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The troubling U.S. death rate

Americans are dying at a record rate compared to residents of other Western nations, and the U.S. medical establishment can’t seem to figure out why.

JAMA Network just last month headlined “Increasing Mortality Rates in the US, but Not From COVID-19.” JAMA publishes a peer-reviewed medical journal for the American Medical Association that comes out 48 times a year. It used to be known as the Journal of the American Medical Association and thus the acronym.

“The worst of the Covi-19 pandemic is behind us,” Dr. Steven Woolf, the senior advisor to Virginia Commonwealth University Center on Society and Health began beneath the headline. “This progress is welcome but deceptive. The U.S. mortality picture is hardly ideal.

“Whatever accounts for this trend appears to be uniquely American. No other high-income country, except perhaps the United Kingdom, has experienced mortality increases as large as the U.S. The life expectancy gap between the U.S. and other countries widened greatly before the pandemic, and U.S. losses to COVID-19 were higher than in peer countries.

“Something systemic to the U.S. is limiting survival. Identifying the cause(s) and enacting social protection policies are urgent,” he later concluded. “A ‘moonshot’ effort by the research community to address the question is clearly warranted. Given the increases in mortality rates, the answer cannot come soon enough.”

One of the “systemic” problems is plainly obvious, but Woolf largely ignored it between his introduction and his conclusion, choosing instead to touch primarily on the ideas that are politically popular, particularly on the left in this country today.

The late President John F. Kennedy had no such reservations when he recognized and commented on a big part of the problem 64 years ago when it was just beginning. The then-president-elect penned an article for Sports Illustrated magazine, then the country’s most-read sporting magazine, titled “The Soft American.”

The whole commentary would likely be considered offensive as hell in these times. Below that headline, Kennedy wrote this:

“…No matter how vigorous the leadership of government, we can fully restore the physical soundness of our nation only if every American is willing to assume responsibility for his own fitness and the fitness of his children. We do not live in a regimented society
where men are forced to live their lives in the interest of the state. We are, all of us, as free to direct the activities of our bodies as we are to pursue the objects of our thought. But if we are to retain this freedom, for ourselves and for generations yet to come, then we must also be willing to work for the physical toughness on which the courage and intelligence and skill of man so largely depend.”

Were JFK still alive today, he’d probably be exiled from the Democrat party for this suggestion that “certain bodies as more worthy, healthy, and desirable than others” as the “Body Liberation” at the University of Vermont put it. 

Let’s be honest here because we all know what “physical toughness” looks like, and it’s not fat-man actor John Goodman circa 2005. Goodman himself eventually recognized that guy – his then nearly 400-pound self – wasn’t healthy and lost 200 pounds by changing his diet and adding exercise under the advice of a “health coach.” 

Lifestyle changes

Goodman got it, many don’t. And it is tempting to blame this solely on America’s obvious slothdemic and declare that Americans have just become lazy and fat, and thus deserve to die early.

Heaven knows, Americans have been warned for decades now that the shift to what one might call the “modern lifestyle” – driving everywhere and walking nowhere, sitting too much in front of TV screens or behind computers, stressing over everything and eating mountains of so-called “junk food” – is unhealthy.

But there’s more to this than just laziness. Americans are suffering from an addiction to speed and convenience.

Don’t walk or, for that matter pedal, if a motor-powered vehicle will get you where you want to go easier and faster. Don’t use a hand tool if a power tool will save even a nanosecond in getting the job done. Don’t waste time cooking if you can throw something in the microwave or order out.

Were JFK alive today, he might want to get down into he weeds surrounding the problem and pen a new commentary entitled “The Suicidal American.” How the American medical community can fail to recognize the biggest underlying cause for the country’s ill health and early death here is the big question.

A skeptic might wonder if it’s because of the all money involved. This is a capitalist country, after all, and so-called “health care” years ago ceased to be about health, which as JFK noted requires individual involvement, and became focused on selling people medical treatments and health insurance.

As a result, health care become a big, big business.

The Brookings think tank now calls the health-care industry “the most consequential part of the United States economy.” It reports the business employs 11 percent of American workers and accounts for 24 percent of government spending. “Health insurance is the largest component (26 percent) of nonwage compensation, and health care is one of the largest categories of consumer spending (8.1 percent of consumer expenditures),” according to Brookings.

Not, however, because the business is particularly successful. “The United States spends more than other countries without obtaining better health outcomes, (and) health care is growing as a share of the economy and government budgets in ways that appear unsustainable,” Brookings adds.

Why is “health care” growing? The simple answer to that it is growing because so many Americans are fundamentally unhealthy.

