State of Our Health Mega-Study: A Poor Report

The new movie “Elysium” is set in Los Angeles, 2154 AD, nearly 150 years into the future. The city is utterly unrecognizable, the world in chaos–over-populated and crime-ridden, destroyed by wars, pollution, and serial economic catastrophes. Most everyone is brown-skinned, speaks an interesting Spanglish, and struggles in a subsistence existence, half starved, chronically diseased, living in half-destroyed housing shells furnished with the detritus of the 20th century.

Those lucky enough to work are employed by a corporation under the control of Elysium, the spectacular off-planet dwelling place for the immensely wealthy, the solar system’s ultimate gated community, strictly off-limits to ordinary Earth dwellers because of anti-immigration laws so strict that any attempt to enter Elysium air space via shuttle is thwarted by brutal and uniformly fatal missiles.  On Elysium itself (which resembles a hybrid of an all-inclusive Caribbean resort and suburban Chicago Kenilworth), the citizens are thin, youthful, white, and extremely healthy. This is in no small part due to their health care system and their access to a device called a Med-Pod, an upscale rapid-MRI that in two quick scans diagnoses your disease and cures you completely. Tired? Let’s see…the Med-Pod reads “acute leukemia.” Hold still now. Okay, you’re cured. Back to your golf game. Naturally, Med-Pod use is verboten to the rabble below.

But once Matt Damon, star of this new SF release, has an accident at work and receives a fatal dose of radiation curable only by a Med-Pod, we have a movie. Although it’s pretty decent for summer action fare, it’s also pretty predictable, especially as we follow one adorable six-year-old whose leukemia can only be cured by access to an off-limits Med-Pod. You know the laws of Hollywood would forbid her death, so the movie ends with her emerging from a Med-Pod, disease-free, asking, “Mommy, am I all right?” everyone weepy with joy.

New research findings make Elysium a real possibility

The reason for this lengthy health tip intro is that the story of Elysium segues effortlessly into an article published in this week’s Journal of the American Medical Association entitled “The State of US Health, 1990-2010.” This is a piece of research so complex that even the accompanying editorial acknowledges that most physician-readers and many of the investigators themselves may not fully grasp all its research methods, ramifications, and conclusions. The editorial writer does reference a comparable article that had appeared four decades earlier in 1975. Back then, they concluded that while the US was a wealthy country, we weren’t doing particularly well when it came to illness prevention, life expectancy, susceptibility to disabling conditions, and universal access to health care. It notes that in 1965 we spent $39 billion (5.7% of the Gross National Product) on health care and by 1975 this had swelled to $119 billion and 8.3% of the GNP. Now we’re at $3.5 trillion and 17.9% of the GNP, and like the Earthlings deprived of Elysium’s Med-Pod, there’s little to show for it.

If we extrapolate the numbers from 1965 to 2010 to the (far) distant future of 2154, the dire situation in the movie becomes a spooky possibility.

The JAMA article is complicated, with all sorts of terminology that was new to me, but I’ll try to explain it as best as I can. If you’re at all concerned with the quality of your life and longevity, I ask that you keep reading.

First, understand we’re dealing with a great deal of data submitted by hundreds of investigators and researchers from around the world–all told, data from 187 countries went into this study, probably the largest ever undertaken in the history of medicine. The goal was to analyze what made people ill, what disabled them, and finally what killed them.

The researchers actually came up with a grand total of 291 diseases, which then multiplied to 1160 complications (they called these complications “sequelae”). For example, high blood pressure was a disease, stroke a complication of it. They also importantly documented a total of 67 risk factors that could predispose people to these diseases or their complications. Regular readers will anticipate that the leading risk factors related to diet, exercise, weight, alcohol, smoking, and environmental pollutants.

Now, I’m afraid, things get a little complicated, but remember, they’re trying to reach conclusions about the health of the whole world.

The article uses four interesting acronyms

YLL=Years of Life Lost  Just like it sounds, this is a bad. This number is a configuration of the number of deaths at every age tallied against the life expectancy in that particular country. Let’s take the US, with a life expectancy of 78. A 25-year-old is shot in a gang war. The YLL for him is 78-25=53 (a very high YLL). If a lot of 20-somethings die by gun violence, this keeps increasing the YLL–i.e., many years of potential life have been lost. A country with no gun deaths, no dead 20-somethings, will have a lower (better) YLL number than ours. A country with no gun deaths and a really great health care system will likely enjoy a high life expectancy and a low YLL among its population. Sometimes, countries take initiatives to reduce risk factors (such as free exercise programs). These countries slowly have their populations living beyond their life expectancies and their YLL becomes a negative number. In fact, you yourself might want to live where the life expectancy is high and the YLL is very low. Someday, it even could be us.

