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IOM Workshop
Reports On Risks And Causes Of Premature Death
“…despite the mounting research findings and high profile
reports…public health and particularly the substantial contributions
of social and behavioral factors to premature mortality have not
received the attention they deserve,” according Richard Suzman
of the National Institute on Aging (NIA). This explains part of the
motivation for the NIA to sponsor a workshop at the Institute of
Medicine to better understand and update the classification of the
“causes of the causes” of death in the United States. These
classifications are carried out using cause of death data or for
multifactorial causes by making estimates based on relative risks and
percent distribution of that behavior or factor in the population.
As
described in the background to the report, several approaches have
been used over the years to get at these root causes. Some of the
findings from this work were that “the greatest opportunity to improve
health and reduce premature deaths lies in personal behavior,
especially that associated with tobacco use, unhealthy diet, physical
inactivity, and problem drinking." Medical care plays a minor role in
this regard.
A
National Research Council report in 2011 and Council and Institute of
Medicine report in 2013 reached the now widely publicized conclusion
that the US spends more on health care than any other country, but its
health outcomes are not superior because Americans are in poorer
health and die earlier than people in other high-income countries.
This latter report found some behaviors more favorable to health in
the US, but several other behaviors less so. For example says the
report, “Americans consume more calories per capita, abuse more drugs,
are less likely to fasten seat belts, have more traffic accidents
involving alcohol, and own more firearms than do people in other
high-income countries."
The
cause of the health disadvantage in the US was also tied to income
inequality and high rates of relative poverty, relative lack of social
mobility, and failure to keep pace with improving educational outcomes
in other countries.
The
IOM report includes the following table from a 2013 publication by
McGinnis on the percentages of proximate preventable factors causing
premature mortality.
|
Cause |
1990 % of
total deaths |
2010 % of
total deaths |
|
Tobacco |
17 |
15 |
|
Diet/Activity patterns |
14 |
18 |
|
Alcohol |
4 |
3 |
|
Microbial agents |
4 |
2 |
|
Medical errors |
NA |
3 |
|
Toxic agents |
3. |
2.5 |
|
Firearms |
2 |
1.5 |
|
Sexual behavior |
2 |
1 |
|
Motor vehicles |
1 |
1 |
|
Illicit use of drugs |
1 |
1 |
| |
|
|
|
Total |
48 |
48 |
|
All causes |
100.0 |
100.0 |
McGinnis, J.M.
(2013).
Actual causes of death, 1990–2010.
Presentation at the Workshop on Determinants of Premature Mortality,
September 18, National Research Council, Washington, DC.
In a summary of the findings from the various national
and international studies, the IOM report states that recent analyses
of the behavioral determinants of premature mortality suggest that the
risk factors amenable to change account for between 35-50% of early
deaths in the United States.
Included
among the tasks for the IOM workshop were to consider the state of the
science of measuring the determinants of the causes of premature
death, assessing the availability and quality of data sources, and
identifying future courses of action to improve the
understanding of the “causes of the causes” of early deaths.
Among the important suggestions made for improving data
sources was the incorporation of social and economic factors among the
risk factors for premature mortality. In fact, one workshop
participant Christine Bachrach stated that “more data and
research are needed to strengthen the basis for communicating about
the importance of social factors because they are deeply intertwined
with and shape behaviors that are important to health outcomes.
Therefore, a focus only on behaviors as health determinants is
seriously misleading,” according to Bachrach. ■
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