The U.S. is one of the wealthiest nations in the world but its citizens are far from the healthiest. In fact, the U.S. lags behind several other developed nations in life expectancy and other population health measures. These disparities persist despite the fact that the U.S. spends more money per capita than any other nation on healthcare delivery.
So what should the U.S. do to improve the health of its citizens? According to a new book by Arizona State University and Mayo Clinic health experts, what is needed is a new frame of mind when it comes to individual health behaviors, especially in regard to diet and exercise.
In "A Roadmap to Better Health," authors Dr. Michael Joyner, Mayo Clinic; Natalie Landman, Robert Smoldt, Adrienne White and Dr. Denis Cortese, all of Arizona State University, say the country is suffering primarily from chronic medical conditions such as heart disease, obesity and type-2 diabetes. These non-communicable diseases are largely the result of individual behaviors and lifestyle choices made in the context of low physical activity and high calorie diets.
The authors provide a roadmap to address lifestyle factors that are best for "health span" - the period of life free of chronic diseases. These lifestyle factors - better choices for diet and steady exercise - can help ensure the highest quality of health for the longest period of life.
"The overall health of individuals is much more dependent upon and a reflection of their personal behaviors than the healthcare they receive," said co-author Denis Cortese, a Foundation Professor and director of the ASU Healthcare Delivery and Policy Program, and emeritus President and CEO of Mayo Clinic. "Healthcare delivery can help when a person is sick, but personal behaviors go a long way to improving an individual's health and preventing the individual from needing healthcare in the first place."
The authors cited statistics on the U.S. at large to illustrate how behaviors are a key to living a healthy life. For example, despite significant progress in educating the public on the dangers of tobacco, there are still nearly 40 million Americans who regularly smoke cigarettes. In addition, more than a third of U.S. adults (35.7 percent) are obese and nearly 17 percent of U.S. children are classified as obese.
"The consequences associated with poor lifestyle choices such as sedentary behaviors, tobacco use and poor nutritional choices have resulted in an epidemic of preventable chronic diseases," said co-author Adrienne White, an instructor in ASU's School for the Science of Health Care Delivery. "The truly terrifying link however, is the socially contagious impact of these behaviors. The prevalence rate of obesity and type II diabetes we are seeing in U.S. children outlines the massive scope of this issue. They say 'it takes a village to raise a child,' and when presented with the alarming health issues facing our children today, it becomes clear that it's our societal responsibility to do better."
The authors suggest that to help individual citizens get on the right track, the country should focus on interventions, or "nudges," that make the healthy choice the default choice.
"There are no magic bullets in the fight for better health," commented co-author Michael Joyner, professor of anesthesiology at the Mayo Clinic, Rochester, Minn. "This is true for individuals and society as a whole. Fixing the health care system will only do so much. This is why we have to surround people with healthier lifestyle choices and encourage them to make these choices."
The authors also say that the best path to a healthier public is one that begins with a focus on physical activity since physical activity seems to compensate for other poor behavior choices, including smoking and obesity. The authors indicate that there are several things that can be done to promote physical activity. For example, environmental nudges to support physical activities would include re-introducing physical education classes and recess in schools. It also would include creating work environments that encourage people to walk 30 minutes each day.
Economic nudges could include varying health insurance premiums and/or deductibles based on the physical activity level and weight of an individual, and providing financial incentives for adhering to a physical activity regimen. Finally, educational nudges would include incorporating content around the importance of physical activities in school curriculum, and leveraging primary care office visits to educate patients on the importance of physical activities.
"The fundamental idea underpinning our book is that increases in most people's physical activity level is the key to both better individual and population health," added Joyner. "We hope this book stimulates discussion on common sense and low cost steps that can be used to improve the health of individual Americans and also help reduce health care costs to society as a whole."
Since 2002, Mayo and ASU have worked closely together on a variety of successful efforts, including a joint nursing education program, collaborative research projects, joint faculty appointments, collaboratively developed medical and online education and dual degree programs including innovative work related to the new Mayo Medical School in Arizona.
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