Steve was 61-years-old and had slightly elevated hemoglobin A1C. It didn’t mean diabetes though the chronic condition could be imminent if he didn’t make changes in his activities.
Ron was 52-years-old and had an elevated red blood cell count. It was likely a reaction to smoking and sleep apnea from obesity. He was also developing a chronic cough from early lung disease. A couple of months earlier, he received his second cardiac stent. He was advised that his chance to survive past 60 years old was not great without changes to his activities.
Dr. James Salwitz describes the resulting changes in activities made by Steve and Ron as a result of their prognosis discussions. Steve lost 15 pounds after giving up candy, dessert and soda while exercising for sixty minutes, five or six times a week. Steve’s hemoglobin dropped to a normal level. Ron refused the many smoking and exercise intervention options Dr. Salwitz recommended. Ron continued to smoke a pack a day and gained 7 pounds.
Ron’s refusal to change his behaviors in the face of an early death is not unusual. A study of US cancer survivors showed they are not more likely to engage healthy behaviors than the general population. Researchers found that 19.8% of women cancer survivors smoked, compared with 15.8% percent of women without cancer. They discovered 83% of cancer survivors didn’t meet the recommended fruit and vegetable guidelines.
Studies show that as much as 50% of the determinants of health outcomes are related to human behavior. Yet few research dollars flow to how to get people like Ron and cancer survivors to change their behaviors. We need to improve our ability to change human behaviors in the face of likely chronic conditions or fatal consequences. Just 2.7% of the people in the United States are living a healthy lifestyle defined by achieving minimum levels of physical activity, nutrition, body fat and not smoking. More than 70% of U.S. adults report at least one of the following unhealthy behaviors: smoking, excessive drinking, insufficient sleep, physical inactivity or obesity.
The political discourse on health insurance overshadows the need to understand how we can more effectively manage health. The following are eight everyday activities that impact health and healthcare outcomes. They don’t include patient activation activities (taking prescription medications, health screening, vaccinations, improving health literacy) or resilience activities (managing stress and change) that also have an significant impact on health and healthcare outcomes.
1. Alcohol Use – An estimated 32% of people in the U.S. had a minimum of one heavy drinking day in the last year.
17 million people are experiencing alcohol dependence or abuse. The top 10% of U.S drinkers consume, on average, 74 alcoholic drinks per week.
2. Falls – this is a significant risk for people over 65 years old and people that are taking 4 or more medications. The national rate of deaths after falls among people 65 and over increased by more than 35 percent between 2005 and 2014. Over 700,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
3. Lifestyle – A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events as compared to an unfavorable lifestyle. Scientist assert that most cancers can be attributed to lifestyle including tobacco, diet (fried foods, red meat), infections, alcohol, sun exposure, environmental pollutants, stress, obesity, and physical inactivity.
4. Nutrition – More than half of what people in the U.S. eat is ‘ultra-processed’ with these foods accounting for 90% of added sugar intake. Improvements in US diet helped reduce disease burden and lower premature deaths from 1999–2012, yet overall diet remains poor. Foods associated with the largest three-year excess weight gain among children and adolescents were fat spread (butter or margarine), coated (breaded or battered) poultry, potatoes cooked in oil (French fries, roasted potatoes, and potato chips), coated fish, processed meats, other meats, desserts and sweets, milk, and sugar-sweetened beverages. Consumption of sugary drinks may lead to an estimated 184,000 adult deaths each year.
5. Physical Activity – CDC estimates that more than a quarter of adults over 50 get no exercise outside of daily life activities. A study found sitting can be bad, especially if you do it for more than 10 hours a day. Researchers found that moderate exercise is associated with a reduced risk of 13 types of cancer. A study shows that too much TV is associated with premature death.
6. Sleep – Automobile crash rates spike with every hour of lost sleep. In United States, sleep deprivation costs up to $411 billion a year due to lower workforce productivity and higher risk of death. A sleep disorder may harm your body and brain if you are one of more that 50 million adults in the U.S. with a disorder such as insomnia, restless leg syndrome or sleep apnea. One in 25 adults in the U.S. take sleeping pills to help them fall asleep and stay asleep at night.
7. Smoking – Smoking costs the world economy $1 trillion per year according to the World Health Organization. New evidence shows there’s no safe amount of smoking. One cigarette a day, or even less than that, still poses significant risks to your health. Smoking a pack a day for a year causes 150 mutations in lung cells. Cigarettes are linked to nearly 30% of cancer deaths.
8. Substance Use – Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin, methamphetamines) in 2015, a 10-year peak. In 2014 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. A 3,000% increase in opioid dependence has led to ‘tsunami’ of medical services. From 1999 to 2015, more than 183,000 people have died in the U.S. from overdoses related to prescription opioids.