Showcased on the Harvard’s T.H. Chan School of Public Health (T.H. Chan) Obesity Prevention Source website, a wealth of information (among other sources), a map from The Center for Disease Control and Prevention (CDC) depicts obesity trends from 1990 to 2010. And in Reddit, a physician writes that in the 1990s, the most obese state (Mississippi) had what was at the time a lower rate of obesity than what the least obese state (Colorado) had by 2010. What are the implications?
As TrialSite News has covered, obesity could be considered a crisis to say the least, if not a public health epidemic. What are the consequences of obesity? Well according to T.H. Chan, massive problems from national economic productivity to even national defense? By 2005 alone, healthcare costs associated with obesity were estimated at $190 billion. The CDC publishes its estimated associated costs.
Dependency on prescription costs increase (see TrialSite News‘ coverage on obesity drug pipeline) as well as comorbidities, from increasing risk in type 2 diabetes mellitus to hypertension; cardiovascular disease and stroke to sleep apnea; osteoarthritis and gout to even certain cancers. Moreover, often acknowledged as an American-centric problem, it is far more pervasive—obesity rates are growing worldwide—from China and India to Mexico and the Middle East.
Based on the CDC and T.H. Chan data from 1990 to 2010, we have witnessed an absolute fattening of America. During this same time period, we have witnessed historical, unprecedented spending increases in health care at a national economy level. On a daily basis, we hear of stories of personal financial disaster due to crippling health care costs. But what are the aggregate national numbers? According to the Centers for Medicare and Medicaid Services (CMS), in 1990, health care expenditure nationwide was $720 billion ($2,843 per person)—by 2018, this same spend totaled $3.6 trillion ($11,172 per person), representing a massive 293% increase in per capital spend—in entirety, totaling about 18% of Gross Domestic Product!
What are the Results?
Did all of this spending translate to healthier people? The answer is clearly no in the aggregate. While there have been unbelievable breakthroughs in advanced medical technologies and medicines that are celebrated by this digital platform on a daily basis, something is terribly wrong. A metric, such as life expectancy, offers some benchmark as to the overall health of a country. In 1980, the U.S. was comparable to similarly developed nation peers when it came to life expectancy rate. However, today the comparable country average is 82.3 and America falls in at 78.6.
Moreover, when ranking America’s overall healthcare system regardless of analyst firm or method the picture looks increasingly bleak. In one recent sophisticated analysis, the United States comes in at number 37 worldwide; think about this in the context that Americans pay shockingly more than any other nation per capital—and, on total, health care spending. There is no getting around this one, except for the people we consider having the “ostrich syndrome”.
Face up to the Facts
No matter how it is cut, sliced or diced, the data points to the fact that while America spends even more than any other country, its people become heavier and unhealthier while its healthcare system performance experiences an ongoing degradation. Again, in what can only be considered a dialectic, we at the same time live in a period of unprecedented biopharmaceutical research and new product development breakthroughs.
The Best of Times & the Worst of Times
We can surely point to incredible breakthroughs during this period across a wide range of therapeutic classes and health categories—disease-fighting drugs in oncology, HIV/AIDs to autoimmune and cardiovascular disease—and many others that showcase American (and worldwide) biopharmaceutical and medical device prowess. The benefits that arise from the biopharmaceutical, medical device, diagnostic, academic, non-profit and government research sectors and the supporting sectors, such as finance (yes, money is required), are palpable and the results historical in nature. We are actually living in a time of revolutionary change in life sciences with the development of cancer drugs, for example, that makes what would have been a death sentence just a decade ago into the chance to live potentially for decades more. This is priceless for anyone who has been diagnosed with cancer who was able to secure access to an advanced treatment and benefited from the science.
There Aren’t ‘Bad Guys’
Politicians like to have a bad guy to point to. It is easier that way to persuade and generate votes than it is facing the more deeply problematic and painful truth for the need of utter and complete systemic overhaul if not fundamental reorganization of the healthcare order as we know it. So, a new Party gets elected and points the finger at “the pharmaceutical industry” as the culprit for the escalating prices. Or the giant health systems can be singled out such as the VA system, which is rife with systemic problems. Moreover, we have heard some smart people make the argument, based on a false dilemma tactic that it is because of these extreme health care cost increases that such health breakthroughs were made possible in the first place. This just isn’t true. Yes, there has been a marketed rise in drug and device costs (and, of course, big pharma has had its share of problems from contribution to opioid epidemic to unbelievable sharp dealing—such as creation of patent thickets to ruthlessly block out competition and hence allow market to function more smoothly), but this cannot be isolated and targeted against an entire industry—full of incredibly smart, dedicated, and committed people—that is making historical breakthroughs. In another words, this industry sector is not the root cause of the underlying problem. Individual firms are operating in a system—trying to satisfy investor demands for value as measured in certain growth and profitability targets, not to mention ongoing innovative breakthrough for competitive differentiation and hence value protection.
Is There a Culprit?
It is important to understand that the underlying core drivers of the growing obesity epidemic—and by extension a staggering healthcare crisis (e.g. lowering life span with escalating per capita costs)—are not caused by any one industry, sector or segment but rather are part of a complex, dynamic unfolding system—driven by federal and myriad state law—that appears to advance, grow, and continuously reproduce itself. This healthcare system pushes over $4 trillion in GDP, makes fortunes but more importantly represents about 20% of GDP now and provides food on the table for an incredible percentage of the population. That is how the system grows—the people need it. We are it.
Making America Slender Again
If you think about it, your health care is your No. 1 priority. If one’s health goes, pretty much everything else goes. If we are not around to enjoy our loved ones, well—there will be our memory but not necessarily us in material form experiencing things with them. It starts with our health care, and first and foremost, accepting that it is our responsibility. It isn’t the responsibility of a health system, hospital or doctor’s office or, for that matter, some government program. It is the individual—the family and the personal network that must, now, be mobilized in an all-out effort to make America (and anywhere else there is rapidly growing obesity) slender again. A healthy and balanced diet (eliminate excess sugars all sodas and similar fare); an hour of physical activity a day (just a walk around the neighborhood can suffice); and if possible, rest. We understand what many have termed “the rat race” or “the grind” for many working people. We can relate and have been there. The perceived time crunch with work, kids, chores, and keeping up a home. None of this precludes a new health revolution. But a new national mission of health and fitness must take off—an individual and social craze—the pendulum must swing now toward the health transformation. We live and operate in a complex health care market, and we must understand it to the best of our capabilities. Start with your own health, your own situation and that of your family. From there, expand your horizon. As you learn more and evolve your awareness, turn your attention to the bigger picture: does your local state or federal congress person call out health as a number one priority? If not, vote them out and vote someone in that does. Over time, the hope is that we transcend what is essentially a “sickcare system” toward a culture truly centered around good health. But we know enough to know that it starts with making ourselves slender again.