The Health of the Nation — Scaring people isn’t healthful

The just released report on the health of the nation, Health, United States, 2007, published by the U.S. Department of Health and Human Services, brought lots of good news. The trouble is, most Americans didn’t hear it. Instead, we continue to be inundated by a continual drumbeat of negative, and worrying reports about the frightful state of our health. We’re told of an “obesogenic” environment, our unhealthy diets and lifestyles, and weights that threaten to shorten our lives and give us and our children chronic diseases. Yet, the facts certainly don’t support these warnings.

Can all of this fear-driven news possibly be good for us?

Surprisingly, amidst all of the wonderful, good news and positive trends about our health evidenced in the CDC stats, there were two main exceptions that suggest today’s climate of fear, and focus on obesity, might not be altogether benign.

Drug use

According to Health US 2007, just since 1995, the number of prescription drugs taken by Americans overall has increased by 71%. By 2002, 45.3% of all Americans (not in institutions) had been taking at least one prescription drug during a one-month period, more than 50% of women and about 40% of men. A stunning 20.4% of women take three or more different prescription drugs in a month, compared to 14.8% of men.

Prescription drug use rises with age and about 85% of those 65 years and older took at least one prescription drug in a month in 2002; and about 52% of them took three or more. The total number of drugs taken per 100 people 65 years and older, for example, increased from 1,047 in 1995-6 to 1,982 in 2004-5.

Antidepressants make up the largest percentages of drugs prescribed for Americans, followed by drugs for hypertension and cholesterol. Prescriptions for antidepressants have dramatically increased, more than tripling among adults just between 1988-94 and 1999-2002 — going from 2.5% to 8%. Usage among women is twice that of men and rose from 3.3% to 10.6%. One in ten women are on antidepressants. [As many women know, the medical literature is increasingly reporting that weight gain also appears a side effect of many anti-depressants.] As the HHS report states:

Prescriptions for antidepressants have been rising, associated with the introduction in 1988 of a new class of drugs known as selective serotonin reuptake inhibitors (SSRIs) . Current SSRIs include the brand names Celexa^®, Lexapro^®, Luvox^®, Paxil^®, Prozac^®, and Zoloft^®. In addition to their use as antidepressants, SSRIs are approved and marketed for the treatment of other mental disorders including obsessive compulsive disorder, panic disorder, anxiety disorders, and premenstrual dysphoric disorder. The substantial increase in prescriptions for antidepressants also suggests widespread "off-label" (other than FDA-approved uses) use for subsyndromal mental health conditions and a variety of physical disorders.

Medicating us wasn’t the only indication in this report of higher rates of stress and anxiety. Suicide attempts among high school students have increased since 1991, rising overall to 8.4% (an increase from 7.3% in 1991). The percentage of deaths by suicide among all adults under age 75 are lower than in 1980, but rates of suicide deaths remain nearly double that of deaths from strokes, respiratory diseases, liver disease, diabetes, HIV or diabetes.

Low birthweight babies

Among our youngest citizens, increasing numbers weigh too little. According to the HHS report, since 1985 the percentage of babies born low birthweight (LBW) has been continually rising, increasing from 6.75% of births to 8.08% in 2004. Preliminary data for 2005 show rates for LBW babies rising further to 8.2%.

Babies born weighing less than 2,500 grams (5.5 pounds) “is associated with elevated risks of death and disability in infants,” according to the HHS report. Babies born under 2,500 grams have 25-fold higher risks of dying in infancy compared to babies over 2,500 grams.

Health US 2007 didn’t include the latest CDC statistics released on premature babies, as were recently examined here in detail. According to the CDC’s data, the percentage of babies born prematurely (not just small for gestational age) in our country has increased 20-29% over the past 15 years, while those born at term have declined 15%. Premature births are increasing among all racial/ethnic groups and among singleton births, too.

These small babies are much more vulnerable to long-term complications such as cerebral palsy, mental retardation, chronic lung disease, vision and hearing loss, learning difficulties, and poor growth and development, according to the July 2006 Institutes of Medicine report “Preterm Birth: Causes Consequences and Prevention.”

This HHS report gave some indication of those possibly related disabilities and the toll on these young lives, showing an increase of physical limitations among children. With a cautionary reminder that increases can partly reflect heightened surveillance and identification, among those under 5 years of age, such conditions went from 3.5% in 1997 to 4.3% in 2005, and rose to 8% among school-age children. The primary disabilities suffered by preschool children were speech problems, breathing problems and mental retardation or other developmental problems. By elementary school age (5-11 years), the primary problems were speech problems, learning disabilities, behavioral problems and mental retardation or other developmental problems.

But the HHS report and its Executive Summary of policy recommendations didn’t give note to these trends. What might be contributing to rising rates of LBW babies? To investigate this question, the report offered some clues, while simultaneously leaving out entirely information on other major contributing factors.

Stress and anxiety. As the surge in antidepressants and anti-anxiety prescriptions indicates, women are feeling increasingly stressed, which is associated with a two-fold increase in LBW babies and nearly 2.5 times the risks for premature babies.

Prenatal care. Prenatal care doesn’t appear a major cause for the population-wide increases in rates of LBW babies, as prenatal care across all ethnic groups has been steadily increasing since 1980. While there have always been distinct racial disparities, the gap is also narrowing. Still, rates of low birthweight babies continue to be highest among Black/African Americans, who also have lower rates of prenatal care (76%) compared to Whites (85%).

Smoking/substance use. Another risk factor identified with LBW babies, maternal smoking during pregnancy, has also dropped by nearly half among all groups. So, it’s another unlikely contributing factor for the increases in LBW babies.

Maternal age. Women are having babies later in life, which is increasingly being identified as possibly playing a role in LBW trends. The age of women giving birth has steadily increased from 1980, according to the HHS report. In 1980, 12.7% of births were among women 25-29 years of age, 9.6% among ages 30-34; and 3.8% among women 35-39 years of age. By 2004, those percentages had shifted to 10.8%, 11.7% and 6.2%, respectively. And by 2004, 1.4% of births were among women 40-44 years of age.

Multiple births. All races have shown a steady increase in the number of twin or higher multiple births, another major contributing factor to LBW babies. Twin births nearly doubled from 1971 to 2004, increasing from 1.78% to 3.22% of live births. Triplets or higher multiple births increased 6-fold, from 0.029% to 0.177%. The percentage of twin births to older mothers between the ages of 35 and 44 doubled from 1971 to 2004; while the triplets and multiples born to older mothers increased 10-fold.

Infertility treatments. While not included in Health United States, according to the June 8, 2007 issue of the CDC Morbidity and Mortality Weekly Report, the use of assisted reproductive technology (ART) has soared since its introduction in 1981. The number of procedures doubled between 1996 and 2004, as did the number of babies born through ART, half of which are multiple birth deliveries. “Approximately 1% of U.S. infants born in 2004 were conceived through ART. Those infants accounted for 18% of multiple births nationwide. Approximately 9% of ART singletons, 56% of ART twins, and 95% of ART triplets or higher-order multiples were low birthweight,” said the CDC, with similar rates of premies.

Weight concerns. Among the other omissions in this report, the CDC keeps no records of dieting behavior and weight concerns among young women of childbearing age; nor did it report on pregnancy weight gain, all of which are shown factors for underweight babies.

While the government and HHS turns its attention on negative public messaging and programs to combat obesity — for which its own data shows no evidence of a public health crisis nor is there any proven way to prevent or eradicate the natural diversity of our sizes — less politically popular health issues receive little notice.

Maybe, rather than focusing on made-up issues, giving the public factual, evidence-based information and turning the panic dial down might help everyone be even healthier.