The Next Moonshot: Moving to Reverse America’s Declining Life Expectancy

Meet Dr. Allen Weiss, veteran health system administrator, former AHA Board member, thought leader, healthcare revolutionary, and Chief Medical Officer for the Blue Zone Project. While Allen was President & CEO of NCH Health System in Naples, FL, Collier County became the first Florida “Blue Zone” community in 2015. Since then, the overall health of Collier County residents has measurably improved. For example, the county now boasts Florida’s lowest death rate from heart disease.

Allen’s passion for public health is as insatiable as his commitment is relentless. For 4sight Health, Allen will write periodic columns that dive into aspects of community health and wellness. Enjoy!  — David Johnson

“Houston, we’ve had a problem here,” are the actual words, signaling a near death experience for the crew of Apollo 13, shared with the ground team. The nation that put a man on the moon and returned him safely now has another distinctly American phenomenon: “Our workforce is dying faster than any other wealthy country,” a Journal of the American Medical Association article [1] from Virginia Commonwealth University stated last year, as reported by USA Today.

For the first time ever, midlife mortality in America has increased for three consecutive years, in contrast to life expectancies in seventeen other high-income countries that have reported improved data for decades. Although our nation has many distinctions including powering the world’s economy, we also spend the most money per person on healthcare without extending life.

America’s first moonshot took us into space, expanded our horizons and achieved something most thought was impossible. America’s next moonshot is even more important and perhaps even more difficult. We need to reach into every American community to prioritize health, wellness, human potential, individual happiness and our shared future.

Our nation’s life expectancy peaked in 2014 at 78.9 years and has decreased since, as measured most recently. Current representative life expectancies for other industrialized nations include Canada 81.9, Japan 82.2, and France 82.4. These nations moved ahead of the U.S. in the 1980s. If the trend continues, the U.S. will need one hundred years to catch up. Mercifully, the CDC last month reported 2018 information [2] showing a slight uptick in America’s life expectancy due to decreased deaths from drug overdoses and cancer.

The now overused expression, “Your ZIP code is more important than your genetic code,” should be replaced by, “Your nation is more important than your genetic code.” Where you reside matters, with economically stressed areas — the industrial Midwest, the thirteen Appalachian states, and upper New England — having the greatest number of deaths above those statistically expected.

The facts are clear — between 1999 and 2017 mortality in the 25 to 64 age group from drug overdoses increased 386.5%, from hypertension-related causes 78.9%, and from suicide 38%.

Most experts agree only 10 to 20% of health outcomes are attributed to medical care. One’s life radius — the place where one lives, works and plays — has a far greater influence on life expectancy and satisfaction.

Health and happiness inculcated early in life are the best antidotes for premature “deaths of despair.” Causes of these midlife “deaths of despair,” often associated with job loss, include drug and alcohol abuse, smoking, overeating and suicide according to Virginia Commonwealth University’s expert.

Many additional examples abound of the importance of one’s community on health outcomes and life satisfaction. The Centers for Disease Control and Prevention recently shared disquieting information about the levels of inactivity [3] in America today. Depending on the state, between 17.3% and 47.7% of folks have not participated in any leisure-time physical activity such as walking, running, gardening, or general exercise during the past month. Colorado citizens are the most active with Puerto Ricans currently the least.

These disturbing statistics are further broken down by region and ethnicity. Regionally, the south (28%) led the way for physical inactivity followed in order by the Northeast (25.6%), Midwest (25%), and West (20.5%). Race and ethnicity showed Hispanics were least likely to engage in physical activity (31.7%), follow by blacks (30.3%), and non-Hispanic whites (23.4%). Cultural norms and perhaps socio-economic stresses also contribute to the variation in physical activity.

Inactivity is a major contributor to obesity which, in turn, ruins health. “Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity,” published in December 2019 in the New England Journal of Medicine [4] predicts that half of Americans will be overweight or obese by 2030. Again, tremendous regional and ethnic variations exist.

The south again, unfortunately, leads the march to obesity exacerbated by adults with an annual household income of less than $20,000 according to this same article. Generally, non-Hispanic white adults are less obese than non-Hispanic blacks and Hispanic adults.

Our next generation’s health, highly affected by the infrastructure of communities, is paramount. Adequate and appropriate supply of parks, playgrounds, green spaces, healthy food, and safe streets, along with home ownership, health insurance coverage, and other socio-economic factors has been challenged over the past few decades. Children’s success in later life, economic mobility, stress levels, life expectancy, and overall satisfaction vary greatly depending on the community where one grows up.

Changing the built environment to encourage moving naturally, forming friendships, and connecting with family are three goals that should be instituted as preventative “therapies” to not only treat midlife mortality but also act as positive influences for physical, emotional, and spiritual success.

Turning to traditional healthcare solutions focused on a repair shop mentality adds to the frustration. Our nation is the best in the world at treating complex disease but among the worst at preventing chronic illnesses.

“Moon shots” exist. As one example, Brandeis University and Ohio State University developed a “comprehensive and useful tool for people who are working to improve the lives of vulnerable children and promote racial/ethnic equality” entitled Child Opportunity Index 2.0 [5]. As another example, over 3.5 million folks in fifty Blue Zones communities across North America are already on a trajectory to become healthier. These regions address policy, places, and people to nudge individuals, organizations, communities, and entire states.

In 1961 JFK challenged, “I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man to the moon and returning him safely to earth.” To amplify JFK: Some believe that this nation should commit to extending life expectancy for all Americans before this new decade is out.

Sources

1. Woolf, Steven H. “Life Expectancy and Mortality Rates in the United States, 1959-2017.” JAMA. American Medical Association, November 26, 2019. https://jamanetwork.com/journals/jama/fullarticle/2756187.
2. Jiaquan Xu, M.D., Sherry L. Murphy, B.S., Kenneth D. Kochanek, M.A., and Elizabeth Arias, Ph.D., “Mortality in the United States, 2018,” January 2020. https://www.cdc.gov/nchs/products/databriefs/db355.htm#ref1
3. “CDC Maps America’s High Levels of Inactivity.” Press Release January 16, 2020. https://www.cdc.gov/media/releases/2020/0116-americas-inactivity.html
4. Zachary Ward, M.P.H., Sara Bleich, Ph.D., Angie Cradock, Sc/D., Jessica Barrett, M.P.H., Catherine Giles, M.P.H., Chasmine Flax, M.P.H., Michael Long, Sc.D., Steven Gortmaker, Ph.D., “Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity” NEJM, December 19, 2019. https://www.ncbi.nlm.nih.gov/pubmed/31851800.
5. “DiversityDataKids,” Heller School for Social Policy and Management at Brandeis University. http://www.diversitydatakids.org/child-opportunity-index