“Some explanations for increasing mortality are obvious: addiction disorders, increases in obesity and its complications (eg, hypertension, kidney disease), and easier access to firearms, among others. However, the pervasiveness of the mortality trends – involving diseases affecting many body systems and various forms of injury – makes it important to consider systemic factors and characteristics of life in the U.S., which could affect health in multiple ways,” Woolf wrote.

Ironically many, if not most, of these diseases are linked to the sedentary American lifestyle in one way or another. But instead of addressing the fact that “exercise is medicine,” a medicine many Americans now don’t want to take, Woolf defaults to  the money-producing solutions favored by most of the U.S. medical community, writing this:

“An example is the U.S. health care system. Whereas older adults have access to Medicare, a form of universal health care, young and middle-aged adults – the population most affected by increasing mortality – must contend with a health care system offering limited access and affordability.”

Translation

Easy access to medical care is a great idea, but healthy people don’t need medical care. What Woolf is arguing has little to do with getting the young and middle-aged healthy and everything to do with getting them treated by doctors.

Unhealthy people are good for business if you’re in the medical business,  and the country appears to still have a disproportionate number of sick despite the Covid pandemic killing 1.2 million, nearly all of whom were already plagued by other diseases.

The pandemic presented the perfect opportunity to tell Americans what JFK told them long ago: That it’s time to assume some responsibility for your own health.

Almost from the beginning of the pandemic it was recognized that SARS-CoV-2 infections, many of which produced no symptoms, affected the healthy differently than the unhealthy. Just six months into the pandemic, researchers in the UK picked up on the fact that “fast walkers,” as fit people tend to be, were at a lot less risk from Covid than slow or non-walkers.

“Slow walkers had the highest risk of severe COVID-19 regardless of their obesity status,” they concluded in an early study destined to later to appear in a peer-reviewed publication, “with normal weight, overweight or obese slow walkers all having over twice the risk of severe COVID-19 compared to normal weight brisk walkers.”

Later researchers studying the SARS-CoV-2 virus and the “mechanisms of disease-state interactions” would warn in a peer-reviewed, 2023 study in Nature Medicine that “public health efforts to improve baseline population health are an integral part of pandemic preparedness.”

Readers might remember this advice being offered during the pandemic, right? The advice to get out in the fresh, clean, open air and begin walking, jogging, running, cycling, skiing, roller skating or some other physical activity to improve fitness.

Well, of course not. Because the advice was never offered.

All attention was focused on vaccines, the latest medical treatment to save us all. Now most are vaccinated, and unhealthy though vaccinated Americans are continuing to die from Covid, the disease caused by the SARS-CoV-2 virus.

But most believe they are safe because the healthcare industry has sold them on the idea that JFK’s warning was meaningless and because they now believe modern medicine is the total answer answer to healthcare.

The Centers for Disease Control (CDC) does still recommend Americans get their weight down to a healthy level and devote a minimum of at least 150 minutes per week to exercise, but when researchers sampled Americans last year they found that “approximately one in 10 U.S. adults and parents reported being aware of the guidelines. Only the percent of adults knew the correct adult aerobic guideline.”

Why does exercise matter?

Americans today seem happy to ignore the hundreds of thousands of years of evolution that shaped our species if doing so makes life easier today and to hell with tomorrow. The use-it-or-lose-it nature of human physiology, which affects our immune system just as much or more than our musculature, has been lost to history.

And we have given in to the addiction to machines. The U.S. is today the most machine-addicted society in the Western world.

We drive more than people anywhere. When Bryn Huxley-Reicher, an analyst at the public policy Frontier Group, dug into global data in 2022, he found that “the average American traveled 1.98 times more miles on the road each year than the average resident of France, 2.06 times more than the average German, and 2.23 times more than the average person in Great Britain.”

Frontier Group is an entity focused largely on environmental issues like the global warming of the future about which some younger Americans worry. So it ignored the health problems of the here and now related to all this motorized transport, which is daily infiltrating the places people used to get at least some exercise.

Anyone who spent much time on Anchorage city trails this summer is sure to have noticed how these places where people used to walk, run and cycle are now being taken over by the machines – throttle-operated “ebikes,” which require no pedaling and are really more motorcycle than bike; 60 mph electric-powered scooters, 30 mph Onewheels, electric skateboard and long boards, and even electric all-terrain vehicles because in the view of the Municipality of Anchorage, a motorized vehicle isn’t motorized if the motor is powered by electricity.

This phenomenon is not unique to Anchorage.

