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Sunday, November 29, 2009

What really ails us?

We all know the grim statistics. The four most common causes of death in the US in the last few years have been heart attacks, cancer, stroke and chronic lung disease, accounting for almost two thirds of all deaths, or close to two million deaths last year. Health care expenditure in the US is now over 2.2 trillion dollars a year, approximately $7,400 per person in 2007. The cost is now over 16% of our gross national product, and is expected to rise to 20% within 10 years. The out of pocket cost to you in the form of co-pays, deductibles and non-covered services is also increasing dramatically, from an average of $850 per person 3 years ago to an estimated $1,400 in less than ten years. And in comparison with other industrialized countries, we are losing our edge and are actually lagging by many measurements of health care, such as longevity and infant mortality.

What does all of this mean to you, the health care consumer? As you’ll see, you’ll have to actively participate in your own health care.

In a landmark article published back in 1993 in JAMA (the official Journal of the American Medical Association) but rarely quoted since then, McGinnis and Foegel published what they described as the “Actual causes of death in the United States.” In that article they identified modifiable factors that contributed to death in the US, such as smoking and obesity. In a subsequent JAMA article in 2003, another group of investigators (Dr. Mokdad and others) found that about half of all deaths in the US in the year 2000 could be attributed to “a limited number of largely preventable behaviors and exposures.” The main culprits were: smoking, obesity and physical inactivity, and alcohol consumption, in that order. Also in the top ten were: infections, toxic agents, use of firearms, sexual behavior patterns, motor vehicle accidents, and the use of illicit drugs. What’s most important, lifestyle factors are playing an increasing role in the development of disease in the US. The biggest negative change is a steady rise in obesity and a continuing decrease in physical activity. And it will only get worse as our overweight children become overweight adults. If allowed to continue, this factor will soon overtake smoking in importance.
What is true for actual causes of death is doubly true for what I would like to term the actual causes of disease. It is disease prevention that we’re looking for, which inherently will bring along with it an increase in the quality of life and longevity, together with a reduction in the need for, and the cost of, medical care.

Who will help you modify the harmful lifestyles? Your doctor can give you advice. But he/she can only go so far. Third party payers such as Medicare and most HMOs frequently deny or ignore payment for these extremely important lifestyle services which are both lifesaving and make excellent economic sense. And I doubt the new health care reform will give what really ails us the serious attention it so badly needs.

The fight for disease prevention is mostly yours.

So, buckle up, get the best lifestyle advice from a knowledgeable physician, and stop smoking, decrease the size of your food portions, increase your physical activity, drink alcohol in moderation and wear your seatbelt.

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