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Dead by design?

World Health Organization graphic

With the U.S. now the world leader by far in deaths linked to COVID-19, isn’t it about time Americans recognize there is more to this situation than simply the newly emergent SARS-CoV-2 virus?

The data on deaths increasingly links fatalities to physiologically unhealthy lifestyles, and much of the U.S. problem with physiologically unhealthy lifestyles is in turn linked to America’s love with the automobile.

Americans drive about 13,500 miles per year, according to the Federal Highway Administration. European Union countries average about 7,500 miles per year, according to an analysis done by the European Commission’s Odyssee-Mure project.

As of this writing, the World Health Organization (WHO) reports 505,000 dead in the U.S. and 859,000 dead in Europe. But Europe is today home to about 749 million people, according to the World Population Review. The U.S. population is estimated at 332 million at this time.

Adjusting for population, the U.S. has a death rate of 152 per 100,000, which compares to a European death rate of 114 per 100,000. But where the data gets really interesting is when the countries where people walk and bicycle as much as they drive enter the analysis.

Africa has suffered but 72,000 deaths, according to WHO, for an overall death rate of around 5.5 per 100,000. Death rates in Asia are similarly low. The Worldometer tracker puts the death rate in India today at 11.2 per 100,000. 

Motor vehicle ownership in India – where only seven out of every 100 people own a car – is a twelfth that of the U.S. – where 84 out of every 100 people own a car or truck. Huge numbers of Indians still get around by walking, bicycling, or hiring a rickshaw or pedicab.

Indians fleeing that nation’s cities on foot to return to their rural homes during the pandemic made international news.. An India-based reporter for the BBC reported meeting “a five-year-old boy who was on a 700 kilometer (434 miles) journey by foot with his father, a construction worker, from Delhi to their home in Madhya Pradesh state in central India.”

And what does this have to do with all those miles Americans drive?

Sedentary lifestyles

A peer-reviewed study published in the Journal of the America Heart Association last week links just shy of two-thirds of U.S. COVID-19 deaths, 63.5 percent to be exact, to four, pre-existing medical conditions: diabetes, obesity, hypertension and heart disease. 

The study’s authors from Tufts University and the Ichan School of Medicine concede these findings should come as no big surprise.

“Studies of clinical characteristics of patients with COVID‐19 in Wuhan, China, and Italy first suggested that diabetes mellitus, hypertension, and ischemic heart disease were the most distinctive and/or frequent comorbidities associated with severe infection,” they wrote. “Similarly, a high prevalence of cardiometabolic comorbidities were found among patients hospitalized with COVID‐19 in New York City (NYC) and Washington state. Cardiometabolic comorbidities including obesity, chronic cardiac disease, hypertension, diabetes mellitus, and chronic kidney disease have been further identified as strong predictors of COVID‐19 hospitalization among infected patients in NYC and of in‐hospital mortality in China and the United Kingdom.”

What the new study brings to the table is a big sample size – 906,849 U.S. cases – and a recognition that some of the underlying problems involve not just this pandemic but those possible in the future.

‘The strong links between these conditions and poor outcomes in COVID‐19 provide a compelling signal to clinicians and policymakers on additional approaches to improve population resilience for COVID‐19 as well as future pandemics,” they wrote.

The study’s findings, they said, support a “need for prioritizing vaccine distribution to individuals with cardiometabolic conditions” and continued use of so-called nonpharmeceutical interventions, but also “highlight the urgent need for trials to understand whether improving cardiometabolic health will reduce hospitalizations, morbidity, and healthcare strains from COVID‐19.

“Controlled trials demonstrate rapid improvements in cardiometabolic health from lifestyle changes. In randomized controlled feeding trials, changes in diet quality alone, without weight loss, led to improvements in just six to eight weeks…and if changes in diet quality included healthy dietary fats, insulin sensitivity also improved.

“In one trial, dietary guidance emphasizing healthful minimally processed foods, without any focus on energy restriction, resulted in an average, approximately 6 kilogream (13.2 pound) weight loss…with corresponding improvements in multiple cardiometabolic risk parameters. Increases in physical activity also significantly improve cardiometabolic health in controlled trials, even without weight loss.

“Given the estimated burdens of COVID‐19 hospitalizations attributable to cardiometabolic conditions, our results indicate a need to test whether even modest improvements in cardiometabolic health in individuals and populations, through clinical efforts, public guidance, or other public health actions, could have an impact.”

The need for improvements in cardiometabolic health is a tune doctors in the U.S. have been singing for a long, long time. Those involved with the now famous, 73-year-old Framingham Heart Study began talking about the threats of poor diets and lack of fitness decades ago.

