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Americans are living longer, but not necessarily healthier

Bad habits could begin to undermine many of the nation's strides in health care, physicians warn.

By Victoria Stagg Elliott, amednews staff. Oct. 27, 2003.

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Advances in medicine, improvements in public health and increased access to preventive care are resulting in longer life expectancies, according to Health, United States, 2003, the latest annual report on the state of the nation's health by the Dept. of Health and Human Services.

"This report shows we're continuing to make progress in improving Americans' health," HHS Secretary Tommy Thompson said. For example, life expectancy rose from 75.4 years in 1990 to 77.2 years in 2001.

But while there is a lot of good news, experts are also quick to point out the bad news behind some of the numbers. Some health care disparities persist, and unhealthy habits, such as overeating, could begin to undermine medical advances.

The report showed that access to preventive services has improved in several areas, but trouble spots still exist. Statistics on women's health are a case in point.

An increasing number of women are receiving Pap smears, mammograms and prenatal care in the first trimester of pregnancy.

However, significant disparities remain. Younger women, for example, were far more likely to have had a Pap smear than those older than 65.

"Yes, it's great that the overall numbers have gone up, and the good news here is that younger women are getting Paps, and hopefully this will be a lifetime pattern for them," said Wendy Chavkin, MD, MPH, professor of public health and obstetrics-gynecology at Columbia College of Physicians and Surgeons and the Columbia School of Public Health in New York City. "But the highest-risk people are still in pretty crummy shape. The poor and the oldest are not getting them."

And although African-American women had a higher rate of Pap smears than their Caucasian counterparts, they were less likely to get prenatal care early on in their pregnancies. More than 85% of white women had medical care during the first trimester, but less than 75% of African-American women did.

On the positive side, the overall prenatal care rate rose from 76% in 1990 to 83% in 2001. Experts say, however, that while the increase is a good thing, more needs to be done to improve women's health.

"That's admirable," said Sharon Phelan, MD, professor of obstetrics and gynecology at the University of New Mexico, Albuquerque.

"What would be nice to now shoot for is not only the early prenatal care but even getting more preconceptive care," she said.

Battling infectious diseases

And while the report also documented significant public health gains against infectious diseases, several numbers pointed to disturbing trends in this area.

Pediatric AIDS has bottomed out because of efforts to eliminate transmission from mother to child and because blood products used to treat some diseases are far safer. However, the number of adults who become HIV-positive has remained stubbornly at around 40,000 per year.

"Pediatric AIDS has been one of the great success stories of medicine," said John G. Bartlett, MD, head of the infectious diseases division at Johns Hopkins University School of Medicine in Baltimore. "But the 40,000 [adults] is a somewhat humbling figure."

Thanks to public health community efforts to immunize children, many vaccine-preventable diseases, such as diphtheria, mumps and measles, have practically disappeared.

Meanwhile, significant progress has been made with the newer vaccines against hepatitis A and B.

Tuberculosis, however, while still declining, is doing so at a slower rate.

Sexually transmitted diseases, such as syphilis, gonorrhea and chlamydiosis, appear to be on the increase. There were more than 32,000 cases of syphilis in 2001 but only around 31,000 in 2000.

Better devices, worse habits

Advances in drug treatments and new medical devices have led to successes against many ailments. One example is heart disease. Rates of high cholesterol are lower than ever, and heart disease deaths continued their decline.

"We have remarkable new technology, powerful new drugs and amazing interventions, which will help people with early and late heart disease live better," said Richard Stein, MD, a cardiologist and professor of clinical medicine at Weill Cornell Medical Center in New York.

But experts expressed concern that people's behaviors might begin to counteract health gains accomplished by better drugs and technology.

Rates of heart disease have gone up, along with several risk factors.

Nearly a third of Americans are now obese, and diabetes is increasing. Smoking rates have ceased declining, and hypertension is starting to inch up.

"We have a worsening of the American diet," said Dr. Stein, who is also a spokesman for the American Heart Assn.

"We have a dramatic increase in weight gain and inactivity. We are going to see more heart disease, and we are going to see more people needing these wonderful drugs, and ultimately the diabetes and the metabolic syndrome are probably going to overwhelm the scientific advances."

With health indicators in many areas decidedly mixed, the HHS report also has some experts questioning whether the world's most expensive health system is providing good value for the money.

"When someone is sick, we have a great system," said Rae-Ellen Kavey, MD, MPH, chief of cardiology at Children's Memorial Hospital in Chicago. "What we need is the kind of services to promote health rather than to treat disease. That's where we need to make change. There's plenty of room for improvement."

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