The Status of Aging and Health in America:
Part II – The Good News and Bad News on Health
Michael G. Garko, Ph.D.
Host – Let’s Talk Nutrition
The most recent data on health expenditures in America indicate that “the United States spends more on health per capita than any other country, and health spending continues to increase” (National Center for Health Statistics, 2009, p.4). In 2007, $2.2 trillion was spent on health in the United States, a 6% increase from 2006. In terms of gross domestic product (GDP), current health expenditures represent 16% of GDP compared to 9% in 1980 (see National Center for Health Statistics, 2009).
With such large amounts of money spent on health, one might be tempted to infer that either the health of Americans is very good if not excellent because of extensive health expenditures or it is so abysmal and large expenditures are required to keep the population people healthy. As it turns out, neither is the case.
As the reader will learn in this August, 2010, issue of Healthful Hints, there is good news and bad news when it comes to the health of Americans. This month’s newsletter is not purported to be an in-depth analysis on the status of health in America. Rather, it is a sketch of health in the United States, with particular attention devoted to the size and increasing age of the population and mortality (measured in terms of life expectancy, leading causes of death for all ages and infant mortality).
The most current statistics (i.e., for the year, 2007) reveal there are 302 million U.S. residents. In 2000, there were 281 million. In 1980 there were 227 million U.S. residents, representing an average increase of 1.1% a year from 1980 to 2007. Experts anticipate that by 2050 the population in the United States will increase to 440 million (see National Center for Health Statistics, 2009).
Along with its size of increasing, it is projected that from 2007 to 2050 the population will become older. There are basically three reasons for this: 1. Percentage of the population under 18 years is predicted to remain the same, 2. percentage of the population 18-44 and 45-64 years of age is forecasted to decrease and 3.percentage of the population 65-74 years of age is envisaged to grow from 6% to 9% and the percentage of the population 75 years of age and older is anticipated to nearly double from 6% to 11% (see National Center for Health Statistics, 2009).
The population becoming older bears upon its health status. According to the National Center for Health Statistics (2009), “as the population ages, the need and demand for health care will increase because older adults are more likely to suffer from chronic conditions and to seek medical care and other services associates with the aging process (p. 14).
Leading Causes of Death
The top six causes of death in the United States for all ages are as follows: 1. Heart disease, 2. cancer, 3. stroke, 4. chronic lower respiratory diseases (CLRD), 5.unintentional injuries and 6.diabetes (National Center for Health Statistics, 2009). Generally speaking, beginning in the middle of the 20th century people have been dying at a slower rate. In 2006 (the most recent year reported) there was a 46% lower overall age-adjusted death rate in the United States.
Lower death rates from heart disease (66% reduction since 1950) the number one cause of death, stroke (76% reduction since 1950) the number three cause of death and unintentional injuries (49% reduction since 1950) the number five cause of death accounted for most of the variance in the reduction of overall mortality since 1950. However, notwithstanding the lower death rates attributed to them, heart disease and stroke (cardiovascular related diseases) and unintentional injuries still make the top six leading causes of death in the United States.
Coronary heart disease. Commonly referred to just as heart disease, Coronary heart disease (CHD) is the most common type of cardiovascular disease (CVD) in the United States. About every 25 seconds an American will experience a coronary related event and about every minute one will experience a fatal cardiac event, usually a heart attack (Lloyd-Jones, et al., 2010).
Of the estimated 81,100, 000 American adults (more than 1 in 3) who suffer from one or more types of CVD, 17,600,000 who are 20 years of age and older have CHD. Total CHD prevalence for adults in the United States is 7.9%. The prevalence of CHD for men is 9.1% and for women it is 7.0%.
It is the single largest killer of both adult American males and females. CHD caused approximately one out of every six deaths in the United States in 2006. CHD mortality was 425,425,000 in 2006 (Lloyd-Jones, et al., 2010).
According to the American Heart Association (2005), “CHD comprises more than half of all cardiovascular events in men and women under age 75” and that “the lifetime risk of developing CHD after age 40 is 49% for men and 32% for women” (p. 92).
Fifty percent of men and 64% of women who died suddenly of CHD experience no prior symptoms of the disease. Further, between 70% and 89% of sudden cardiac deaths happen in men, with the annual incidence being three to four times greater in men compared to women. However, this disparity between men and women tends to decrease with advancing age (Lloyd-Jones, et al., 2010).
The American Heart Association reported that “from 1996 to 2006, the annual death rate due to CHD declined 36.4%, and the actual number of deaths declined 21.9%. In 2006, the overall CHD death rate was 134.9 per 100 000 population (Lloyd-Jones, et al., 2010, p. e42).
Stroke. According to the American Heart Association, in 2006 (the most recent year reported) an estimated 6,400, 000 Americans 20 years of age and older experienced a stroke. Annually, about 780,000 people experience either a new or recurrent stroke. Of these, approximately 600,000 of these are first attacks, and 180, 000 are recurrent attacks. Every 40 seconds, on average, a person in the United States will have a stroke (Lloyd-Jones et al., 2010).