Chicken-fat America

The detiorating physiological condition of the nation drove late President John F. Kennedy (JFK) to in the 1960s launch a national campaign to to improve physical fitness. Shortly after he took office, Sports Illustrated magazine published a JFK-written essay titled “The Soft American.”

The administration then took to promoting 50-mile hikes, according to the JFK Library, which records that “many Americans took the hike as a challenge from their president. The Kennedy council (on fitness) capitalized on this enthusiasm with a national publicity campaign on physical fitness. The campaign was organized, extensive, media-savvy, and above all, countrywide. 

“The oddest contribution to the effort may have been the ‘Chicken Fat’ song. Meredith Willson, creator of The Music Man, wrote the song. It was sung by Robert Preston, the star of the musical. ‘Chicken Fat’ was produced in a three-minute, radio-friendly version and a six-minute version to accompany schoolchildren during workout routines.”

With its lyrics of “nuts to the flabby guys!  Go, you chicken fat, go away!” it might today get Preston and Wilson roasted on Twitter for “fat shaming.” So many Americans are now fat that they really don’t like being reminded of it.

When Kennedy was president, the average U.S. male weighed 166 pounds. By 2010, the average female weighed the same, having increased from 140 pounds in 1960, and the average male had ballooned to 195.5 pounds, according to the U.S. Centers for Disease Control and Prevention (CDC).

Americans have only kept getting bigger since then. The CDC in 2018 reported almost three-quarters of the nation’s population was overweight or obese. 

Obesity is not a direct measure of cardiometabolic health, but as with rates of COVID-19 infections and COVID-19 deaths, when one goes up, the other starts climbing as well.

This is far from the fault of individual Americans themselves. A 2014 Stanford study that looked at U.S. diet from 1988 to 2010 found Americans weren’t eating any more calories in 2010 than in 1988, they were just burning a lot less because they spent less time moving.

The peer-reviewed study published in the American Journal Medicine (AMJ) pointed the finger at “leisure-time physical activity,” but that isn’t the only place where Americans now burn fewer calories. Day in and day out, a lot of Americans spend too much time sitting on their asses.

Cities designed around motor vehicles largely dictate such behavior.

“There is no easy answer in our ongoing battle against obesity, but identifying the link between the drop in physical activity and increased body mass indexes (a measure of obesity)…can assist public health officials to develop targeted, effective interventions,” the AMJ observed on its blog in the wake of the Stanford study.

If we as a country truly want to take control of our health and our health care costs, the Ladabaum et al paper should be our clarion call,”  AJM managing editor Pamela Powers Hannley in an accompanying commentary. From encouraging communities to provide safe places for physical activity to ensuring ample supply of healthy food to empowering Americans to take control of their health, we must launch a concerted comprehensive effort to control obesity.”

Not moving enough

The link between the lack of physical activity and obsesity is obvious. Americans use human power less and less to get around.

A 2016 Brookings examination of how Americans get to work found less than 3 percent walk and less than 1 percent cycle. More than 75 percent get in a motor vehicle and make a lone drive, the think tank discovered.

Not many calories are burned by people sitting behind the wheel. And it’s not just work to which people drive; it’s to almost everything. For decades, motor vehicles have dictated how cities grow with residents in one area and businesses, including supermarkets and grocery stories, in another with a motor vehicle required to get between the two.

American waistlines have tracked this evolution.

“Each additional hour spent in a car per day was associated with a 6 percent increase in the likelihood of obesity,” a peer-reviewed study in the American Journal of Preventative Medicine reported. “Conversely, each additional kilometer walked per day was associated with a 4.8 percent reduction in the likelihood of obesity.”

There has been a nascent movement to redesign cities to get people moving, but it has gained little traction despite being sold as a way to cut down on motor vehicle use and thus help slow global warming.

Public health might, however, be a more immediate and pressing issue of concern. The connection between chronic, sedentary-lifestyle-linked illnesses and COVID-19 deaths is making it harder and harder to ignore the issue of fundamental fitness, even if the lack of it has been killing Americans for a long time.

Framingham data long ago indicated that sedentary lifestyles were making Americans ill and shortening lifespans by years.

Avoiding a sedentary lifestyle during adulthood not only prevents cardiovascular disease independently of other risk factors but also substantially expands the total life expectancy and the cardiovascular disease–free life expectancy for men and women,” Dutch and Australian researchers reported in a peer-reviewed study JAMA, the Journal of the American Medical Association in 2005. “This effect is already seen at moderate levels of physical activity, and the gains in cardiovascular disease–free life expectancy are twice as large at higher activity levels.

