivation for starting this blog. Although health trends on a national level often seem distant or irrelevant to many of us as individuals, the trends shown in these types of reports reflect the physical and social environment in which we live. This environment strongly affects our personal health. Many of my blog posts have tried, and will continue to try, to shed light on how we can improve our health in spite of the statistics that show the erosion of our national health.
Dr. Nicole Fenske
Reporting on the State of Health in the U.S.
(from the Institute for Functional Medicine)
The August 14, 2013 issue of JAMA (Journal of the American Medical Association) contained a lengthy report (and brief commentary) on findings pertaining to the health of the US population, derived from the Global Burden of Disease (GBD) project (Fineberg 2013; US Burden of Disease Collaborations 2013). The GBD is a massive undertaking reflecting the contributions of hundreds of collaborators from dozens of countries, using data analysis techniques that would be all but incomprehensible to most of us. For the first time, the JAMA report compares the state of health in the US to that of 34 countries on measures of diseases, injuries, and risk factors, providing comutations of years of life lost to premature mortality (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). A healthy life expectancy (HALE) measurement was computed by taking into account not only length of life but also levels of ill health at different ages.
It will surely come as no surprise to the IFM community—and, indeed, to most primary care clinicians—that not only has the chronic disease epidemic continued to spread, but the US is doing worse (sometimes much worse) than many other countries with similar economic strength. While some of this is due to the aging of our population, much more is due to the unhealthy lifestyles, diet, and environmental exposures that constitute the American way of life today.
Among many interesting facts presented in this report are these:
- “The diseases and injuries with the largest number of YLLs (premature mortality) in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury.” (ALL of these are largely preventable diseases.)
- “Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls.” (MANY of these are preventable conditions.)
- “The diseases with the largest number of YLDs (years lived with disability) in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders.” (SOME of these are preventable conditions.)
- “The leading risk factors relating to DALYs (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.” (MOST of these are preventable risks.)
- US rankings relative to other countries worsened for:
- the age-standardized death rate (from 18th to 27th)
- the age-standardized YLL rate (from 23rd to 28th)
- the age-standardized YLD rate (from 5th to 6th)
- life expectancy at birth (from 20th to 27th)
- HALE (Healthy Life Expectancy Measurement) (from 14th to 26th)
From the abstract comes this succinct statement: “…morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.” And from the opening sentences, the authors pose the problem starkly: “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.”