1.2 Global and National Health Concerns

Global health relates to populations around the world. Although it transcends national concerns, the well-being of people in far-flung countries affects us all. Human health and wellness, education, income, productivity, environmental health, and political stability all intertwine.

For many years, national and international organizations such as the Centers for Disease Control and Prevention (CDC), the United Nations (UN), and the World Health Organization (WHO) have focused on reducing and, if possible, eliminating communicable diseasesIllnesses caused by infectious agents or their toxins that people can acquire from other humans, animals, and the environment (contaminated food, air, water, soil, etc.).—illnesses caused by infectious agents or their toxins that people can acquire from other humans, animals, insects, and the environment (contaminated food, air, water, soil, surfaces, etc.). Illnesses such as infectious diarrhea, malaria, tuberculosis, cholera, measles, and HIV/AIDS end lives prematurely. In addition to these established endemic infections, emerging infectious agents pose an ongoing threat to human health. Most recently, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or more often “the COVID-19 virus,” crossed from animal to human hosts in late 2019. This particular novel coronavirus causes a disease known as COVID-19 that has led to substantial illness and death worldwide. It is called a novel coronavirus (novel means “new”) because it had never infected human beings before its recent emergence.

Transmission of some infectious diseases, such as the COVID-19 virus, can be reduced by social distancingAlso called “physical distancing." Keeping space between yourself and other people outside of those with whom you live in order to slow or avoid the transmission of an infectious disease.—keeping ourselves separated by sufficient distance from anyone outside our own households. Such physical distancing in social situations makes it harder to pass the virus on to others or to come into contact with it ourselves. Along with keeping a physical distance, social distancing usually involves minimizing travel outside our own homes to avoid unnecessary interactions with other people. Fewer interactions with others lessen the opportunities to become infected. Therefore, social distancing guidelines generally discourage or restrict attendance at large gatherings such as sports events or concerts. These measures can allow for smaller groups—for example, limiting get-togethers to a maximum of ten people. During severe outbreaks, however, even such small groups may be discouraged or banned altogether.

In the case of the COVID-19 virus, the social distancing guidelines outlined by the CDC suggest a separation of at least six feet between individuals to prevent the transmission of the virus. Even so, one early research study conducted in China, which also appeared on the CDC’s website, indicated six feet of separation might not be fully effective in all situations, such as indoors where droplets could be propelled further than six feet due to air-conditioned ventilation. So, it makes sense to remain alert for updates about what constitutes a safe social distance in various situations because information about the pandemic will continue to evolve.

Some of these infections are acute illnessesThose illnesses that last a short period of time., meaning they last a short time. Acute illnesses can be mild or life-threatening. Many cases of infectious diarrhea are acute, though they can be deadly, especially in infants and small children. On the other hand, tuberculosis and AIDS are chronic illnessesThose illnesses that last three months or longer., meaning they last longer than three months.

Communicable diseases are rampant in the developing world. Their solutions lie in providing clean water and food, sanitation, vaccinations, and strategies to eradicate disease-causing agents from the environment. Antimicrobial drugs help treat those infections that elude prevention. These advances increase quality and quantity of life.

More recently, international experts have recognized the parallel threat of noncommunicable diseasesIllnesses that are not infectious or readily transmissible., illnesses that are not infectious or readily transmissible. In 2012, such illnesses killed 68 percent of the 56 million who died worldwide. Conditions such as heart disease, diabetes, and cancer are chronic, sapping health years before death occurs.

For decades, noncommunicable diseases have caused significant morbidityIllness. (illness) and mortality in the developed world. As the “Western lifestyle” of tobacco; inactivity; and salty, fatty, sugary foods has spread around the globe, these chronic diseases have likewise become common in developing countries. These risk factors contribute to disease incidenceWhen talking about diseases, the term refers to the rate at which new cases appear. (the number of new cases of a condition occurring within a certain time frame) and prevalenceWhen talking about diseases, the term refers to the proportion of the population affected with that condition at a particular period of time. (how many people have the condition at any point in time).

