Where we stand
The story so far
The United States has the highest costs of healthcare in the world and a terrible track record of delivering a return on that investment. It is ranked as the fattest country in the world. It consumes more processed foods and illicit substances than any other country in the world. It has failed to address a mental health epidemic. Although these statements are all true, I’m not really concerned about them. I don’t care about the comparison between countries or being the worst at something; it tells me nothing constructive or definitive. Those metrics have been blasted over so many blogs and media outlets that we've become desensitized to them.
I'm significantly more interested in what the statistics say objectively. Numbers don't lie. They can paint a picture of the true scope and severity of our national health crisis in a way the blanket statements above cannot. As a result, this post will be entirely focused on doing just that; on using numbers, facts, and statistics to answer the question: Just how unhealthy are Americans?
Answering this question proved to be frustrating since our culture tends to evaluate health on a mostly physical basis. Stress, sleep deprivation, loneliness, anxiety, depression, addiction, and other mental or emotional health complications are largely ignored, overlooked, or misreported. It’s hard to build accurate estimates on mental health, given that physical health has more evidence backing it up. This is especially true given the way most health screenings are conducted. Just think about the last time you went in for a checkup with your doctor.
It probably went something like this:
A nurse sat you down and began measuring your blood pressure, heart rate, temperature, and other vitals. They may have weighed you and asked some general questions. Then the nurse left and the doctor came in. The two of you made small talk for a minute before they began performing various examinations: listening to your heart and lungs through a stethoscope, checking your throat by making you say “ah”, and prodding various parts of your body. Assuming the doctor found no red flags, they would ask a few questions about your general wellbeing and state of mind. If you didn’t raise any concerns, the doctor then gave you a recommendation or two based on his observations, pronounced you in good health, and left. You may or may not have gotten a sticker.
But the doctor doesn’t really ask how you’re feeling. Oh sure, they ask the actual question, but having anything more than a superficial conversation with them on your mental state leads them to refer you to a psychologist or psychiatrist. The amount of time and effort examining a patient for physical maladies far outweighs their mental and emotional screening.
It’s not the doctor’s fault. Your primary care physicians do care, they realize that mental health is important; they just don’t have time to address it. They have to stick to a schedule and see several more patients by the end of their shift. It's just how the system is structured. If doctors stop to get personally involved in your mental issues during your visit they would never be able to do their job and see all those other patients. Even doctors that specialize in treating mental illnesses, psychologists and psychiatrists, schedule their help on an hourly basis and work across yearly time-frames. There is only so much progress that can be made in a single session. Mental health treatments require long-term commitments and consistent effort to deliver results, it’s just a reality of the illnesses.
Despite its failings in mental health, this annual checkup system is a great way to evaluate a person’s physical health. The procedures are, for the most part, non-invasive and cover a wide range of basic disorders. It’s a tried and true procedure for detecting acute, life-threatening illnesses. The annual doctor’s visit is the way Western civilization has conducted maintenance on itself for the past century.
That’s exactly my problem with it: we haven’t changed how we evaluate our health in over a century. In that time the field of medicine has advanced by leaps and bounds. We know so much more about the human body, the brain, genes, DNA, and how the various pieces of the biochemical puzzle interact than we did a hundred, fifty, even twenty years ago. The annual checkup has failed to incorporate recent discoveries and research, but perhaps more importantly, it has failed to adapt to changes in human behavior.
Our healthcare system is still structured to prevent the next disease outbreak and identifying while it can still be contained. Ebola was the last major outbreak of disease; it killed just over 11,000 people, mobilized the international community, and dominated our news cycles for a month plus. While this was a tragic loss of life, it absolutely pales in comparison with a pandemic like the Spanish Flu, which a century ago was responsible for killing more than 50 million people. A quarter of America was infected and when all was said and done, over a billion individuals had been infected globally. In response to this terrible loss of life stemming from disease outbreaks like Smallpox and the Flu, brilliant minds like Louis Pasteur and Alexander Fleming discovered lifesaving treatments in vaccines and antibiotics. The medical advances of the late 19th and early 20th centuries helped saved millions of lives and mitigated the risk of an infectious pandemic.
People don't die of smallpox, yellow fever, or the Black Plague anymore. Malaria is the last major active disease and Bill Gates is hard at work stopping it for good. We eradicated and suppressed contagious diseases across a global scale. Today’s health crisis is not about treating acute problems or infectious epidemics. Today’s health crisis is dealing with self-inflicted chronic conditions.
So how bad is it doc?
So how many people are dealing with chronic conditions? What portion of our population is affected by this epidemic?