YDL=Years of Disability  Meaning, of course, you’re not actually dead but your life has been significantly impaired by disability. You’ll have a high YDL, for example, if you have a stroke at age 40 and rather than die immediately you end up completely disabled and non-functional. With your stroke at 40 and the life expectancy of your country at 78, your YDL is 78-40=38, a very high number. You can imagine that if you’re living in a country with less-than-the-best health care, your country’s YDL will be high. Again, you need a good health care system and national policies in risk factor reduction to keep your life expectancy high and your YDL low.

DALY=Disability-Adjusted Life Years  This is the sum of the YLL and YDL. From what I’ve written so far, you can guess that you want to live where the DALY is very low. For example, if you’re very healthy and don’t develop an illness that either kills or disables you, your personal DALY will be low. If everyone in your country is healthy and doesn’t either die young or become disabled, then your whole country’s DALY is low. You likely didn’t know you wanted this, but you’ll be happier with a low YLL (you won’t die young) and a low YDL (you won’t be disabled), the combination of the two being your DALY.

HALE=Healthy Life Expectancy  This is not only your ultimate goal, but should be the goal of our country. Certainly, it’s our goal for you here at WholeHealth Chicago. We want you so healthy that nothing comes along that would either shorten your life or disable you. We want you healthy well beyond your life expectancy of 78 and for you to die peacefully well into your 90s, ideally with no disabilities other than tennis elbow, cataracts, or erectile dysfunction.

Now that you’ve got the acronyms down pat, here’s how we fared overall in the US in comparison to other countries of similar wealth and development: C-minus.

The most common causes of our YLL (Years of Life Lost, or early death) were coronary artery disease (eg, heart disease from blockage of your coronary arteries), lung cancer, stroke, chronic obstructive lung disease, car accidents, Alzheimer’s, and kidney failure. Note carefully how each of these except for Alzheimer’s could have been significantly prevented by paying more attention to risk factors.

The commonest causes of YDL (years of disability) were low back pain, chronic depression, chronic muscular pain (like fibromyalgia), and general anxiety disorder. And most of these are preventable by lifestyle changes, counseling, and modest medical interventions.

The major risk factors for all chronic illnesses (both fatal and disabling) were unhealthful eating habits, smoking, being overweight, high blood pressure, high fasting blood sugar level, and alcohol. No surprises here. By ignoring our risk factors, we raise our own YLLs, YDLs, DALYs. We chip away at our own HALEs. Hence, our C-minus rating.

What this incredibly complex study concluded was:

1. From 1970 to 2010, although our overall life expectancy improved from 75.2 to 78.2, when compared to other countries of similar economic status (like Canada or Germany), we did poorly, actually falling in rank from 20th to 27th. Worse yet, in 4 out of 10 counties throughout the US, the life expectancy of women actually dropped. Women are living shorter lives in many areas of the US than they lived 30 years ago. This is mainly in the South and Southeast and due to obesity, inactivity, and smoking. I personally find this truly shocking and am sickened when I read that the governors of many southern states have taken steps to block access of the poor to the Affordable Care Act. Flawed as Obamacare is, it is unconscionable to sit around and do nothing while women’s life expectancies are declining.

2. In comparison to other countries, our YLL (years of life lost) and our YDL (years of disability) were stable, but certainly not improving. Our HALE (our ability to be healthy until we die) marginally improved from ages 65.8 to 68.1 (which means we’ll be healthy until 68, but have a strong possibility of becoming disabled from 68 to our life expectancy of 78). When compared to other similar countries the YLL, YDL, and DALY of the US fell from 14th to 26th. Compared to Canadians, Germans, the French, and the 25 other countries above us, we have shorter life expectancies and suffer more disabling chronic illnesses. You have a better chance of enjoying your senior years if you live in Sweden, Switzerland, the UK, or any of two dozen other countries.

3.  Many factors are responsible for the failure of our numbers to keep up with those in Europe. The major risk factors are our unhealthy eating habits, obesity, inactivity, failure to have any significant preventive measures (like gun control, air quality control, etc.), and our incredible disparity of access to the health care system.

In other words, we’re well on the road to the two separate worlds depicted in Elysium. One small and healthy segment of the population controls the money and the health care system. They enjoy low YLL, YDL, and DALYs, a nice high HALE, and everyone down below is circling the drain.

Of course we could improve your numbers without agonizing over the future of the health care system. After all, you can’t really rely on access to any healthcare system to monitor how you eat, exercise, smoke, or drink. Those are the most important factors for your YLL, YDL, DALY, and HALE. Some day, you might luck out and like the citizens of Elysium have access to a Medi-Pod. But for now, much of your HALE is a (one more acronym) DIY affair.

Neill Blomkamp, the movie’s writer and director, said in a recent interview that his film  is not about the future, but rather “Elysium is now.”

Be well,
David Edelberg, MD