The Health of the Nation — Did you hear the good news?
The U.S. Department of Health and Human Services released its 31st report on the health of the nation ... last week. This long-awaited report is always big news and dominates headlines ... but no longer. It seems the news is too good and we’re just too darn healthy to stir up much excitement. Nor do the facts support the need for another report issued by the HHS this past week: it’s latest budget.
Health, United States, 2007 is a compilation of more than 150 health indice tables from the CDC’s NationalCenter for Health Statistics and examines every aspect of the nation’s health, mortality and life expectancy, as well as health trends going back to 1950. This exhaustive report is issued each year to the President, Congress and “those entrusted with safeguarding the Nation’s health.”
Health, United States forms the foundation — or is supposed to — for “making sound health policy and setting research and program priorities.” More importantly, it identifies diseases and conditions that “warrant study and intervention” and provides the “essential information for determining how the Nation’s resources should be directed to improve the population’s health.”
Since media didn't read the 551 pages and report the good news, let’s look at its key health findings.
First of all, major changes have occured in the population of our country, most notably over the past half century. These are important to keep in mind anytime we’re looking at statistics of trends over the decades because we’re looking at very different populations. Older. Foreign born. Diverse. We’re becoming an extraordinarily more diverse population. The percentages of Hispanic or Asian minorities have each more than doubled just since 1980. Racial or ethnic minorities now represent 30% of adults and 40% of children. The big news: Our life expectancy has hit another record high. We are living longer than at anytime in the history of our country. Babies born in 2004 can expect to live 75.2 years if male and 80.4 if female. In contrast, Babyboomers born in 1950 had a life expectancy of 65.5 and 71 years, respectively. And our grandparents born in 1900 had a life expectancy of a mere 48 and 51 years, respectively. Compared to babies born in 1990, boys today are expected to live 3.4 years longer and girls 1.6 years longer. Despite all of the doomsday speculations, our children today are not sicker or expected to live shorter lifespans than their parents. There simply is no good evidence. Young people — from infancy through teen years — were about 60% less likely to be in fair to poor health in 2005 (1.8%) compared to kids in 1991-1995. An overwhelming majority — 98.2% — of today’s young people are healthy. Infant and neonatal mortality rates continue to drop and are 6.8 and 4.5 per 1,000 births, respectively. In contast, rates were about 4.5 times as high in 1950. As other CDC data recently reported here showed, infant mortality has dropped nearly 99% from 1900 through 1997. Age-adusted death rates (per 100,000 people) for heart disease have gone from: 586.8 in 1950 to 321.8 in 1990 to 217 in 2004 Age-adjusted death rates for cancers have gone from: 216 in 1990 to 185.8 in 2004 Age-adjusted death rates for strokes have gone from: 180.7 in 1950 to 50 in 2004 The leading cause of death differs by age, of course. While rates have dropped, the causes haven’t notably changed for decades. The leading cause of death for infants is congenital malformations, for people 1–44 years of age it’s unintentional injuries, for ages 45–64 it’s cancer, and for those 65 years and older it is heart disease. But with increasing numbers of us living into advanced ages, we are living long enough to succumb to things like lower respiratory infections and alzheimer’s, which are now the 4th and 5th cause of death among those over age 65. The leading cause of death for young black males remains homicide, but rates decreased sharply from the 1990s and remained stable since. Still, the bottom line is that, after infancy, old age is the single biggest risk for dying. In 2004, the death rate was: 0.08% for ages 18-24 (38% lower than in 1950) 0.19% for ages 35-44 0.42% for ages 45-54 0.91% for ages 55-64 (52% lower than in 1950) 2.16% for ages 65-74 5.27% for ages 75-84 13.82% for ages 85+ (32% lower than in 1950) Dying of cancer is one of the biggest fears for young adults, but it can be reassuring to realize that, despite the media portrayals, cancers are primarily diseases of aging. Overall death rates from cancers are 0.09% for ages 25-34 years and don’t even cross above 1% until age 75+. The percentage of people who report being in fair to poor health in our country has dropped by more than 10% since 1991 — going from 10.4 to 9.2% in 2005. In other words, nearly 91% of Americans are in good or excellent health. And most all children and teenagers (98.2%) today are reported to be healthy. The percent of Americans of all ages with untreated dental caries has dropped dramatically since 1971. Among children 6 to 19 years of age, for example, the percent has gone from 54.7% in 1971 to 22.9%. Among seniors age 65 to 74 years of age, it’s gone