39.8% of U.S. adults are obese as of 2016. That’s almost two out of every five people or 129 million Americans. This should terrify you, since the prevalence of obesity in this country has roughly tripled since the 1980’s. It's showing no sign of slowing down either: by 2030, it is estimated that 86% of Americans will be overweight and 47% will be obese. Obesity was a factor in 400,000 annual deaths in the U.S in 2015, imagine what those numbers will be in 2030. By then its likely that the biggest killer in America won't be cancer, it will be overeating.
OK, fine, so most of us weigh more than we should, why is it so bad to be big? Well, because being obese makes you feel worse, spend significantly more on healthcare, and die sooner. The average obese individual pays more than $200,000 more in healthcare expenses over the course of their lifetimes than the average person. They spend more on procedures, medication, health insurance - literally every form of medical care costs more. Obese individuals are more likely to have Type 2 diabetes, strokes, heart attacks, respiratory complications, arthritis, several forms of cancer, and emotional health issues. Being obese at age 20 reduces shaves approximately 20 years off a mans life and 8 years off a woman's. It's not a question of being morbidly obese either, even being overweight at age 40 reduced life expectancy in men and women by 3 years.
An estimated 43.4 million American adults had a mental illness in 2015, of which 9.8 million were categorized as serious mental illnesses. Out of the 43.4 million, 24.8 million had no access to mental health services – they received no professional help dealing with their issues. An estimated 8.1 million adults dealt with a form of mental illness and a substance abuse problem. Talk about a double whammy.
These mental illnesses have serious consequences, affecting the psyche and mental stability of individuals. Particularly worrying is the rise in suicides among our youth. Over the past 50 years, suicide rates among young Americans have increased by 200%. 6% of undergrads seriously thought about attempting suicide in the past year, with a quarter of them actually attempting it. Put those numbers into context: if you sent you kid to college in the US, the odds they seriously considered suicide are 1 in 20. How much of this increase in suicides can be attributed to depression, anxiety, or other mental illnesses remains up for debate.
18.1% of the U.S. adult population experience some level of chronic anxiety, with just over a third of them receiving minimally adequate treatment. This "18.1%" figure is showcased on the website of the National Institute of Mental Health and referenced throughout the internet. The NIMH draws this number from a 2005 study, meaning that they last updated this statistic twelve years ago. This figure does not account for the introduction of the smartphone and social media platforms, two huge sources of reported anxiety. This is frankly absurd.
Time Magazine recently ran a piece on severe anxiety in younger generations. Although their aggregate data was a decade out of date as well, they cited several recent and small-scale studies. The most striking to me was a study conducted by UCLA that measures how many incoming freshmen felt “overwhelmed by all they had to do”. In 1985, 18% of the incoming class felt overwhelmed. In 2010, it was 29%. In 2016, it was 41%. In the 25 years before 2010, the number of freshmen feeling overwhelmed went up by 11%. In the six years after 2010, that number went up by 12%. I have absolutely no proof of this, but I would bet that the increase in suicidal tendencies among undergraduates has a lot to do with a similar trend in anxiety and "feeling overwhelmed".
Although anxiety has overtaken depression as the most common mental illness, depression hits harder, leaving its victims feeling powerless against an unending flow of negative thoughts and emotions. In total, 16.1 million of American adults suffered from a major depressive episode in 2015. 10.3% of Americans aged 18-25 suffered a major depressive episode that year; the generation that is supposed to be the most optimistic is the most depressed. Depression carries the heaviest burden of disability among mental and behavioral health disorders, accounting for 8.3% of all years lived with disability.
Even chronic loneliness is becoming a serious problem in our society. Being well connected to other humans is a need, its crucial for both our wellbeing and survival. We live in a world where almost every single person we've ever met is just a chatbox or phone call away. Ironically, despite this explosion of connectivity, we are becoming increasingly isolated.
In 2010, 35% of Americans aged 45 and older suffered from chronic loneliness, totaling about 43 million people. Half our country is unmarried and more than a quarter lives alone, and those trends are increasing. Not only does loneliness suck, its harmful; in a study that covered 3.4 million participants, chronic loneliness was found to be as big a factor in health as obesity. If you think that loneliness isn't really a big deal, think about it: isolation cells are used as a last resort to keep our hardest convicts and criminals in line. It’s the ultimate punishment available to correctional officers. If isolation can break murderers, gangsters, and rapists, you can bet it hurt your grandma when you didn't call on her birthday.
So we’ve discussed obesity, anxiety, depression, and even loneliness in significant detail, but what about addiction?
