{"id":44976,"date":"2019-07-03T16:16:00","date_gmt":"2019-07-03T15:16:00","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=44976"},"modified":"2019-07-08T20:48:46","modified_gmt":"2019-07-08T19:48:46","slug":"km-venkat-narayan-the-united-states-of-poor-health-reflections-on-the-fourth-of-july","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/07\/03\/km-venkat-narayan-the-united-states-of-poor-health-reflections-on-the-fourth-of-july\/","title":{"rendered":"KM Venkat Narayan: The United States of poor health\u2014reflections on the Fourth of July"},"content":{"rendered":"<p class=\"standfirst\">This Fourth of July, Americans need to face the facts of the country\u2019s declining health, says KM Venkat Narayan<\/p>\n<p><!--more--><span style=\"font-weight: 400\"><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/07\/KM_Venkat_Narayan2019.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-44982\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/07\/KM_Venkat_Narayan2019.png\" alt=\"\" width=\"187\" height=\"136\" \/><\/a>On this day 243 years ago, the Second Continental Congress approved the final text of the \u201cDeclaration of Independence.\u201d With this statement, the first 13 states that were to form the United States of American made a collective decision that was the start of a young and idealistic republic founded on the premise that \u201cAll men are created equal\u201d and are endowed with the \u201cunalienable rights\u201d of life, liberty, and the pursuit of happiness. It is worth taking stock of the state of health of this rather remarkable country, which so believes in its meritocratic and problem solving culture.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As part of the Fourth of July <\/span><span style=\"font-weight: 400\">celebrations, an estimated <\/span><a href=\"https:\/\/www.washingtonpost.com\/news\/wonk\/wp\/2016\/07\/01\/thousands-of-you-are-going-to-hurt-yourselves-with-fireworks-this-weekend\/?utm_term=.c0bc335a4016\"><span style=\"font-weight: 400\">285 million pounds of fireworks<\/span><\/a><span style=\"font-weight: 400\"> (costing over a billion dollars) will light up the skies, <\/span><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1352231015301369\"><span style=\"font-weight: 400\">temporarily raising airborne pollution by about 42%<\/span><\/a><span style=\"font-weight: 400\">\u2014 hardly a responsible statement given that climate change is one of the biggest threats of this century.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Celebrations around the Fourth of July will see <\/span><a href=\"https:\/\/cpsc.gov\/Newsroom\/News-Releases\/2019\/CPSC-Reminds-Consumers-to-Celebrate-with-Safety-This-Fourth-of-July-Season\"><span style=\"font-weight: 400\">thousands of people<\/span><\/a><span style=\"font-weight: 400\"> head to hospital emergency rooms with fireworks related injuries, and last year <\/span><a href=\"https:\/\/cpsc.gov\/s3fs-public\/Fireworks_Report_2018.pdf\"><span style=\"font-weight: 400\">four people<\/span><\/a><span style=\"font-weight: 400\"> were known to have died around this holiday period from these injuries . While these four unnatural deaths are four too many, the nation\u2019s <\/span><a href=\"https:\/\/www.gunviolencearchive.org\/past-tolls\"><span style=\"font-weight: 400\">annual toll from gun violence<\/span><\/a><span style=\"font-weight: 400\"> presents a truly shocking picture. Last year there were 57 338 gun incidents, 340 mass shootings, 28 227 injuries, and 14 760 gun related deaths of whom 668 were children aged 0-11 years and 2846 were teenagers aged 12-17 years. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The US leads the world with the highest number of people incarcerated\u2014nearly <\/span><a href=\"https:\/\/www.prisonpolicy.org\/reports\/pie2019.html\"><span style=\"font-weight: 400\">2.3 million people are in jail<\/span><\/a><span style=\"font-weight: 400\">, with some race minority groups disproportionately represented. For example, <\/span><a href=\"https:\/\/www.naacp.org\/criminal-justice-fact-sheet\/\"><span style=\"font-weight: 400\">34% of people in prison are African American<\/span><\/a><span style=\"font-weight: 400\">, even though this group makes up <\/span><a href=\"https:\/\/www.census.gov\/quickfacts\/fact\/table\/US\/PST045218\"><span style=\"font-weight: 400\">only 13%<\/span><\/a><span style=\"font-weight: 400\"> of the total US population.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">While almost all of the countries of the world are experiencing rapidly increasing life expectancy, the US\u00a0 has experienced <\/span><a href=\"https:\/\/annals.org\/aim\/fullarticle\/2724339\/ominous-reversal-health-gains-united-states-time-rethink-research-priorities\"><span style=\"font-weight: 400\">a decline in life expectancy for four years in a row<\/span><\/a><span style=\"font-weight: 400\">. This phenomenon is driven by rising mortality rates during middle age, which were first observed in 2015 among white men, but are now more pervasive. People who identify as white, Hispanic, Asian, or as being from the Pacific Islands are all showing a downward trend in life expectancy. Many of the conditions contributing to rising midlife mortality rates are potentially preventable and include opioid and substance abuse, poor mental health, homicides, suicides, hypertensive disease, metabolic disorders, some cancers, and chronic respiratory disease. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Furthermore, the gaps in life expectancy between <a href=\"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2626194\">the richest and poorest Americans is about 20 years<\/a>\u2014with the poorest people in the US having a life expectancy <a href=\"https:\/\/annals.org\/aim\/fullarticle\/2724339\/ominous-reversal-health-gains-united-states-time-rethink-research-priorities\">similar to people<\/a> in Niger, the Congo, and Afghanistan. The US, with <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/68\/wr\/mm6818e1.htm?s_cid=mm6818e1_w\">17.2\u00a0 deaths per 100 000<\/a> live births, also has the <\/span><a href=\"https:\/\/www.bmj.com\/content\/365\/bmj.l2169\"><span style=\"font-weight: 400\">highest maternal mortality<\/span><\/a><span style=\"font-weight: 400\"> rate of all developed countries, and is among <\/span><span style=\"font-weight: 400\">a handful of countries worldwide<\/span><span style=\"font-weight: 400\"> where maternal mortality rates are increasing.<\/span><\/p>\n<p><span style=\"font-weight: 400\">More than <\/span><a href=\"https:\/\/www.cdc.gov\/nchs\/fastats\/obesity-overweight.htm\"><span style=\"font-weight: 400\">two thirds of American adults are overweight or obese<\/span><\/a><span style=\"font-weight: 400\">.<\/span><span style=\"font-weight: 400\"> Yet government policy still fails to curb the commercial forces that drive the excess consumption of fast food and a diet dominated by meat, foods high in sugar, and foods with fructose corn syrup. Americans ate nearly <\/span><a href=\"https:\/\/www.forbes.com\/sites\/michelinemaynard\/2018\/01\/02\/veggies-may-be-healthier-but-in-2018-americans-will-eat-a-record-amount-of-meat\/#21d055f419b9\"><span style=\"font-weight: 400\">100 billion pounds<\/span><\/a><span style=\"font-weight: 400\"> of meat in 2017. Each year, nearly <\/span><a href=\"https:\/\/www.hot-dog.org\/culture\/hot-dog-fast-facts\"><span style=\"font-weight: 400\">20 billion hot dogs are eaten<\/span><\/a><span style=\"font-weight: 400\">, almost 155 million on Fourth of July alone when the nation merrily indulges in celebratory picnics and barbecues, seemingly oblivious to the health and environmental impact of such heavy meat consumption.<\/span><\/p>\n<p><span style=\"font-weight: 400\">For a country that has achieved so much in its brief history, the US\u2019s current state of health presents grave threats. Despite spending <\/span><a href=\"https:\/\/www.commonwealthfund.org\/publications\/journal-article\/2018\/mar\/health-care-spending-united-states-and-other-high-income\"><span style=\"font-weight: 400\">17% of its GDP on healthcare<\/span><\/a><span style=\"font-weight: 400\">, on average, the US ranks poorly among high income countries on several <\/span><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/1710486\"><span style=\"font-weight: 400\">health indicators<\/span><\/a><span style=\"font-weight: 400\">. Furthermore, vast disparities in health persist and expand: the rates of <\/span><a href=\"https:\/\/academic.oup.com\/aje\/article\/184\/12\/933\/2548927\"><span style=\"font-weight: 400\">cardiovascular mortality<\/span><\/a><span style=\"font-weight: 400\"> and <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29233722\"><span style=\"font-weight: 400\">diabetes incidence<\/span><\/a><span style=\"font-weight: 400\"> are about 8 to 10 fold higher in the US\u2019s poorest counties compared with its richest counties. Only a fraction of these variations can be explained by healthcare factors, while sociopolitical factors, such as poverty, unemployment, and poor education, explain the largest proportion of health disparities.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">This Fourth of July, Americans need to wake up from their illusion of exceptionalism, and face the facts of the country\u2019s declining health with all the open minded innovativeness the country is known for. That would be true patriotism.\u00a0<\/span><\/p>\n<p><b><i>KM Venkat Narayan<\/i><\/b><i><span style=\"font-weight: 400\"> is Ruth and O.C. Hubert professor of global health and professor of epidemiology and medicine at Emory University Atlanta. He is a product of three continents, having lived and worked in India, United Arab Emirates, United Kingdom, and the US.<\/span><\/i><\/p>\n<p><strong>Competing interests:<\/strong> None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>This Fourth of July, Americans need to face the facts of the country\u2019s declining health, says KM Venkat Narayan [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/07\/03\/km-venkat-narayan-the-united-states-of-poor-health-reflections-on-the-fourth-of-july\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":44994,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1357],"tags":[],"class_list":["post-44976","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-us-health-care"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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