Medical care in the United States is extremely expensive. We spend 3.8 trillion dollars annually (11,000 dollars per person). Other nations spend less than half of that (5,000 per person). In spite of this, life expectancy has gone down to 77 years old, infant mortality is high for a developed nation, and maternal mortality is very high. Why are our costs so high, and our results so mediocre?
The United States does not have a health care system, it has a disease-care system. We wait for you to get sick, and then we treat you with the best and most expensive technology. The goal of a health care system is to prevent diseases from occurring (e.g. polio), or screen for them for early diagnosis.
The three most common causes of death are:
- Vascular disease:
It causes heart attacks and strokes and results in 800,000 death per year. It may be related to a genetic tendency, a diet high in saturated fat, sugar, and salt, tobacco, hypertension, diabetes, and an inactive lifestyle.
It results in 600,000 death per year and is caused by many factors, including genetic tendency, tobacco, alcohol, exposure to certain chemicals and drugs, and obesity.
Injuries cause 250,000 deaths per year, and, tragically, most of these are young people. It includes 93,000 deaths from drug overdoses, 48,000 suicides, 38,000 automobile accidents, and 38,000 gun-related deaths.
Suggestions to prevent or delay these diseases include the following Dos:
- Do know your family history. Many diseases run in families. For women with strong family histories of breast or ovarian cancer, genetic studies can be done. Strong family histories for heart disease, hypertension, diabetes, thyroid disease, colon, and prostate cancer should also prompt regular screening.
- Do have a healthy diet. Calories should not be excessive. Foods should be low in saturated fat, salt, and sugar. Read the labels, and do your own cooking. Avoid fad diets; they are unhealthy. Don’t eat unless you’re hungry. Avoid restaurants that serve high-fat meals. No liquid calories except water and 1% or skim milk. Daily caloric needs are 1500 to 1800 calories for a woman and 1800 to 2200 calories for a man. If you have just one 12 oz can of coke (or fruit juice or wine or beer) daily you will gain 14 pounds in a year.
- Do Exercise. There are three types of exercise: aerobic, strength training, and stretching. Sports is not exercising. Waiting in the right field for a fly ball has no cardiovascular benefit. Five times a week you should do aerobics (fast walking, jogging, biking, or rowing). Three times a week do weights and stretching.
- Do take recommended screening tests for common cancers (colon, breast, and prostate).
- Do take all recommended vaccines.
Now for the Do Nots:
- Don’t smoke or use tobacco in any form. In the USA, smoking causes 480,000 deaths per year with health care costs of 300 billion dollars. Smokers live an average of 10 years less than non-smokers. Smoking causes cancer of the lung, throat, and bladder, and heart disease, COPD, and stroke.
- Don’t drink. Each year 95,000 people in the USA die of alcohol-related causes at a cost of 250 billion dollars. There is no safe form of alcohol. Alcohol is addictive (30% of people who drink will have an alcohol disorder at some time in their lives). Alcohol is associated with 13 different cancers, cirrhosis, pancreatitis, and heart disease. Even moderate drinking is unsafe. One study found that women who have 8 drinks per week had a 50% increase in breast cancer.
- Don’t do drugs. All drugs are poisons, Oxycontin, prescription medication is highly addictive and may lead to addiction in as little as 4 or 5 days. Heroin and cocaine are often mixed with cheap fentanyl, a highly dangerous drug that causes many fatal overdoses. Last year 93,000 young people died of drug overdoses.
- Don’t be sedentary. An inactive lifestyle doubles the risk of heart disease, diabetes, and obesity. It increases blood pressure, and the risk of colon cancer, osteoporosis, and depression.
Why do, or don’t do all these things? A recent study showed that people who didn’t smoke or drink, ate a healthy diet, maintained healthy body weight, and exercised 5 or more times per week lived 12 to 16 years longer (88 to 92 years of age). So, what is better for you, a disease care system or a health care system?
David Lowe, MD, is an Infectious Disease Specialist and Hospital Epidemiologist, Kent Hospital and Women & Infants Hospital.