“E-bikes are steadily gaining market share, from an insignificant 2 percent in 2016 to more than 18 percent of pedal-only bike sales in 2023,” Bicycle Retailer reported in March. Grandview Research concluded the market for these bikes in the U.S. is now valued at “$1.98 billion and is expected to grow at a compound annual growth rate of 15.6 percent from 2023 to 2030.”

Were these all pedal-assist e-bikes, which require people to pedal lightly to get a mild assist from the motor on the flat and a big assist on the hills, this might be a good thing. Some early studies of e-bikes found that the people who rode them were getting as much exercise as most pedal cyclists,  mainly because the e-bikers rode farther.

But the trend in America is toward throttle-powered e-bikes, according to the IMARC research group. Riders of those bikes get about the same amount of exercise as the dude sitting on his sofa watching NFL football and exercising his biceps by doing “curls” with his 12-ounce can of light beer.

And that beer is, of course, another problem.

“Alcohol-related mortality, which has been increasing for decades, surged during the COVID-19 pandemic, particularly for individuals aged 45 to 64 years,” Woolf observed at JAMA. “Between 2000 and 2019, alcohol-related mortality in that age group increased by 51.6 percent (from 17.24 per 100 000 to 26.13 per 100 000, respectively) and climbed to 34.90 per 100 000 in 2021. Alcoholic liver disease increased, particularly among adults aged 25 to 44 years, increasing by 60.0 percent between 2010 and 2019 (from 2.75 per 100 000 to 4.40 per 100 000, respectively) and surging to 7.33 per 100 000 in 2021. Rates decreased in 2022, but remained well above 2019 values.”

But what do we also know about alcohol? Well, research says exercise mutes the damage it can do. Researchers years ago reported that all-cause mortality related to alcohol was significantly reduced by daily physical activity (PA) and “nearly nullified” for cancer “among individuals who met the PA recommendations.”

Meanwhile, later researchers concluded that “exercise interventions may decrease alcohol consumption and improve fitness and can be an effective adjunctive treatment for individuals with alcohol-related diagnoses including alcohol use disorder,” meaning exercise can provide something of a double whammy here.

And then there is dementia, which Woolf noted, writing that “mortality from neurologic diseases (notably Alzheimer disease) has been increasing for decades.”

Alzheiemer’s is now approaching crisis levels in this country with the Centers for Disease Control (CDC) reporting that it is today “the sixth leading cause of death among U.S. adults” with “an estimated 6.7 million Americans aged 65 years or older (suffering) Alzheimer’s disease. This number is projected to nearly triple to 14 million people by 2060.”

In 1962, there were so few people dying from Alzheimer’s that the disease didn’t make the CDC’s list of the top 15 causes of death. In fact, the disease didn’t even warrant a mention in the CDC’s 432-page report on mortality for that year. 

Exercise is not wholly protective against Alzheimer’s Disease (AD), but researchers report its benefits in reducing the risk are such “that it has been cited as a possible lifestyle intervention. Some previous studies have proof to support this hypothesis. A study measured that 54 percent of Alzheimer’s disease (AD) risk factors may be avertible. Another study (that) estimated the demographic risk of global AD which can be attributed to seven potentially adjustable risk factors…(found) the lack of physical activity was the highest attributable risk….

“In a systematic review that collated evidence from 163,000 non-psychotic participants and compared highest physical activity category to the participants with least relative risk of dementia, (researchers) also found that the risk of dementia and AD can be lowered by 28 percent to and 45 percent with physical activity.”

Almost everywhere you look in the field of medical research, this connection between exercise and better health, not to mention longer lives, pops out. Given that we evolved with an always-on-the-move lifestyle similar to that of our canine companions, this is to be expected as a result of evolutionary biology.

In terms of exercise, our evolutionary history parallels that of dogs, and among the things now known about dogs is that a healthy amount of exercise can increase their lifespans and their cognitive function. Or, as researchers publishing in the peer-reviewed Scientific Reports – Nature, put it in a 2023 study, “we found that activity patterns in dogs are associated with fractional lifespan and working memory.”

Fractional lifespan is a measure of a dog’s age relative to its expected lifespan. It is used in canine studies because small-breed dogs are well known for normally living longer than large-breed dogs.

“Dogs,” the study noted, “are a remarkable model for translational studies in aging and cognition as they are prone to Canine Cognitive Dysfunction ICCD) syndrome, which has many similarities with Alzheimer’s disease.”

Sadly, a lot of dogs with CCD now get put down because there is no treatment. And to think their owners might have saved them, and possibly themselves, by getting out and taking Fido for a walk. But who wants to get up and move when you can sit and be comfortable?