“Americans deserve better health, particularly given the amount of money they spend on health care. We have made progress, but can do much better.” That’s how CDC Director Tom Frieden and Associate Director for Science Harold Jaffe conclude their commentary on the state of health in the US. They were writing at the invitation of The Lancet as part of a set of review papers on US health published in the July 5, 2014 issue by CDC authors.

Included in the series are reviews of chronic diseases, infectious diseases, violence and injury, and health care. Also, numerous other papers by non-CDC authors on health topics in the US are included in the early July issue as well book reviews on a history of the role of the Surgeon General and on health care in the US.

The Good News First

While in some important respects it can be said that the health of Americans has never been better---they have a life expectancy of 78.7 years which is the highest ever achieved---and age-adjusted death rates for the four leading causes of death are falling, commentators are always quick to point out that the US spends more money on health care than other high-income countries but is experiencing generally poorer health outcomes. Also, health outcomes are not uniform for all Americans with some sub-populations such as African Americans and some state populations experiencing much less favorable outcomes.

Strategies Called For

Frieden and Jaffe call for broadly applicable policies that protect health (not further defined in this article), improved access and quality of health care (some of which will occur with passage of the Affordable Health Care Act), increased delivery of preventive services, and individual behavior change to meet the challenges of US health. Also, combining both public health and clinical approaches to health is described as a useful strategy. Frieden and Jaffe point to the national initiative to reduce heart attacks as a promising example of this public- private approach.

Chronic Disease Challenges

Key observations by CDC’s Ursula Bauer and colleagues in the Lancet series are that chronic diseases cause two-thirds of deaths worldwide and are the main causes of morbidity, disability, and health care costs in the US. Well known risk factors such as high blood pressure, tobacco smoking, second-hand smoke exposure, high body mass index, physical inactivity, alcohol use, and diets low in fruits and vegetables and high in sodium and saturated fats are implicated in these chronic diseases. The reviewers highlight 1) the importance of epidemiology and surveillance to inform health policies and practices going forward, 2) greater focus on prevention services, 3) the use of “environmental” approaches to encourage healthy behaviors, and 4) effective management of chronic conditions.

Violence and Injury

In the paper by Tamara Haegerich and colleagues, the five largest causes of death in this category are identified as motor vehicle crashes, poisoning, falls, firearm suicides, and firearm homicides. The strategies proposed for addressing these are not unlike those for the major chronic diseases and include education, behavioral changes, policy, engineering, and environmental supports. There is no mention of the recent controversy surrounding the ban on CDC research on gun violence, however, one of the actions called for is continuing investments in research to further reduce the burden of injury and violence.

Infectious Diseases

CDC’s Rima Khabbaz and co-authors remind us that infectious diseases present substantial challenges, particularly related to “high-burden” diseases such as HIV, chronic hepatitis, foodborne diseases, and health care associated infections. Perhaps the largest threat at present is related to antibiotic resistance which the reviewers characterize as “a global health crisis” needing urgent action.

Decisive Time

According to the Lancet editors who organized this special issue, “The next three years—encompassing the remainder of President Obama’s term, an election, and the formation of a new administration—will be a decisive time in the history of health for the USA. There is an unprecedented opportunity to deliver health improvements for the least advantaged Americans. But there are dangers too—not the least of which is securing the sustainability of American health care.”  ■
 

Reader Comments:
Have a thought or comment on this story ?  Fill out the information below and we'll post it on this page once it's been reviewed by our editors.