Are Americans Healthy?
We hear that Americans are doing better – at least in terms of health. Childhood obesity is not increasing. Adults and children are living longer.
But what about the future?
A recent study out of Mayo Clinic Proceedings is more disturbing. It looked at ten year old data (it takes a while to research this stuff) from comprehensive national NHANES program the government uses to assay American health. This time up the question was healthy behavior. Four factors were looked at: Smoking, physical activity, a “healthy” diet with several acceptable models, and body fat percentage -20% or less for men, 30% for women.
Smoked was not tested by self report, but by blood cotinine levels. Diets were assayed subjectively, but rather exhaustively if for short periods; body fat was looked at by scans, and physical activity measured by accelerometer with the cutoff of 150 minutes of sort of active moving per week.
How many people fit all these characteristics? Three percent.
That’s right – a grand total of 3% of adults fit relatively minimal criteria for health.
Numbers were worse among those over 60 and blacks. Women as usual had better results than men – though only marginally.
Was This a Surprise?
Not really. A similar study of self reported measures, using weight as opposed to percent body fat, found the same 3% figure among men several years ago.
Where Was the Biggest Single Fall-off in Healthy Behavior?
Body fat. Only 9.6% were felt to be within normal limits. This argues that BMI, usually felt to be “too severe” if 25 is the declared upper bound limit, may not be so severe after all. We hide lots of fat wrapped around abdominal organs, a decidedly not healthy result. Only 37.9% of participants were thought to have a relatively healthy diet engaging at least a small portion of daily consumption of fruits and vegetables. Curiously, almost half of adults were found to move more than 150 minutes a week.
What Were the Effects on Overall Health?
The more positive factors, the less the problems in blood pressure, high lipids, glucose levels, and other physical parameters. What physical health measures were looked at all showed more positive results with more “healthy behaviors.”
Why Are These Numbers So Bad?
The variables are legion, but include:
1. Greater sitting time and immobility with increasingly sedentary occupations, plus greater internet use. Work matters a lot for these kinds of measures. When robots do the job, factory workers move less.
2. An ability to get people off cigarettes. Though these data are ten years old fully 28.5% of adults were found to have cotinine in their blood. Even second hand smoke is really bad for you.
3. Difficulties in changing diet. Education regarding healthy diets bombards the public, but people like to eat processed foods, if not always junk, and still don’t like their vegetables. Several tens of billions of dollars in food advertising tries to keep things that way.
Are Their Other Forms of Healthy Behaviors?
Many. There is very good evidence that other aspects of healthy behavior also have large impacts on survival – and daily pleasure.
These include:
Physical Health: Sleep and body clocks are large factors in overall health. Here the numbers are not great, either; a recent study like NHANES found at least a third of Americans get less than 7 hours of sleep a night. One other national survey put the number at close to 40%. Though body clocks are rarely assayed, the impact of the Internet on waking during the night for work and social purposes also looks pretty negative, with worse results the younger the cohort population.
Mental Health: Depression rates are not declining. Overall use of addictive drugs is not trending well either, particularly if overall deaths by overdose is used as a measure. Recent CDC guidelines arguing approximately 2 million people should immediately get off chronic opioids will certainly change prescribing behavior. How many opioid dependent people will (or can) avail themselves of CBT programs and other treatments remains a great unknown, as is the number of patients who will shift from unavailable synthetic opioids to illegal heroin. So far the auguries are not auspicious.
Social Health: More friends and acquaintances means less heart disease and stroke, depression, even tumors. Social health and general health are more strongly linked than most know. What the Internet provokes in terms of social health remains another large unknown. With increasing penetration of social media, many community and political programs have advanced, while the general population professes to more social isolation than ever, particularly in younger groups. Chances are effects on overall health will prove overlapping and markedly differ from group to group.
Spiritual Health: A connection to things greater than oneself appears to aid overall health. Like social health, you won’t find much data on this in national surveys.
Bottom Line:
Even with a definition severely limited to medical conditions, or behaviors directly linked to them, America is not doing well in the health department. With only 3% of the adult population following “healthy behaviors,” it’s time to reallocate money – and particularly attention – to public health issues rather than the most costly, end of life procedures.
You’ll get a much bigger bang for your buck. But the people who control the bucks will fight that change tooth and nail.