Recent analyses of changes in disease incidence and prevalence around the globe have yielded expected as well as startling findings. The Institute for Health Metrics and Evaluation periodically measures the world’s most significant health problems and evaluates their possible solutions. Their 2010 Global Burden of Disease study analyzed health statistics from 50 countries and compared the data collected in 1990. Here are some of the key findings:

Chronic, noncommunicable illnesses rob people and nations productivity, prosperity, and both quality and quantity of life. They are also more expensive and complicated to prevent and treat than acute infectious illnesses. Antibiotics and vaccinations against infectious diseases are relatively cheap. Distributing mosquito nets and draining standing water where malaria-carrying mosquitoes breed dramatically reduce malaria. However, changing the factors that fuel most noncommunicable diseases is more difficult. Doing so requires a complete revamping of the food industry, eating habits, activity levels, sleep habits, and stress levels.

Since the nation’s founding, the trend has been that each generation of Americans enjoyed longer, healthier lives than the last. During the 20th century, U.S. life expectancy rose an astounding 30 years. In 1900, the life expectancy at birth was 47.3 years. The average American man lived 46.3 years; women lived 48.3 years. The three leading causes of death were tuberculosis, pneumonia and influenza, and diarrheal illnesses. By 1999, the longevity rates had climbed to 76.7 years (73.9 years for men and 79.4 years for women). The three leading causes of death were heart disease, cancer, and stroke. Notice the change in the top killers from infectious diseases to chronic diseases associated primarily with personal habits.

Public health improvements paved the way to longevity. They included sanitation and hygiene, family planning, improvements in the food supply, and immunizations (vaccinations) against childhood infectious diseases. Better medical care for women during pregnancy and childbirth drove down maternal and infant deaths. Contraceptives allowed women to avoid teen pregnancies and to space births, which improved children’s health. In addition to immunization programs, antibiotic treatment of bacterial infections helped children and young adults survive to older ages. Improvements in medical technology played a much smaller role in extending life, though medical treatment increases the survival of those with chronic illnesses.

Another trend has been a marked increase in the proportion of older adults in the population. In the past, the most populous age group was infants and children. As you can see in Figure 1.5 that situation still holds in Africa and other countries where infectious diseases and malnutrition continue to cut life short. In the United States and other developed countries, the graph has become more rectangular. In fact, organizations such as the World Health Organization note that populations around the world are rapidly aging.

Four factors explain that shift toward a population top-heavy in older adults:

Now older Americans (those age 65 and up) are the fastest growing segment of the population. The proportion of people over age 85 has also increased dramatically. At the turn of the 20th century, 4.1 percent of Americans were over the age of 65. In 2018, 16 percent of Americans were age 65 and older. By 2030, an estimated 71 million older adults will make up 20 percent of the population. After 2030, this growth is expected to slow once the last baby boomers blow out the candles on their 65th birthday cakes. 

Unfortunately, increased longevity combined with the “Western lifestyle” has bred chronic diseases. About 80 percent of American elders live with at least one chronic condition. In terms of health care costs for older Americans, 95 percent goes to pay for chronic diseases. Managing these illnesses drives the escalating cost of health care. 

However, long-term medical conditions such as obesity, diabetes, and high blood pressure have become more common at all ages, even children. In 2012, at least one chronic illness plagued 117 million Americans—approximately half the adult population. One in four adults endure multiple chronic conditions. Obesity, inactivity, poor nutrition (cheap, fast, widely available junk food), smoking, stress overload, sleep deprivation, social isolation, and other ills have increased the proportion of chronic diseases.

