Living Longer,

But Not Necessarily Better

 

Advances in modern medicine are remarkably good at forestalling death, even in the face of serious chronic disease.

By: Dr. David L. Katz*

 

The Centers for Disease Control and Prevention (CDC) issued a press release recently indicating life expectancy in the United States had reached an all-time high – 77.9 years on average. This is up from an average of 75.8 years in 1995, and 69.6 years in 1955. Adding years to life is a good thing – but adding vital years to one’s life may be even more important. On that subject, the report is silent.

 

The report – based on mortality statistics only – was compiled by the CDC’s National Center for Health Statistics using death certificates gathered through 2005 (see http://www.cdc.gov/nchs/ for details).

The report reveals a very small reduction in a persistent life expectancy gap between blacks and whites, with blacks living 5 years less on average. Women continue to outlive men by 5 years on average, too. Deaths from heart disease, cancer and stroke have all declined.

But data from the selfsame CDC indicate that obesity is epidemic, diabetes rates at an all time high, and the impact of chronic diseases monumental. In 2004, CDC published a report entitled “The Burden of Chronic Diseases and Their Risk Factors” indicating that one in ten Americans – over 25 million – experience major limitations to our daily lives as a result of chronic illness.

The combination of an increased life expectancy with an increasing disease burden adds up to more – but less vital – years of life. Living long and living well are a wonderful combination, but not a guaranteed package deal.

Deaths from heart disease, cancer and stroke are all down in this latest report. But the data on chronic disease suggest that the number of people surviving these conditions is up. These considerations highlight the obvious question we should ask when we hear that life expectancy is rising: Why? There are two primary answers from which to choose.

The first – and preferable – answer is that we are healthier. But that does not seem to be the case. We are less likely to die young, but not more likely to be free of chronic disease, than in the recent past.

The second, less desirable answer – and the one I think is correct – is that advances in modern medicine are remarkably good at forestalling death, even in the face of serious chronic disease. Recent years have seen great strides in pharmacology, with new drugs for everything from lipid lowering to cancer chemotherapy. Surgical techniques are less invasive and more effective with each passing year. We have coronary stents and laparoscopy; gamma knives and radiation seed implants; robotic surgery and open MRI.

The cost of all this is high in both human terms and dollars.

People are living longer – but with diseases requiring all modern medicine has to offer to keep us alive. Extra years of being sick are not consistently desirable achievements. A 2006 report in Public Health by researchers at Emory University attributes ever-increasing health care cost – a threat to the very solvency of our economy – to the rising percentage of the population under treatment for chronic disease.

This less rose-colored view of increasing life expectancy raises yet another question. Why are we managing to live longer, but not managing to live better?

For that answer, we must look to ourselves. The simple fact is that modern medicine is very good at preventing death, much less adept at conferring health. Lasers, scalpels, and fiber-optic devices are not designed to confer health; they treat disease. Very little in medicine is truly about promoting health. As a Preventive Medicine specialist, I must acknowledge that the true power of disease prevention resides with patients, not health care providers.

The foundation of health, once genetics and chance factors have been accounted for, is built from lifestyle, behaviors, and environmental exposures. Surgery and chemotherapy can save your life if you have colon cancer. Screening colonoscopy can find that cancer early when it’s curable. But eating well, being active, controlling weight, and avoiding toxins across the lifespan can prevent colon cancer from developing in the first place. Similar considerations pertain to heart disease, diabetes, and a variety of other conditions. Taking good care of ourselves long before there is disease to treat is the most reliable way to cultivate health. Evidence of meaningful progress in this area is scarce at best. Years of life matter. But years of health matter more. This new report is thus just half a story, and a glass half-full, at best. It will require attention to the determinants of health we ourselves control by the lifestyle choices we make every day to ensure that we live well, as well as longer. The cup of life is larger now. But it seems to me we have a long way to go before we have clear cause to toast our good fortune.

 

*         David L. Katz, MD, MPH, FACPM, FACP; Director, Prevention Research Center, Yale University School of Medicine  and medical contributor for ABC News. He may be reached at www.davidkatzmd.com.)

Taking good care of ourselves long before there is disease to treat is the most reliable way to cultivate health. Evidence of meaningful progress in this area is scarce at best.