An in-depth examination of Framingham data, they said, led them to the conclusion that on average “moderate and high physical activity levels led to 1.3 and 3.7 years more in total life expectancy and 1.1 and 3.2 more years lived without cardiovascular disease, respectively, for men aged 50 years or older compared with those who maintained a low physical activity level. For women the differences were 1.5 and 3.5 years in total life expectancy and 1.3 and 3.3 more years lived free of cardiovascular disease, respectively.”

And there were pre-COVID-19 studies indicating the gains could be even bigger. When cardiologist Dr. Benjamin Rosin undertook an examination of 54, serious, old marathoners in California in 2107, he discovered they were, on average, living 19 years longer than comparable, inactive men who had reached age 40 in 1975.

The average age of the 18 runners who died between ’75 and 2017 was 81. Seven died of cancer – the nation’s second-leading killer – at an average age of 77.2  Heart disease – the nation’s leading killer – claimed the lives of five, but not until they’d reached the average age of 86.

Rosin conceded the marathoners collectively benefitted from high social-economic status (SES), a known protectant against all forms of illness and disease, including COVID-19. But that alone could not fully explain the difference between their long lives and the shorter lives of non-exercising contemporaries.

And now?

Scientists studying the reasons why athletes engaged in intense training programs become more vulnerable to infections 14 years ago reported “type 1 T cells promote cell-mediated immune responses, which primarily provide protection against viruses.”

“Regular moderate exercise” helps strengthen T-cells, they reported in a peer-reviewed study in the Journal of Applied Physiology. “However, prolonged bouts of strenuous exercise cause a temporary depression of various aspects of immune function…that usually lasts 3 to 24 hours after exercise, depending on the intensity and duration of the exercise bout.”

Researchers studying COVID-19 have identified T-cells as the most important natural response to the virus.

There is no doubt getting people fitter and healthier through moderate exercise would boost T-cell performance and save lives, but the urban and suburban landscape of a modern United States largely designed to accommodate the automobile doesn’t encourage getting people healthy.

The result is the U.S. might be the world leader in COVID-19 deaths by design.

 

 

 

 

 

 

 

 

 

 

 

 

 

15 replies »

    • There were 10 – 15 variants identified this time a year ago. CDC is chumming the waters.

      One of the reasons there were never any vaccines for the common cold is because it is caused by multiple viruses, several of them COVID. Things kept changing from year to year to the point where they couldn’t develop anything quick enough to do any good. You see the same thing with the yearly flu shot, which often takes some sort of artificial panic to “encourage” people to get the shot. Note that this year flu numbers are way, way down to non-existent. Cheers –

      • I learned this as a child, I asked my mom one day, why can you not just get a shot to not ever catch a cold. She said because they are caused by many different viruses, but the good thing is, once you’ve had that virus, you will Not catch that same cold again. So, if I do catch a cold, it always makes me feel better to think that there’s another one down I won’t catch again, and I also learned at an early age that sometimes you catch colds, it sucks, but that’s life.

  1. In Typical Communist fashion – cause the problem and then provide a solution..
    “China’s state-run Global Times bragged Sunday that Chinese companies are making a fortune selling syringes and needles to the United States during the coronavirus pandemic, a tidal wave of imports that makes a mockery of “the U.S. government’s attempt to get rid of the Chinese supply chain.”

    The Global Times quoted U.S. officials admitting in congressional testimony that 80 percent of the needles and syringes used in the United States, and about 90 percent of the supplies purchased worldwide, originate from China. Chinese officials said China’s factories produce hundreds of thousands of syringes a day.

    According to Chinese government and business sources, low costs of production and labor, combined with supply chains that have not been decimated by the coronavirus as thoroughly as those in most other countries, make the Chinese syringe industry unbeatable.”

  2. I went to Walmart the other day. I walked up and down the isles and was shocked to learn “food” really does come out of a box labeled “Made in China”. I then headed to the pharmacy to grab a script. While waiting I saw a poster about Covid-19 and in fine print “Made in China”. As I was checking my meds, on the bottle said “Made in China”. Isnt life grand?
    In general we are idividually targeted by China..Covid’s target is specific.. most have nothing to fear – yet….

  3. Sedentary lifestyles are a given as jobs increasingly are connected to a computer instead of a hay bale. But also the food industry has marketed and sold increasing amounts of junk food. Did you know there are 47 different types of Cheezits? Your grocery store dedicates an entire aisle to sugary drinks. Americans have 300 times the amount of sugar in our diet than we had in the 1950’s. We need to mine our harbors to prevent shiploads of sugar from other countries from docking. A more logical idea would be to end sugar price supports, apply tariffs to foreign sugar, and then tax the crap out of all of it!

