What Modifiable Factors Contribute to Premature Death in the U.S.?

In 2007, the New England Journal of Medicine published an article by Dr. Steven Schroeder, “We Can Do Better – Improving the Health of the American People.”  At the time, Dr. Schroeder was working in the Department of Medicine, University of California at San Francisco.  He opines that the “determinants of premature death” are a key measure of health status. Here’s a smattering of interesting quotes:

• Health is influenced by factors in five domains – genetics, social circumstances, environmental exposures, behavioral patterns, and health care. When it comes to reducing early deaths, medical care has a relatively minor role.  [These five domains are his determinants of premature death.]
• Even if the entire U.S. population had access to excellent medical care – which it does not – only a small fraction of these [early] deaths could be prevented.
• The United States spends more on health care than any other nation in the world, yet it ranks poorly on nearly every measure of health status.
• U.S. expenditures on health care in 2006 were an estimated $2.1 trillion, accounting for 16% of gross domestic product.  Few other countries even reach double digits in health care spending.
• . . . inadequate health care accounts for only 10% of premature deaths . . .
• The single greatest opportunity to improve health and reduce premature deaths lies in personal behavior [emphasis added].  In fact, behavioral causes account for nearly 40% of all deaths in the United States.
• Although there has been disagreement over the actual number of deaths that can be attributed to obesity and physical inactivity combined, it is clear that this pair of factors and smoking are the top two behavioral causes of premature death.
• If the public’s health is to improve, however, that improvement is more likely to come from behavioral change than from technological innovation.

From Dr. Schroeder’s article:

Figure 1.  Determinants of Health and Their Contribution to Premature Death.  Adapted from McGinnis et al.  Copyright 2007 Massachusetts Medical Society.  All rights reserved.

My Comments

Behavioral patterns cause 40% of poor health and premature death.  Since healthcare determines only 10% of health status and premature death, let’s focus our health-promotion attention on the other 90% – behavioral patterns, social circumstances, genetics, and environmental exposure.  Bigger bang for the buck.

Don’t we the people already know what to do to improve our health?  Execution is the problem.

Most of the burden of poor health and premature death falls on the Medicare population, over 65 years old.  Much of this burden is a result of many years of poor health choices, such as obesity, physical inactivity, improper food choices, and smoking.  But who pays the bulk of healthcare costs of those choices?  Not the people who made poor choices, but the younger, working taxpayers.

The U.S. Medicare payroll tax is about 3% of gross compensation, and it’s paid by all working people, even healthy 20-year-olds who are barely making ends meet working at the “call center.”

People will make better lifestyle choices when they bear an immediate and/or direct cost for poor choices.  Let’s figure out how to do that, rather than having distant and unresponsive politicians and bureaucrats take over the healthcare and health insurance industries.

We’re smart enough to solve this problem.  But are we too lazy?

Steve Parker, M.D.

References:  Schroeder, Steven A.  We Can Do Better – Improving the Health of the American People.  New England Journal of Medicine, 357 (2007): 1,221-1,228.