Tuesday, April 22, 2008

Obesity and Smoking--One Step Forward and Two Steps Back

Young Americans risk being the first generation whose health status will be worse off then the last.

I have repeated that prediction many times but today it looks like tomorrow is here.

A study by the Harvard School of Public Health and the University of Washington and published in the journal PLoS Medicine now tells us that the overall of life expectancy of many Americans has actually been in decline for almost two decades. At the heart of it all are the lifestyles of these people--particularly smoking and obesity.

Women were impacted far more than men. For 20% of women the increase in rising life expectancy that occurred from 1980 to 1999 leveled out or reversed. The deterioration is most pronounced in a swath of America from Appalachia to Texas. Geography aside, the deterioration is most pronounced among women who smoke and are obese. Diabetes is a big part of the problem complicated, or driven, by smoking and being overweight.

The health care industry has made enormous strides in improving the management of the cost and quality of health care. Insurers, hospitals, docs, all participate in a health care system more adept at controlling costs and managing toward a better quality of care then we did 20 years ago. Yet, costs continue to soar and health care outcomes deteriorate.

Is the health care system/business blameless? No.

But so much of what is pushing costs up are the poor lifestyle choices too many Americans make. As professionals in the health care system make progress on cost and quality too many citizens undermine all of that with foolish behavior. We then look to presidential policy proposals or the next generation of managed care to bail us out. But we keep sliding backward anyway. It's like the health care system takes a step forward and dumb lifestyle decisions by people cause us to take two steps back.

This from a recent post: "The obesity epidemic has caused a tenfold increase in the nation's private health insurance bill for conditions related to being overweight, according to a self-funded study by researchers with the Emory University Rollins School of Public Health published in the online version of the journal Health Affairs. According to the study, the cost of treating conditions linked to obesity increased from $3.6 billion to $36.5 billion between 1987 and 2002. The study concludes that the best way to lower health care spending is to target the rise in population risk factors -- especially obesity."

"Current approaches to controlling health care costs are not working because they ignore the true drivers of those costs. Increases in the number of people getting treatment for serious health problems like diabetes, heart disease, high cholesterol, and mental disorders are directly linked to population increases in obesity. If insurers and employers are serious about reining in health care spending, then obesity prevention should be at the top of their agenda."

It looks like things such as smoking cessation and obesity also need to be at the top of the agenda for these many people who are killing themselves.

It is also time for the rest of us to stop pussyfooting around the problem of unhealthy lifestyles and to label smoking and obesity for what they are--really stupid.

Everything we try from health information technology to presidential proposals to reform health care will continue to make only a modest difference unless we start to call a spade a spade and change some behaviors by making these choices socially unacceptable.
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