Among American adults, over 35 percent are obese; nearly 70 percent are either overweight or obese. Childhood obesity soared from 1994 to 2004 (10 percent to 17 percent) and then stabilized to about 17.2 percent in 2014. Close to 18 percent of young people 6 to 19 years old and 12 percent of children 2 to 5 years old are considered to be obese. Unfortunately, overweight and obesity in childhood often persists into adulthood, heightening the risk of chronic illnesses such as diabetes, heart disease, stroke, arthritis, and some cancers. Experts predict that, unless society halts this trend, this generation of children will be the first not to live longer than their parents. Furthermore, the economic burden of lost productivity and increased health care costs will be staggering.  

The state of health in the United State ranks surprisingly poorly relative to its peer nations. In early 2013, researchers from the National Research Council and Institute of Medicine published an analysis of health and longevity called U.S. Health in International Perspective: Shorter Lives, Poorer Health. The subtitle says it all. Here are the findings of this study and a follow-up analysis of the data.

The big question is why, despite spending more on health care than any other country, has the health of U.S. citizens steadily slipped?

A number of factors probably contribute. As Chapter 2 “Conventional, Complementary, and Integrative Medicine” discusses in more detail, our medical system focuses on treating rather than preventing disease.

The aforementioned 2013 comparison between the United States and other peer nations addressed underlying causes. Compared to citizens of other affluent nations, the authors noted the following:

In addition to multicountry objective comparisons, surveys show Americans don’t rate their own health very highly. One in five rates his or her health as fair or poor. Many Americans admit to neglecting the personal behaviors that maintain health. Many say they suffer from too much stress, too little sleep, and not enough time for quality relationships.

Some people don’t recognize the importance of lifestyle factors to health. Even when they do, there’s a gap between knowing and doing. Over half of respondents in one survey agreed to the importance of regular physical activity, but only about one-quarter met that goal. Nearly 60 percent believed a healthy diet was important to health, yet only 31 percent said they actually ate well.

The problem seems to be getting worse. Another national survey revealed that the proportion of Americans who adhered to four key elements of a healthy lifestyle—eating enough fruits and vegetables, exercising regularly, maintaining healthy weight, and moderating alcohol intake—fell from 15 percent to 8 percent between 1988 and 2006 and to less than 3 percent in 2016. People primarily blame lack of time, money, and willpower as barriers to healthier living.

On a brighter note, the 2017 National College Health Assessment found that 53 percent of college students (60 percent of men and 50 percent of women) rate their health as very good or excellent. Nearly 93 percent of students rate their health as good.

For over 85 years, heart disease has been the number one cause of death in the United States. Cancer, stroke, chronic lung disease, and unintentional injuries (accidents) have ranked in the top 10 for many years, though they tend to shift positions. (See the sidebar “The 10 Leading Causes of Death in 2015 for Americans of All Ages”)

Patterns for causes of death shift depending on the age group considered. For instance, in people under age 45, unintentional injuries (accidents) top the list. Chapter 12 will explore the reasons accidents rather than chronic illnesses kill more young people. For now, suffice it to say that inexperience, alcohol, and a sense of invulnerability factor in. Furthermore, chronic diseases take many years to become serious enough to cause death.

The following list is for adolescents and young adults. Of the 12,514 deaths due to unintentional injuries, 6,787 involved motor vehicle accidents. In 2015, 10,265 people of all ages (one-third of all traffic-related deaths) died in alcohol-impaired motor vehicle accidents.

We all have to die at some point. However, most of the conditions that sicken and prematurely kill Americans could be avoided or postponed. The sidebar “The 10 Leading Preventable Causes of Death” shows how researchers rank the top risk factors for disability and death in the United States.

In 1979, the U.S. Department of Health and Human Services established an initiative called Healthy People. The program established measurable targets for improving the nation’s health at the end of each decade. For example, some of the goals for 1990 were to reduce infant mortality by 35 percent and childhood deaths by 20 percent. Most of the objectives were met.

Three decades later, the program continues. Healthy People 2020 established ambitious yet achievable goals for a number of areas. Here are some examples of those goals.