Most American adults (nearly 70%) want to live between 79 and 100 years, which is longer than the average life expectancy of 78.7; yet, one-half of American adults are living with chronic health conditions, and 7 of the top 10 causes of death in 2014 were chronic diseases, many of which are preventable. How is this possible in a country that spends more than $9,000 per person on healthcare annually, more than any other country?
If you go back to the beginning of the 20th century, the top three causes of death in the United States were infectious diseases - pneumonia and flu, tuberculosis, and gastrointestinal infections. Generally, the treatment of infectious disease is primarily an acute care process. The patient exhibits signs of infection; the doctor diagnoses the infection; and then a treatment, such as an antibiotic, is given to treat the infection. Vaccination took it one step further by striving to create immunity against particular diseases. While in practice before the 20th century, research and development ramped up in the beginning of the 20th century, becoming quite active in the 50s. It’s why someone dying from tuberculosis, cholera, measles or mumps is almost unheard of today. With 20th century improvements in sanitation, vaccinations, and antibiotics, the impact of infectious diseases on mortality have declined dramatically. These had huge positive impacts on public health yet at the same time, the 20th century brought in an era of technology and convenience that would also impact health. It was the beginning of packaged, highly processed foods, sedentary jobs, and automation. Even though technology has created unimaginable improvements in overall productivity for society, as individuals we are moving less, sleeping less, spending less quality time with loved ones, and spending less time in and around our kitchens than the generations that came before us.
With infectious disease no longer a major threat to morbidity and mortality, today Americans are dying at a shockingly high rate from preventable causes. According to the Centers for Disease Control (CDC), more than two-thirds of Americans die from chronic diseases, like heart disease, stroke, cancer, diabetes, and chronic respiratory diseases. Most chronic diseases are highly preventable, with many being some of the most preventable health problems facing our country. In fact, in 2009, the CDC called chronic diseases the public health challenge of the 21st century. Not only are we dying from chronic disease, but Americans, on average, are living up to 20% of our lives with a chronic illness. So while we may be living into our 70’s or 80’s, the first onset of preventable chronic illness is setting in, on average, when people are in their late 40’s to early 60’s.
The acute care model that worked against infectious disease isn’t working against preventable chronic disease. The problem is, unlike with infectious diseases, we can’t simply apply an acute solution - like a vaccine or antibiotic - to chronic diseases. Chronic diseases can be preventable, but many times the major contributor to prevention isn’t medical intervention, it’s lifestyle. A study called the Danish Twin Study demonstrated that only about 10% of how long the average person lives is dictated by our genes. The other 90% is dictated by our lifestyle. While that number may be a little high, most research today agrees that at least 70% - 80% of our longevity is dictated by our lifestyle.
According to the CDC, modifiable risk factors are largely responsible for each of the leading causes of death in the U.S. The leading modifiable risk factors for heart disease, cancer, and stroke are:
While it is true that lifestyle factors alone will never prevent all instances of chronic disease, research shows that healthy lifestyle choices are key contributors in preventing the development and progression of chronic diseases. Additionally, medical studies show that adults with common chronic conditions who participate in comprehensive lifestyle modification programs experience rapid, significant, clinically meaningful and sustainable improvements in various markers of health.
As the team at the Sightlines Project at Stanford have pointed out, maintaining health and delaying the onset of chronic disease represent the most promising paths to continued longevity gains and quality of life improvements. Those who make lifestyle improvements or make healthy choices can on average expect longer lives - more than a decade longer, on average, according to a study at Harvard T.H. Chan School of Public Health. When it comes to these behaviors, most Americans may not be fully aware of just how important it is to eat well, exercise, get enough sleep, manage their stress level, and maintain meaningful relationships with other people.
We are doing a poor job as a society when it comes to adopting and sustaining a healthy lifestyle.
More than ⅓ of American adults (36%), or about 84 million people, are obese.
More than 80% of American adults don’t meet the minimum requirements for both aerobic and muscle-strengthening activities.
More than 35% of Americans are getting insufficient sleep.
More than one-half of the average American’s calories come from ultra-processed foods (like breakfast cereals, soft drinks, frozen meals, canned soup), which also account for 90% of the added sugars in our diets.
It is both daunting and confusing to know how to lead a healthy lifestyle. It’s hard to navigate and understand what is best. Paleo or vegan? Low-fat or low-carb? Is running good or bad? Should you be doing yoga and/or meditation? Do you need to buy organic? Should you be taking supplements? Then add on a food industry that is overly processing our foods and filling them with tons of sugar, sodium, and added chemicals. With all this conflicting information and the stressors of more demanding jobs and less time, it’s no wonder Americans are choosing to heat up a frozen dinner, grab a beer, and sit in front of the television when they get home.
It may not seem like it, but we have been here before. The infectious disease epidemics of the past centuries taught us how to make infrastructural changes to our society and how to modify our daily behaviors. As we began to understand the importance of sanitation on health in the 19th and 20th centuries, cities built water systems to bring clean water to homes and to safely remove wastewater. It may be hard to imagine today, but prior to this era it was common to dump wastewater into agricultural lands where we grew our food, or even worse, we sometimes dumped the sewage directly back into the body of water where we sourced our clean water. We simply didn’t understand the connection between the microbial world and our health, which led to massive spread of infectious disease. Similarly, it wasn’t until 1858 that we first discovered the importance of washing our hands. While some people may be familiar with the story of Florence Nightingale and other early proponents of handwashing, astonishingly it was not until the 1980s, when a string of foodborne outbreaks and healthcare-associated infections led to public concern that the United States Centers for Disease Control and Prevention identified hand hygiene as an important way to prevent the spread of infection. While hand washing is something nearly every American does at least once a day, it’s still a very recently learned activity.
We are now entering the period where we are beginning to understand how our lifestyle is directly impacting both the quality and duration of our health. While it may take time to rethink our approach to health as a society, we can start today as individuals by focusing on what we can control. We have the ability to assess the five major lifestyle factors affecting our health. Are you eating well? Do you get regular movement and exercise into your life? Are you getting enough sleep? Are you able to manage the stressors in your life? Do you have a community of family and friends with whom you have regular and meaningful connections? By finding an aspect of your lifestyle you’d like to work on, starting small, and making one change at a time, you can begin to develop healthy lifestyle habits. Making the changes you want takes time and commitment. Unhealthy behaviors develop over the course of time, so replacing unhealthy behaviors with healthy ones requires time as well. As new healthy behaviors become a habit, you can add another goal that works toward the overall change you’re striving for. In the end, being aware of how your lifestyle impacts your health and taking small steps to improve will set you on the path to live a life that is younger, healthier, and longer.