As regular readers of these posts know, I think that all parties in the U.S. healthcare “non-system” overcharge for what they do, and often under-deliver. While hospitals, insurance companies, the pharmaceutical industry and many doctors clearly contribute to our excess spending, the under-performance of the U.S. in health outcomes is largely not their fault.
Most public health experts agree that 75-80% of a nation’s health is the result of factors other than the quality of its hospitals and doctors. Things such as housing, travel, air and water quality and poverty are much more important to our life expectancy. Also outside of the control of the healthcare system are our personal behaviors.
This post was prompted by a recent study out of Michigan looking at the modifiable risk factors in patients found to have advanced coronary disease. We know that beyond age, major risk factors for coronary disease include cigarette smoking, hypertension, hyperlipidemia, diabetes and obesity. Almost all (95.5%) patients undergoing angioplasty had one or more of these risk factors, and half had three or more. Current smokers presented a full decade earlier than non-smokers and obese patients four years younger than those at normal weight with their advanced coronary disease.
These findings dovetailed nicely with a 2018 study in the journal Circulation. That study looked at five factors almost entirely in our control: a healthy diet, not smoking, modest or no alcohol use, regular aerobic exercise and keeping a healthy weight. Doing more of these things resulted in fewer cancers, fewer heart attacks and longer lives. They calculated that a 50 year old woman who did all five of these things right would live 14 years longer than a woman who did none; a 50 year old man who was 5/5 would live 12 years longer than one who did none.
So, get off that couch, put down the remote and the chips and get out there!
To quote William Shakespeare, "The fault, dear Brutus, is not in our stars, but in ourselves.."
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