A Healthier Tomorrow – February 2019

A Healthier Tomorrow – Chronic Disease is Killing Us

Imagine a Healthier Tomorrow

By Alison H. Page

Health care costs in our country are out of control.  In poll after poll Americans site the cost of health care and the availability of health insurance as a top priority for elected officials to address.  Democrats argue that health care is a basic human right and providing health care services is a collective responsibility of our society.  Republicans argue that health care, like other businesses, should function like a competitive market in which individuals and businesses make choices based on quality and service to control costs. Every couple of years we drop a vote in the ballot box for the candidates who align with our beliefs. The problem with both positions is that they ignore the greatest factor influencing the cost of health care; the real cost culprit is chronic disease. 

As individuals, we tend to think about the cost of health care in terms of our own experience; the cost of our last doctor visit or the total out-of-pocket cost for a hip replacement.  Efforts abound to try to contain the direct cost of health care services to people, but it is not enough.  Regardless of what employers, insurance companies, hospitals and doctors do to try to control costs, it won’t be enough.  Why?  Because chronic disease is killing us, literally and financially.  Chronic disease is on the rise.  The care is costing a fortune and the cost to society and business in terms of lost productivity is tremendous. 

Step with me if you will to the 20,000-foot level to look at the cost of chronic disease to society.  The Center for Disease Control (CDC) reports that 90% of the nation’s 3.3 trillion in health care expenditures goes to treat people with chronic health conditions (e.g. heart disease and stroke, cancer, diabetes, obesity, arthritis, Alzheimer’s disease, epilepsy and tooth decay).  

Nothing kills more Americans than heart disease and stroke. More than 810,000 Americans die of heart disease or stroke every year—that’s one-third of all deaths. These diseases take an economic toll, as well, costing our health care system $190 billion per year and causing $126 billion in lost productivity on the job.

Here’s another example – More than 29 million Americans have diabetes, and another 86 million adults in the United States have a condition called prediabetes, which puts them at risk for type 2 diabetes. Diabetes can cause heart disease, kidney failure, and blindness, and costs the US health care system and employers $245 billion every year.  

I could go on and on, but what can be done about it?  America’s chronic disease crisis is not inevitable.  We can change course. 

Medical care has long been focused on the science of individuals, or groups of individuals.  We have researched how to best treat disease by looking inside people and gauging biological response to various medications and treatments.  This is good for those who suffer from disease but does little to prevent the disease from occurring in the first place.  As it turns out, the key to reducing chronic disease resides outside the world of traditional medical research. 

Clayton Dalton, MD, a physician from Boston, MA, shared this perspective in a recent article posted on bluezones.com that looked at traditional cultures across the globe, from hunter-gatherers to pastoralists to horticulturists.  These cultures have shown little evidence of chronic disease. It’s not because they don’t live long enough – recent analysis has found a common lifespan of up to 78 years among hunter-gatherers, once the bottlenecks of high mortality in infancy and young adulthood are bypassed. We can’t blame genes, since many of these groups appear to be more genetically susceptible to chronic disease than those of European descent.

Evidence suggests it is how they live. Though traditional cultures span an immensely diverse gamut of lifestyles, they share a common denominator defined by the absence of modern banes: absence of processed foodstuffs, absence of sedentary lifestyle, and likely absence of chronic stressors.

Indeed, evidence suggests that lack of chronic disease in these groups flows from how they live, how they move, how they eat. Diet looks to be an especially powerful driver – adoption of a Western diet, rich in processed foods, has mirrored the development of chronic disease worldwide, and prospective studies with healthy and diabetic subjects have documented the powerful influence of food on health. Physical exercise, long touted as merely a means to calorie disposal, turns out to have complex endocrine and metabolic effects on insulin signalling, stress response, sleep, mental health, and even neuronal function in the brain. What the science seems to say is that an ancestral way of life aligns the machinery of our metabolisms toward good health.

Thus, it appears that our bodies aren’t, after all, destined for chronic disease as they age – rather, it is the environment we’ve put them in that should bear the blame.

As Dr. Dalton points out, our ship is sinking, and the current approach is akin to bailing with a thimble. If we are to stem the rising tide of chronic disease, we must alter the elements of our environment that promote chronic disease. With the global price tag of chronic disease projected to rise to $30 trillion by 2030, we simply can’t afford not to.

As it turns out, the decisions we make about what to put in our ice box are really more important to controlling health care costs than the decisions we make in the ballot box!