For the first time since 1962 and 1963, the United States life expectancy at birth has declined two years in a row. This has been mostly attributed to higher death rates among young and middle-aged Americans with a 21 percent increase in fatal drug overdoses and the death rate doubling from synthetic opioids like fentanyl. This overshadows the progress made on reducing deaths from seven of the ten leading causes of death (heart disease, cancer, chronic lower respiratory disease, stroke, diabetes, influenza and pneumonia, and kidney disease) over the past year. The three of the ten leading causes of death that contributed to the decline in life expectancy were unintentional injuries, Alzheimer’s disease, and suicides.
We have added 38 years to life expectancy over the past 150 years, though our progress has seemed to hit a wall. We learned how to address and eradicate infectious diseases with immunizations, reduce deaths from infections with the discovery of antibiotics in the 1930s, reduce heart attacks through education, medicines and treatments, reduce cancer deaths with smoking awareness and inventing chemotherapy and radiation treatments, as well as improving health outcomes by identifying maladies earlier with the advances in medical imaging.
Unless we invent something as profound as antibiotics or immunizations, it is unlikely we will make much progress without a clear mission and new approach. Here are the areas that need improvement:
1. Managing Complexity – To get better with improving the top ten leading causes of death.
Complexity – the unpredictability of many impacting elements (people, communities and realities) that operate, interact and react in both certain and uncertain ways.
We must go beyond managing the complexity of medical treatments. We must address the 80-85% of health determinants (impacting elements) that contribute to health outcomes that are outside the health care system. These impacting elements include behavior, health literacy, environment, socioeconomic and other social determinants. To get better with managing the complexity of health, we will need to improve our understanding of how these thousands of certain and uncertain elements are impacting our individual health.
2. Mission – Develop clearly defined missions.
Our mission probably should be to improve health span (years without functional limitations) rather than live span. Who owns improving the health span mission? This is obviously a mission beyond any one organization. Yet we can agree it is a worthy mission. Therefore, we need to link the many missions that could contribute to achieving this mission. The improvement in seven of the leading causes of death (heart disease, cancer, chronic lower respiratory disease, stroke, diabetes, influenza and pneumonia, and kidney disease) was due to many organizations with missions to improve health outcomes without anyone owning the entire mission. By linking the missions together, we can identify areas of impacting elements (health determinants) that are not being addressed.
3. Strategies – that make progress toward the mission and that address the impacting elements
An example of this is the four strategies offered by Dr. Joshua Sharfstein to address the increasing death rate from opioids in an article in Journal of the American Medical Association.
Addiction Treatment – The use of the opioid agonists methadone and buprenorphine reduces overdose, illicit drug use, crime, and transmission of infectious diseases.
Criminal Justice – It is now recognized by many across the political spectrum that the arrest and jailing of millions of Americans for their addiction has complicated efforts to address the opioid epidemic.
Health Care System – There is now broad understanding that the overprescribing of opioids has contributed to today’s opioid epidemic.
Looking to Evidence – On opioids, it can sometimes seem that there are 3 bad ideas for every good one. Public officials have supported limiting the number of naloxone resuscitations and afterwards letting people die, requiring drug testing before enrolling in Medicaid, and launching stigmatizing public relations campaigns that can reduce the chance people will seek treatment.
Managing these strategies to reduce the death rate from opioids will not be easy. These strategies could benefit, as well as the ten leading causes of death, from an overarching strategy to address the impacting elements (health determinants) that are common across each of the leading causes of death.
4. Solutions – interventions that get us closer to our mission and address the impacting elements
It would require understanding how to cost-effectively manage the complexity of the many interacting and uncertain elements that impact health outcomes. It may require thousands of different medical and non-medical interventions that can be measured for cost-effectiveness. If the solutions are not cost effective, they cannot be sustained.
5. Measures – to measure progress
This includes measuring the progress toward achieving the mission and the understanding of the impacting elements. We must also measure the performance of strategies and solutions to determine what works.
The approacch to measure could be similar to what Google does with its search algorithm, Facebook does with engagement improvement and Amazon does with moving merchandise. They have created frameworks to manage complexity by using data to provide insight on opportunities to drive incremental improvements.
While genetics plays into many of our chronic diseases that limit our function (health span) and contributes to early deaths (life span), we also need to understand how the non-biological factors (impacting elements) impact and influence gene regulatory functions. This will not be easy. It will be a worthy journey rather than a destination.
There is no doubt artificial intelligence will help us in the future with managing the complexity of improving health span. Yet, for artificial intelligence to help us get over the complexity wall, we will need a framework and massive amounts of data for it to be effective like it is with Google, Facebook and Amazon. To create this framework and data, we need to address the five areas listed above as soon as possible. This will provide insight on how to make incremental improvements every year to health span and life expectancy like we have done for most of the past 150 years.
This post first appeared at ManagingComplexity.net