The State of America's Health as Obama Takes Office

Health reform efforts that focus on prevention can save lives but are often costly.


Video: Family Health

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President-elect Barack Obama's political opponents used to suggest that he's different from the average American. Indeed he is, though in ways that have nothing to do with his unusual name or upbringing. Just look at the man. He's lean. He goes to the gym every morning. When he hits the bottle, it's got water in it. Sure, he has admitted to lighting up the occasional cigarette. But compared with the typical pudgy, sedentary, fast-food-craving American's lifestyle, the president's healthful habits make him anything but average.

As the national conversation about healthcare reform continues, the new president has a chance to do much more than lead by example. Despite the continuing economic uncertainty and a host of competing priorities,

Obama has pledged to keep his campaign promise to bring comprehensive reform to our ailing healthcare system. In contrast to the last big push for reform, during the Clinton administration, this time there has been more agreement among insurers, employers, consumers, and lawmakers on the broad outlines for change. Although many specifics have yet to emerge, all parties agree that any plan must place a strong emphasis on encouraging healthful behaviors and preventing disease.

Reform can't happen soon enough. Americans today are fatter and less active than ever. Two thirds of adults are either overweight or obese, and fewer than a third exercise at least three times a week. Twenty-four million people have diabetes, the vast majority of it related to lifestyle, and an additional 57 million are prediabetic. Despite decades of public anti-tobacco campaigns, 1 in 5 adults smokes. At the same time, nearly 46 million Americans, including 8 million children, lack health insurance.

The news isn't all bad, though. In recent years, we've made inroads against some of the most lethal illnesses: The death rate for heart disease, the No. 1 killer, has declined by 26 percent since 1999. Both the incidence of and death rate for cancer, the second most common killer, are in decline for the first time.

Preventable deaths. But experts worry that progress will be halted or reversed if Americans don't start taking better care of themselves. Take smoking, the leading cause of preventable death. After declining for many years, smoking rates have leveled off and haven't budged for the past five years. Every year, in fact, an estimated 900,000 people die from avoidable causes: because they failed to maintain a healthy weight, eat nutritiously, and exercise, or because they smoked or drank excessively, for example. That's roughly 40 percent of all U.S. deaths.

Our expanding girth is America's most visible health problem. Not only are most adults too heavy, but obesity rates for children have more than doubled in the past 30 years. Excess weight is a significant factor in four of the six leading causes of death: heart disease, cancer, stroke, and diabetes. Obesity has fueled a 45 percent rise in diabetes over the past 20 years; someone born in 2000 has a 1 in 3 chance of developing the disease.

Unhealthful behaviors take a toll not only on individuals' lives but also on our already overburdened healthcare system. The United States spent more than $2 trillion on healthcare in 2006. It accounts for a whopping 16 percent of our gross domestic product, and that's projected to rise to 20 percent by 2017. Much of this healthcare spending can be tied to preventable health problems. For example, obesity-related spending, chiefly to treat high blood pressure and diabetes, accounted for 27 percent of the increase in overall health spending between 1987 and 2001, according to a study by Kenneth Thorpe, a professor of health policy at Emory University. Overall, caring for people with chronic medical conditions, many of them preventable, accounts for about 75 percent of medical spending nationwide.

Given the heavy human and financial cost of chronic disease, heading off a medical condition, or at least its potential complications, seems like a no-brainer. Indeed, politicians frequently extol the money-saving benefits of preventive medicine. In its section on reducing healthcare costs, for example, the Obama-Biden healthcare reform plan says the team will "improve access to prevention and proven disease management programs."