46% of American adults have a friend or family member that has struggled with addiction. But only 10% of those suffering from a substance abuse disorder will receive treatment. To make matters worse, these substance abuse addictions are lethal. In 2015, drug overdoses claimed more lives than car accidents and gun violence. Things have gotten so bad that the body count from overdose fatalities levels are beginning to rival the AIDS epidemic at its peak. Although legal addictions like tobacco and alcohol might seem better, they account for more than half a million deaths annually.
Just because a substance is legal doesn’t mean its non-addictive, safe, or healthy. Alcohol and tobacco are the two examples that immediately spring to mind. 15.7 million Americans suffer from an alcohol abuse disorder. It is responsible for 1 in 10 deaths among working-age adults aged 20-64, killing its victims roughly 30 years earlier than expected. Among the 52.0 million current cigarette smokers in 2015, 30.2 million were daily cigarette smokers and 12.4 million smoked more than a pack a day. Smoking is neck and neck with obesity for the most harmful lifestyle choice you can make. Its responsible for 1 in 5 deaths in the US, accounting for almost half a million lives lost annually.
In 2015, 27.1 million people aged 12 or older used an illicit drug in the past 30 days in a survey conducted by the National Survey on Drug Use and Health. Of those, over a quarter, 7.7 million Americans, suffer from an illicit drug use problem; an addiction, as the kids call it nowadays.
Misuse of prescription medication is the nation’s current poster child for drug addictions. To say we're overmedicated with pills and prescriptions is a given at this point. More than 4 billion prescriptions were filled in 2011 for a population of roughly 300 million, and the numbers have steadily increased since then. Prescription drugs account for 10 times more deaths than illegal drugs on a yearly basis. In 2015, opioid overdoses killed a record 33,091 Americans. In 2016, we broke that record by 16%. Am I the only one that realizes how absurd this is? 100 years ago these chemicals didn't even exist, and now individuals who go see a medical professional have a 70+% chance of receiving these compounds as part of their treatment.
where we stand
These statistics drive home a single, indisputable conclusion: our current state of health is abysmal. Forget about being the least healthy country in the world, we're the least health-conscious collection of individuals in history. Since we’ve started keeping reliable records, human life expectancy has gone up; reflecting the advances in technology, healthcare, and security that an advancing civilization provided its people. 2015 was the second data point ever to break that trend in America, with our life expecting falling by 0.1 years. When people died before the turn of the millennium, it was usually because they got sick with something like influenza or they suffered some sort of major physical trauma like getting stabbed on a battlefield. That is no longer the case. The leading causes of death are mostly self inflicted. We overmedicate, overeat, and have weaker social support systems than any other culture or society in our history. The only way to accurately label this shift in behavior is as an epidemic of addiction and chronic conditions.
129 million Americans are obese, 43 million are coping with mental illnesses, at least 43 million are painfully isolated, and 36 million abuse illicit drugs, alcohol, or cigarettes. The vast majority of these people are not getting adequate treatment for their conditions. The modern healthcare system isn’t designed to support behavioral change across broad a population, its designed to detect and repair acute problems. The treatment for chronic conditions is just too time-consuming for medical professionals and/or too expensive for patients. The supply and demand lines are too far apart.
If you blew out your knee, got stabbed, or are suffering from pneumonia then boy do we have a healthcare system for you! If your condition isn't life threatening or in need of immediate attention, well, there are more important things to take care of.
The question doctors should be asking at your checkup is no longer "Are you living a healthy lifestyle?" It should be "What is your addiction and how are you treating it?" We can be addicted to processed foods with high levels of fat and sugar, social media, prescription drugs, illegal drugs, alcohol, tobacco, watching TV, pornography, gambling, or any one of a million things that our society enables us to do. The annual checkup & emergency room combo that Western healthcare loves does not help those suffering from addictions solve their problems, it just helps them patch over the symptoms.
The way we think, the very way our brain chemistry operates, is out of date. An addict, whether they are hooked on opioids, sugar, Netflix, or cigarettes, has had their brain hijacked by that particular reward. It's not a matter of replacing one reward with another, we need to take back control of our minds. We need to start dealing with these conditions at their source, not just resolving the symptoms. It’s not good enough for us to prescribe antidepressants by the bucket. It’s not good enough for us to tell obese patients to opt for bariatric surgery or just eat less and exercise more. It’s not good enough for us to tell addicts and those struggling with substance abuse to just stop taking those nasty drugs. None of these are realistic long-term solutions.
We need to treat ourselves. We need to challenge our already ingrained thoughts and behaviors. It’s clear, given the scope and severity of the health crisis facing our nation, that we need to fundamentally rethink healthcare's approach to health care. But before we can focus on building a solution, we need to examine how, and why, things got so bad in the first place.