from 29.7% to 16.6%. The percent of American adults who smoke cigarettes has dropped in half since 1965, to 20.8% in 2005, and is highest among men (23.4%). Rates for all reportable communicable diseases have dropped dramatically since 1950; the only increase seen among the population since 1990 has been pertussis (whooping cough) which has gone from1.84 cases/100,000 to 8.72/100,000. The age-adjusted death rate for HIV disease continues to drop since 1995, reaching 4.5 cases/100,000 in 2004. The highest rates are among 35 to 54 year old males and Black or African Americans. Indications of health habits among high school students recorded in this report have shown improvements, including lower rates of illicit drug use and drinking. Smoking rates have decreased by one-third just since 1997. Fewer teens are having babies. Among those under 18 years of age, birth rates were 6.3% in 1970 and down to 3.4% in 2004. Preliminary data, according to the report, shows the teen birth rate in 2005 dropped another 2% since 2004. Overall, the actual health and life expectancies for Americans have greatly improved, yet the Executive Summary downplayed the good news. Instead, it stated: Yet, even as progress is made in improving life expectancy, increased longevity is accompanied by increased prevalence of ... You guessed it, overweight. In fact, just a week ago, the biggest overweight and obesity prevention initiative by the HHS to date was announced at the National Prevention Summit. As the overall health and life expectancies of Americans of all ages have reached new heights, deaths from the leading causes of deaths have dropped, and virtually all of us are in good to excellent health for our age, the focus of HHS' Executive Summary is on our weight? The core of HHS initiatives remains on “the high prevalence of people with unhealthy lifestyles and behaviors, such as insufficient exercise and overweight, which are risk factors for many chronic diseases and disabilities...” Where is the evidence for such programs? More than 500 pages and 50 years of their own statistics illustrated that those apparent bad behaviors and weights and “risk factors” are associated with improved health and longevity. Why the continued focus on fear-driven bad news and attempts to heighten anxieties over the dire state of our nation’s health? While it may help to convince the American public or legislators of the need for an ever increasing HHS, in size and powers, the costs are rarely mentioned. Consumers, given the full picture, might see things differently. The but…. next.
Most significant, is that while our population has grown by 145 million since 1950, at a rate of 1.2% a year, it has grown considerably older. Those of us over the age of 65 have grown 2% a year and those over 75 years of age have grown even more, 2.8% a year. 
We’re also a country with increasing numbers of new immigrants. Just since 1970, the percentage of foreign-born people living in the U.S. has more than doubled and is growing faster than naturalized citizens. Foreign-born now represent 7.3% of our population.
Life Expectancy
Good news for parents
Far fewer percentages of our children are sick or die today. Children under one year of age and those through age 14, were nearly half as likely to die in childhood in 2004 than they were in 1980. And compared to children born in 1950, today’s young children are nearly 5 times less likely to die in childhood.
Death rates
Overall, age-adjusted mortality for the leading causes of death have been cut nearly in half since 1950, with significant decreases continuing over recent decades. Heart disease, the leading overall cause of death, dropped by one-third just between 1990 and 2004; cancers, the second leading cause of death overall, decreased 14%; and strokes, the third leading cause of death, decreased by 72%.
General health 
Since 1997, the CDC has been monitoring the physical limitations of activity caused by chronic conditions. Those rates for all ages, both crude and age-adjusted, have steadily dropped since 1997. Physical limitations are age-related, however, with the highest rates among those 75+ years of age. The primary cause of activity limitation remains arthritis and other musculoskeletal conditions, followed by mental illness. Overall, rates of physical limitations have dropped from 13.3% in 1997 to 11.7% in 2005. Age-adjusted rates for vision and hearing limitations have also dropped, going from 10% to 3.5%.
Teens
Good news is bad?
The HHS “is one of the largest, most complex financial organizations in the world,” according to last week’s press release announcing its financial report. It operates more than 300 programs, is the nation’s largest health insurer, and is the federal government’s largest grant-making agency. The HHS Fiscal Year 2007 budget was just audited and showed that the HHS is spending more than $650 billion this year ... of taxpayer money. “Our role is to protect the health and well-being of Americans,” said HHS Secretary Mike Leavitt. This financial report was said to present its “high-level performance” relative to its mission.
© 2007 Sandy Szwarc
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