Critical Debate on the Future of Healthcare

How Do We Americans Stack up Healthwise? Very Poorly!

Despite 4 trillion dollars or nearly 20% of GDP spent on healthcare we are not a healthy population. How unhealthy are we? Very!

In a newly released study from the CDC of 55,081 Americans followed in the National Health and Nutrition Examination Survey from 1999 to 2018, cardiometabolic health was found to be poor and worsening over time. The criteria defining good health were not outlandish, by any means. It consisted of not being obese or substantially overweight, having normal blood sugar (glucose) levels, reasonable cholesterol levels, normal blood pressure measurements, and no overt cardiovascular disease.

Only 6.8% of the group in 2017-2018 had what would be considered optimal cardiometabolic health. And the trend is down, substantially. (See the article text for the graphic presentation.)

Let that sink in for a moment. We Americans stack up health wise very poorly.

African Americans and Mexican Americans fared somewhat worse than whites as did men compared to women, less educated vs more educated, and less affluent than more so participants.

But for you well-educated, affluent whites, be aware, you still did poorly.

Equally important, the trend is down in every category over the almost twenty years of this survey.

It is notable that the survey criteria used here did not include measurements of exercise (most Americans are deficient,) diet (most Americans eat an unhealthy diet,) stress (most are chronically stressed,) or sleep (most are sleep deprived.) Add these in along with tobacco usage (fortunately now down below 15%) and excessive alcohol consumption and we are a woeful group wondering why we develop diabetes, angina, a heart attack or a stroke, cancer, kidney disease or Alzheimer’s.

The authors of the study made the obvious conclusion that “the findings inform the need for nationwide clinical and public health interventions to improve cardiometabolic health and health equity.”

In an accompanying editorial, Failing Cardiovascular Health: A Population Code Blue in the Journal of Cardiology, the authors observe, “The reported findings of secular trends of stalling and worsening cardiometabolic profile should not be a surprise as the obesogenic lifestyle—unhealthy dietary patterns that feature foods and beverages high in saturated fat, sugar, salt, and calories; little or no physical activity; alcohol; too much or too little sleep; and hours of screen time—seems to be the norm for many Americans and other populations. These obesogenic behaviors are promoted by increasing opportunities for screen time, a snack food industry [the link will bring you to an interesting short article] that uses science to craft products that are tasty and addictive yet neither satisfying nor filling, and community designs that favor travel by automobile and discourage walking and bicycling. We are particularly concerned about the potential for the developing metaverse to decrease physical activity and increase obesity.

“Regaining the momentum toward positive cardiovascular health will not occur spontaneously. It will require the engagement of every physician and every public health policy with action at 3 levels—personal, clinical, and community.”

My last article in this series on our dysfunctional healthcare delivery system was titled “Follow the Money in Healthcare – It Will Lead You to Chronic Diseases.”

In a reader’s comment, with only the first two paragraphs copied here, Jo Lis wrote, “Prevention of chronic disease is as a practical matter, for most people; eat sensibly, exercise, don’t smoke, don’t drink excessively, get enough sleep, time outdoors, etc. We all know this, and yet only some of us check a few of those boxes regularly. Food is the key to all of this, and it is the most misunderstood ingredient in preventative care. The big #1 one principle is to eat sensibly. Most of us don’t even know what that means anymore. Consuming whole foods is the point. But that is not profitable for the big food companies, so we get told lies to make us buy processed foods that end up causing preventable chronic disease. You see the vicious circle there? … Follow the money, as usual.”

Since industry and government probably will not help much, it is incumbent upon us to take the first steps. In this regard, the American Heart Association (AHA) has set out a set of metrics designed to assist us in determining our health status and watching it into the future. Called “Life’s Essential 8,” it is an update in June 2022 of their earlier “Life’s Simple 7” published in 2010. That was a “a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course.” This is an important paradigm shift as the vast majority of the dollars expended today for are for diagnosis and treatment of chronic disease; hardly any goes to disease prevention, wellness maintenance and health preservation.

“Life’s Essential 8,” by the American Heart Association

Each of the four health behaviors and four health factors are graded on a scale of 1-10. Those summarize as a composite score shown on the Overall scale at the top which, in this example, gives a score of 68. See text for details.