In terms of gender, each year, approximately 60,000 more women than men suffer a stroke. The incidence rates of stroke are larger for men than women at younger ages but not at older ages. The reason more women than men die of stroke each year is because there is a larger number of elderly women (Lloyd-Jones et al., 2010).
On average, every four minutes, a person in the United States dies from a stroke. In 2006, stroke accounted for one of every 18 deaths (Lloyd-Jones, et al., 2010). In 2006, the overall death rate for stroke was 43.6 per 100,000 (Lloyd-Jones et al., 2010).
The American Heart Association reported that “from 1996 to 2006, the annual stroke death rate decreased 33.5%, and the actual number of stroke deaths declined 18.4%” (Lloyd-Jones et al., 2010, p. e56).
Cancer. With respect to cancer (the second leading cause of death), overall age adjusted death rates increased between 1960 and 1990 and declined between 1990 and 2006 by 16% (see Fryar et al., 2010).
According to the American Cancer Society, “a total of 1,529,560 new cancer cases and 569,490 deaths from cancer are projected to occur in the United States in 2010” (Jemal et al., 2010). Overall cancer incidence rates decreased in men at a rate of 1.3% per year from 2000 to 2006 and in women at a rate of 0.5% per year from 1998 to 2006.
This decrease incidence of cancer in men and women was due primarily to a decrease in three primary cancer sites in men lung, prostate, and colon and rectum [colorectum]) and two primary cancer sites in women (breast and colorectum). The decrease held for men and women across all racial/ethnic groups, except for American Indian/Alaska Native women whose rates remained the same (Jemal et al., 2010).
For men, there was a death rate decrease for all races of 21% between 1990 and 2006. Decreases in lung, prostate, and colorectal cancer rates were responsible for nearly 80% of the total decrease. For women, there was a decrease in death rates of 12.3% between 1991 and 2006. A decrease in cancer rates for both breast and colorectal cancer was responsible for 60% of the total decrease (Jemal et al., 2010).
The reported decrease in overall cancer death rates converts approximately to 767,000 less deaths from cancer over the 16-year period from 1991 to 2006 (Jemal et al., 2010).
Chronic lower respiratory diseases. Since 1980, the age-adjusted death rate for CLRD rose 43%. Deaths from CLRD included bronchitis, emphysema and asthma (see Fryar, et al., 2010).
Unintentional injuries. From 1950-1992, the age-adjusted death rate from unintentional injuries declined. While mortality rate due to unintentional injuries has slowly increased since 1992, it is still 49% lower than it was in 1950 (see Fryar et al., 2010).
Diabetes. During the 1970s, there was a decline in the age-adjusted death rate attributed to diabetes. However, from 1986-2002 there was a 48% increase in the age-adjusted rate for the sixth leading cause of death in the United States. Although the rate decreased by 8% from 2002-2006, diabetes presents a major challenge in improving the status of health in America (National Health Statistics, 2009).
Life Expectancy and Mortality
The life expectancy is used frequently to measure a population’s overall health. When used as a summary measure of mortality, the life expectancy statistic most commonly signifies the life expectancy of a group or population (i.e., cohort) at birth or otherwise the median number of years that a cohort born in a particular year is expected to live, assuming current death rates remained constant (National Health Statistics, 2009; Shrestha, 2006).
Life expectancy has increased dramatically in the United States. People born in 1900 were expected on average to live only 47 years. Those born in 2005 are expected on average to live nearly 78 years (77.9) (Centers for Disease Control and Prevention, 2007). Life expectancy at age 65 has also increased. From 1950 through 2006, , life expectancy for men 65 years of age increased from 13 to 17 years, while for women 65 years of age it increased from 15 to 20 years (National Health Statistics, 2009).
Notwithstanding the increase in overall life expectancy for the population born in 2005 and for those 65 years of age, the United States ranks only 49th in life expectancy out of 224 countries (see Central Intelligence Agency, 2010).
Since 1950, stroke, the third leading cause of death, declined 76% (National Center for Health Statistics, 2010). According to the American Heart Association, in 2006 etc.
The infant mortality rate is a measure of the “risk of death during the first year of life” (National Health Statistics, 2009, p. 14). In 2006 (the most recent year reported), the infant mortality rate 77% lower compared to what it was in 1950. This reduction in infant mortality can be accounted for by annual declines in infant deaths between 1960 and 2000. The period between 1950 and 1980 saw a rapid decline in infant mortality rates, with a slower decline subsequent to this period up to 1995 (National Center for Health Statistics, 2010).
Although most racial and ethnic groups have experienced a decline in infant mortality rates, large disparities still exist among non-white groups. For example, during the period between 1995 and 2006 the highest infant mortality rates were for infants of non-Hispanic black mothers. Further, infant mortality rates among mothers of American Indian, Alaska Native and Puerto Rican heritage were high as well (National Center for Health Statistics, 2010).
