Why Does the U.S. Rank Poorly In Longevity?

In the news once again is the poor ranking of the U.S. in terms of longevity compared to other developed countries.  As always, this will spark discussion about what can be done to improve our ranking.

The New England Journal of Medicine in 2007 published an article looking at the determinants of premature death (and poor health, by implication).  Here are some quotations from the article:

  • 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 the article author’s 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.
  • . . . 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.

Parker here again.

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.

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

Steve Parker, M.D.

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