The new AHA metrics recognize that social determinants and psychological health are important determinants of cardiovascular (and all) health. The Life’s Essential 8 include health behaviors of diet, physical activity, tobacco (including vaping and chews), sleep, and health factors of BMI (body mass index), blood lipids (non-high density lipoprotein cholesterol), blood glucose (sugar, as also measured by hemoglobin A1c), and blood pressure.

As the authors point out, “numerous studies have shown strong, stepwise, inverse associations between the number of ideal CVH [cardiovascular health] metrics or overall CVH score and total cardiovascular disease (CVD) and CVD mortality” but also “all-cause mortality and a wide variety of non-CVD outcomes.”

In other words, measuring cardiovascular health status is an excellent guide toward health in general. This suggests that using the Life’s Essential 8 methodology can be an excellent guide to developing effective wellness preservation and chronic disease prevention approaches.

The Life’s Essential 8 emphasizes the importance of social and economic conditions that impact ultimate CVH. Community resources such as education, agriculture, employment, water and sanitation, housing, etc. are foundational to good health overall and CVH in particular. So too are a person’s psychological health where anxiety, depression and pessimism detract from health whereas psychological well-being, gratitude, optimism and a sense of life’s purpose all benefit good health. These factors have consistently been shown to improve longevity and “healthspan,” i.e., life lived without disease.

Obviously, the community resources group are dependent on government actions whereas the psychosocial are closely related to community status and issues but still are largely in the preview of the individual and his or her family and counsellors.

Sleep has been ignored until recently but new science has shown its importance to overall health and to cardiovascular health. Sleep is important to manage stress and inflammation, two interconnected conditions that are extremely important in the development of most all chronic diseases including coronary artery damage and plaque buildup.

Unfortunately, with just food alone, the cards are stacked against us in many ways. Nevertheless, we each need to assume responsibility for our health status. We also need help from the industrial agriculture and manufacturers of food industries, the food purveyors, insurers and governments at all levels. So far, except for tobacco, efforts have been minimal. And it is unlikely to change. There is just too much money being reaped that any attempts to push back is always met with strong resistance. Lobbyists keep Congress under control and marketing encourages us to eat more and more unhealthy processed foods.

So, it is up to you and you alone. If you would like to augment your and your loved one’s lives toward better health and a longer health lifespan, I encourage you to focus on at least some of the elements of healthy living. Read the AHA’s article in full. In later articles I will review the key concepts as outlined in the books noted below in my bio sketch.

The authors of the newly released study from the CDC referred to at the top of this article also note that the prevalence of an ideal diet among all age groups of Americans is “negligible (<1%).” So, for now, focus on what you eat. That will be a great place to start. You don’t have to be perfect, just a bit better than yesterday. Each day you can make added headway.

Cut way down on sugar (soda, candies, ice cream) and white flour products (white bread, pastries, muffins, most cereals, even pizza.) Those are the “Nos.” Instead focus on fresh fruits and vegetables, whole grains, seeds and nuts, olives and olive oil, fatty fin fish like salmon, mackerel, or sardines, plus some dairy, poultry (preferably free range), and a limited amount of red meat, again preferably free range, grass fed. Look at the image above; do not think of this as unpleasant. Instead, make it a tasty, enjoyable meal preferably shared with a friend or two.

This will be an excellent start. You will feel better and then you can address some of the other key steps including exercise, stress management, and enhanced sleep. Follow the money; you will save dollars, not only now but big dollars in a future of lessened chronic illnesses. Your health will stack up way better than most.

Discuss this Essay

Agree? Disagree? Engage in open debate and discourse on the FOHI Forum. Every article we publish has it's own thread.

Stephen Schimpff MD
Stephen Schimpff MD
Early career at the National Cancer Institute's Baltimore Cancer Research Center developing new approaches to infection prevention and treatment of leukemia and lymphoma patients. Then the head of infectious diseases and director of the University of Maryland Cancer Center followed by senior leadership positions in the Medical School and Medical System culminating as CEO of the University of Maryland Medical Center. Now the author of 7 books on health and wellness, our dysfunctional healthcare delivery system & the crisis in primary care. Lover of nature. Happily married for 58 years.

More on this topic

Most read articles