Although the United States spends more money on health per capita than any other country and although life expectancy has increased and death rates for have improved for nearly all of the six leading causes of death, there is still considerable room for improvement when it comes to the status of health in America. In fact, given that current health expenditures in the United States are 16% of GDP, a reasonable argument can be made that the health status of Americans should be considerably better and the death rates for the leading causes of death should be lower.
Furthermore, it could be contended that the health care system in the United States should be the best in the world. In fact, many make such a claim. However, according to The Commonwealth Fund (2010), “Despite having the most expensive health care system, the United States ranks last overall compared to six other industrialized countries—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—on measures of health system performance in five areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives” (p. 1).
Having a health care system that ranks last on quality, efficiency, access to care, equity and the ability to lead a long, healthy, productive life compared to six other leading industrialized countries which spend considerably less on health care, does not help with improving the health status of Americans. Rather, it tends to undermine it and poses serious questions about its ability to care for an ever growing older population.
An ever growing elderly population, which suffers from more chronic disorders and diseases and require more medical care, in conjunction with a less efficient and effective health care system to care not only for the elderly but all of the other members of the population set the stage for a potential health crisis the likes of which this country has not seen.
Improvements in medical technology can help improve the health status of Americans. However, medical technology will not serve as the sole solution to resolve this impending health crisis nor will it improve the health status of the overall population such that life expectancy will increase and mortality rates for the leading causes of deaths will decline to levels of that typifying a healthy population.
A good example to support this argument is average life expectancy. As it was pointed out earlier, the increase in average life expectancy from 47 years in 1900 to 78 years in 2005 was due in part to (1) an improvement in sanitation, (2) an increase in use of preventative health services, (3) public health efforts and (4) to some lesser extent healthier lifestyles for a small percentage of the population. Most experts would also agree that improvements in medical technology made a major contribution to people living longer over the past 100 years. Yet, notwithstanding all of the factors responsible for increasing average life expectancy (including improvements in medical technology), the United States ranks only 49th in world on this important measure of overall health.
Another example is the improvement in incidents of CHD and stroke. According to the National Center for Health Statistics (2010b), the reasons for the decline in death from heart disease and stroke were “better control of risk factors, improved access to screening, increased early detection, and better treatment and care, including new drugs and expanded uses for existing drugs” (p. 48).
People living a healthy lifestyle is missing in virtually all private and governmental reports on identifying the reasons for the improvements in average life expectancy, heart disease and stroke. It is precisely this factor that will contribute the most to a better report card on the nation’s health status.
Improving the health status of the population of the United States will rest upon the majority of individuals at all stages of life practicing healthy lifestyle behaviors and adopting attitudes, values and beliefs promoting health and wellbeing. Of course, this is easier said than done. In upcoming issues of Healthful Hints, recommendations will be given and attention will be devoted to what experts say needs to be done to help accomplish this goal and improve the health status of Americans.
American Heart Association (2005).Heart disease and stroke statistics – 2005 Update. Dallas, Texas: American Heart Association. Retrieved July 1, 2010, from
Centers for Disease Control and Prevention (2007). Trends in health and aging: Trends in health status and health care use among older women (2007). Retrieved June 1, 2010, from http://www.cdc.gov/nchs/data/ahcd/agingtrends/07olderwomen.pdf
Central Intelligence Agency (2010). The world fact book: Country comparison – Life expectancy at birth. Retrieved June 1, 2010 from https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html
Fryar, C.D., Hirsch, R., Eberhardt, M.S., Yoon, S.S., & Wright, J.D. (2010). Hypertension, high serum total cholesterol, and diabetes: Racial and ethnic prevalence differences in U.S. adults, 1999-2006. NCHS data brief, no 36. National Center for Health Statistics: Hyattsville, MD. Retrieved July 1, 2010, from http://www.cdc.gov/nchs/data/databriefs/db36.htm.
National Center for Health Statistics (2010). Health, United States, 2009: With special feature on medical technology. Hyattsville, MD. Retrieved July 1, 2010, from http://www.cdc.gov/nchs/data/hus/hus09.pdf.
Lloyd-Jones, D. et al. (2010). Heart disease and stroke statistics—2010 Update: A report from the American Heart Association statistics committee and stroke statistics subcommittee. American Heart Association: Dallas, TX. Retrieved July 1, 2010, from http://circ.ahajournals.org/cgi/reprint/115/5/e69
Shrestha, L.B. (2006). CRS report for congress: Life expectancy in the United States. Congressional Research Service. The Library of Congress. Retrieved July 1, 2010, from http://aging.senate.gov/crs/aging1.pdf.
The Commonwealth Fund (2010). U.S. ranks last among seven countries on health system performance based on measures of quality, efficiency, access, equity, and healthy lives. Retrieved July 1, 2010, from http://www.commonwealthfund.org/Content/News/News-Releases/2010/Jun/US-Ranks-Last-Among-Seven-Countries.aspx