Here's to Your Health

Americans Are Posting Gains in the Most Vital Statistic of All

Last month the United Health Foundation released the 2006 version of "America's Health Rankings," accompanied by commentaries from Health and Human Services Secretary Michael Leavitt and officials from national public health organizations. The rather pessimistic assessment was summed up in the foreword: "To our dismay, this year's report once again documents the lack of significant progress in improving health status, a trend we first noticed in 2000."

It is easy to see why the foundation didn't find improvements in the health status of Americans. Scores and rankings were based on 18 individual components, 14 of which were designed to affect the results in a negative way. This scoring system emphasizes areas that need improvement, but it is less likely to reveal positive trends.

In fact, very good news about the health of Americans is revealed, somewhat ironically, by information about the 2.5 million deaths occurring annually in the United States. The National Center for Health Statistics calculates the rates at which Americans die from numerous causes, and the richly detailed, precise and accessible data provide an excellent index with which to evaluate trends regarding the health and longevity of Americans.

Last year NCHS officials released a report, which received very little attention, indicating that Americans experienced an extraordinary decline in mortality, and an increase in life expectancy, between 2003 and 2004 (the latest year for which figures are available). Mortality rates in the United States have declined substantially for decades, but the decline that occurred in just this one year was astounding. The death rate from all causes combined dropped 3.8 percent; diseases of the heart fell 6.6 percent, strokes declined 6.5 percent and the cancer rate dropped 2.3 percent.

Life expectancy at birth increased by three-tenths (0.3) of a year, to an all-time high of 77.8 years. One NCHS official, apparently surprised by the magnitude of this change, said, "We're scratching our heads a bit."

We were also surprised, but only by the fact that such good news received so little attention. Here are some insights regarding the big picture:

· The increase of life expectancy of 0.3 year in just one year equates to a three-year gain per decade. That is 50 percent larger than the average gain in recent years, which was 0.2 year, or about a two-year gain per decade.

· The 0.3-year increase was distributed unequally, with black men gaining 0.5 year, followed by white men (0.4), white women (0.3) and black women (0.2). This is evidence that, although still present, the racial gap is closing. The 0.5-year increase among black men is a gain of historic proportions. It is important to point out that black women have had a longer life expectancy than white men since 1967.

· The bulk of the increase in life expectancy continues to occur among adults over age 40. Before 1950, life expectancy increases were largely due to reductions in deaths occurring in infancy and childhood. Since 1950, however, adults have been the beneficiaries of longevity increases because of improvements in the quality of and access to medical care, disease prevention and smoking reduction, and generally higher standards of living.

Further, NCHS statistics for the past five available years illustrate a decades-old pattern of plummeting death rates for all major diseases. During that period all cancer rates dropped 8 percent (colorectal cancer fell 14 percent; breast cancer, 11 percent; and prostate cancer, 16 percent). Heart diseases declined 18 percent; stroke, 19 percent; and flu-pneumonia, 13 percent.

With all this good news, it is puzzling why some health experts continue to be pessimistic. As Secretary Leavitt suggested, the United Health Foundation report shows "where improvement is needed." But there is irrefutable evidence that our medical and social system, despite its limitations, continues to provide Americans with longer and healthier lives.

Brad Rodu is a professor at the University of Louisville School of Medicine. Philip Cole is professor emeritus in the School of Public Health at the University of Alabama at Birmingham.