Americans may say they want long and healthy lives, but in terms of their actions, the record is mixed. In the late 1990s, the U.S. Department of Health and Human Services gathered experts from across the country to document Americans' health and habits and determine what improvements they hoped to see over the next decade. The initiative, known as Healthy People 2010 (for when the targets would ideally be reached), continues similar programs from 10 and 20 years earlier.
The initiative set out to track progress nationally and by geography, ethnicity, and age. Although final results are not yet in (data of this scope typically lag by several years), the trends are clear—and the news is both very good and awful. As of mid-2009, there was success in reaching 117 of the 635 targets, or over 18 percent, including important markers like age-adjusted death rates for heart disease. But for many other indicators, especially lifestyle-related issues, the numbers are moving in the wrong direction.
"There's a saying: An ounce of prevention is sometimes a ton of work," says Howard Koh, assistant secretary for health at HHS, who oversees the program. "It's a challenge when any individual tries to change behavior, let alone trying to change it for an entire country."
The federal government bolsters the effort by awarding millions of dollars in grants to state and community programs that align with the Healthy People 2010 objectives, Koh says. Healthy People 2020—targets are expected to be set by winter—will continue this endeavor, with the overall goals of increasing the length and quality of healthy life for Americans and eliminating health disparities (such as by race, income level, or location).Yet individuals in midlife (40s to mid-60s) need to make adjustments on their own, experts say, because this is when risks increase for conditions like heart disease, diabetes, and cancer—all of which can greatly affect one's retirement years. "Medical interventions like pharmaceuticals and cardiovascular stents can forestall death, but they don't instill health. Vitality is something that is achieved by improving lifestyle," says David Katz, director of the Yale Prevention Research Center.
Here are federal targets (covering all ages) for several important lifestyle issues, where middle-age Americans stood when the 2010 goals were set, and where they stand now, according to the most recent data. (Because the numbers come from various sources, the "middle age" grouping will vary.)
Target: 60 percent of people at healthy weight
Then: 35 percent of people over 40 Now: 27 percent
Ideally, every person would see a pleasing number on the bathroom scale. When setting objectives, however, government officials balance the aspirational with the achievable. "We want the targets to motivate action, not be viewed as something beyond reach," Koh says. Yet Americans over 40 are adding, rather than subtracting, pounds. (So too are people ages 20 to 39, although 39 percent are now at healthy weight, defined for all adults as a body mass index equal to or greater than 18.5 and less than 25.) Worse, more than a third of people in their 40s and 50s can be classified as obese (BMI of 30 or more), up from 28 percent a decade ago.
"It's particularly ironic that America's waistlines are increasing in parallel with our knowledge about the dangers of obesity," says JoAnn Manson, chief of the division of preventive medicine at Harvard's Brigham and Women's Hospital. But in this age of ubiquitous fatty food, knowing what to do is not enough. "I do think people should take personal responsibility for things that lead to an ideal weight, like eating a healthy diet and exercising, but the environment also has to change to support that," Manson says. One step in that direction: a requirement in the new health reform law that chain restaurants and vending machines display nutritional information starting next year.