    • Good point about diet, Chris, but the problem isn’t sugar, it’s corn. Back in the 1980s the soda companies switched from sugar to high fructose corn syrup because corn from Iowa is cheaper than sugar from Hawai’i. Because corn is so much cheaper it allowed for supersizing of sweet foods and drinks which resulted in supersized Americans. Exercise is obviously important for physical and mental health, but imo a poor diet with lots of HFCS is going to make you fat. I see people in Freddy’s who are so huge they can’t even walk – they have to drive a little cart. What is their cart full of? Cases and cases of soda. The people whose carts are full of fresh produce have very different body types..:

      • Sucrose, Glucose, and Fructose. It’s all sugar by any other name. You brought up Hawaii. The USA overthrew the Hawaiian government because the plantation owners needed Hawaii to become a US possession in order to continue receiving US sugar subsidies.

      • Chris,
        Since you bring up HI,theres a great sugarcane museum on Maui,details the empire that the Baldwin family built up.All the mills and sugar cane in general are going away,or are gone, because of the reasons that you stated (corn, also beets I believe).The value of course is in the land.
        Anyways one of the connections to Alaska is by way of Matson Shipping.Started for the intended purpose of shipping HI sugar to mainland,backhaul goods.They are trans pacific in routes, but got there start in sugar.
        To touch on the health aspect,I think its human nature to look for easier ways doing things.Unfortunately commerce has and continues to take advantage of that particular human trait.
        From exercise(gym membership)to easy food, even delivered piping hot.You dont have to do anything, heck if your lucky, you dont have to leave the safety of your home office chair to go to work(Tele work or whatever they call it).
        Craig has profiled a large handful of crusty tough folks over the past few years.
        I cant imagine myself pushing a bike through sub zero temps for a few hundred miles at 70+.
        Hell I dont want to do it at 59.Ive been cold, and Ive been miserable, and I’ve been cold and miserable.But I cant see myself being cold and miserable for what will seem like days on end, for a challenge.But at the same time I think for a fair number of people theres a bit of Perry,Amundsun or Shackleton in many of us.
        I have always embraced a fairly physical lifestyle, and hopefully things dont wear out to soon.And for that Im very greatfull.
        If you dont have that initial drive than it has to be learned(for most),thats got to be very hard to do
        for the uninitiated.
        Life isn’t all a flip of the coin, we are in control of more than we think.And we can guide our life outcomes to a point.
        This is the best time of winter to enjoy the outdoors in any capacity, gear up, get out somehow.

  4. Speaking of life expectancy, according to Statista life expectancy by region is:

    US about 76 for males and 81 for females
    Africa about 62 for males and 65 for females
    Southeast Asia about 69 for males and 75 for females
    Europe about 75 for males and 82 for females

  5. Two things I remember about elementary school in Minnesota. Playing “Duck, Duck, Gray Duck” and doing jumping jacks and burpees to the Chicken Fat song.

  6. I couldn’t agree more with the fact that Americans are out of shape and that it significantly has contributed to the claimed Covid death rate in the U.S.
    But there is an explanation for why Americans drive their cars so much more than those in Europe. And while we Americans love our cars that is only part of the reason. How else do we get to our jobs, especially in areas west of the Mississippi River. Europe is pretty much built vertically. We have built horizontally, especially in the west. Europe has very efficient mass transit systems that get people to work without the need to drive. Except for BART in the Bay Area ( and it is not used by many, anyway ) their is little to no other way to travel for any purpose without using a motor vehicle.
    When is the last time you traveled to Europe and rented a car. I never have. But when traveling around our country most of us rent a car so we can enjoy the area. How else can we get around efficiently?
    IMO driving cars is not to blame for the obesity problem
    In our country. It’s laziness. Driving in America is much more of a necessity here than in Europe. America is a country flush with money, flat screen TVs, fast foods, sport’s bars, social media, electronic games, and incentives to not work. There lies a major part of the problem. Not cars.

  7. Thank you. Also, a small but wholesome, macro-balanced meal makes you want to turn somersaults. My brood was active in the JFK exercise program, but I don’t remember the Chicken Fat Song. You can find it on YouTube. Cute, but kinda slow beat. Back then, the women were exercising in high heels, and I have the pictures to prove it..

  8. We might not be the fittest, but I would say it’s more of a, the other countries weren’t giving out as big of a Covid money incentives as the US was for cause of death being Covid related. Plus get those numbers up in the country to where the WHO gets most of its money from, or use to, but will now.

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