3 Reasons Why Americans Die Young

here’s yet another story about our lagging health indicators in the U.S. This one is an article titled, “Major Causes of Injury Death and the Life Expectancy Gap between the US and Other High-Income Countries” published in the February 9, 2016 issue of the Journal of the American Medical Association. It turns out we have a lower life expectancy at birth — not because we are dying of diseases that mainly affect the greater than 50 crowd, but because of increased mortality at younger ages.

The researchers compared life expectancy at birth in the U.S. to twelve high-income countries: Austria, Denmark, Finland, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden, and the UK. People in the comparison countries were expected to live 2.2 years longer than in the U.S. (men 78.6 years vs 76.4 and women 83.4 vs 81.2 years).

Screenshot of Table 1 from “Major Causes of Injury Death and the Life Expectancy Gap between the US and Other High-Income Countries” JAMA 2.9.16

Injury deaths

Firearm-related deaths accounted for 21% of the gap in U.S. men accounting for 28,836 deaths compared with only 2,734 in the comparison countries. The statistic for U.S. women is 4,724 vs only 191 in the other countries (4% of the gap).

Hmmmm….it appears guns DO kill people. And, they kill more people in our country because (duh!) we have more guns per capita (112.6 guns per 100 residents compared to the Cyprus, number two on the list, with a paltry 69.7). The comparison country with the most guns per 100 is Switzerland with 45.7, this number includes personal weapons of the militia, which, according to the report, are not equipped with ammunition at home. Omitting those, the Swiss only have 25 guns per 100 residents.

Drug poisonings, both from illicit and non-illicit drugs, contributed 14% and car crashes 13% to U.S. men’s life expectancy gap. Altogether, guns, drugs and crashes contributed 48% or 1.02 years to the life expectancy gap in men and 19% or .42 years of the gap in women.

Drug poisonings

Drug poisonings are the largest cause of U.S. injury death when data from men and women are combined (the largest cause in men only is guns) accounting for 14% of the gap in men and 9% in women. The authors of the article speculate this may be because of the extraordinary epidemic of prescription opioids that we are now experiencing. In fact, drugs overdoses were cited in an article in the New York Times as one of the reasons that death rates are rising in middle-aged white men in America.

I wonder, is this in turn the consequence of the big push over the last decade to have doctors be more aggressive in treating chronic pain? It’s hard to say, but I bet it is also because of the under-prescribing of alternatives to opioids such as non-opioids (gabapentin, NSAIDs, THC, and others), acupuncture, medical massage, mindfulness techniques, and other complementary and alternative medicine (CAM) interventions.

Car crashes

After years of decline, deaths from motor vehicles crashes are again on the rise. Part of the reason is that we are driving more because of an improving economy and cheap gas prices. Another reason, as highlighted in an article in Newsweek, is texting while driving. This all too pervasive habit raises the likelihood of a crash by 8 times. Crashes involving texting or talking on a cell phone (hands-free or handheld) account for 27% of all accidents. And then, of course, there is the continuing problem of driving under the influence. Perhaps the way Uber and Lyft can really help healthcare is to get us out of the driver’s seat…as long as their drivers aren’t loaded, of course.

The bottom line

Many injury deaths are preventable, but it would require tackling head on the anti-science, anti-public health mentality (that has become so pervasive in the U.S. in recent years) head-on. That means we need to appropriately fund our public health institutions, in particular, the Centers for Disease Control and Prevention (CDC). And, we need to keep politics out of science — how many lives have been lost because of the NRA-led threat to defund the CDC if they continued doing firearm injury prevention research? We have to quit deriding public health programs as being part of a nanny state. Come on, don’t we want our public institutions to help us stay healthy and safe?? I know I do.

Lastly, we need to address the appalling health illiteracy in this country. It is very hard to improve our health indices when, for example, so many people still think autism is caused by vaccines despite reams of well-designed studies that have definitively proved otherwise.

Maybe I have gone too retro, but I yearn for the days when America and Americans were sincere when we said our children are our future. A time when we put our money where our mouths were and funded public schools and programs to get kids vaccinated (polio was virtually eliminated as a cause of death and disability during my childhood). Remember the days when you actually had a chance to pay back student loans before you retired, or you could aspire to become a doctor when no one else in your family ever graduated from college?

We can do this but first we have to want to. If the JAMA story doesn’t shame us into action, things will have to get even worse before we’re motivated to act. Maybe, just maybe, we have to start dying in the streets. Oh, wait, I forgot! That won’t happen if we elect The Donald. All we have to do is sit back and wait for him to “Make America Great Again.” Fools that we are!

That’s my opinion, what’s yours?

Originally posted on Epic Times.

Dr. Patricia Salber and friends weigh in on leading news in health and healthcare

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