Lifelong Health by Dr. David Lipschitz

The life expectancy of Americans is at an all-time high. But, before you get too excited, I must let you know that the Census Bureau and the National Center for Health Statistics report that America ranks poorly in life expectancy among the world's developed countries. Twenty years ago, America ranked 11th in the world. Today, it has dropped to 42nd. We spend more health dollars per capita than any other nation, and yet Japan, Singapore, Macau, most of Europe, Jordan and the Cayman Islands are all ahead of us in longevity.

The straight statistics are embarrassing, but dig a little deeper, and the story grows worse. Longevity is not just an "American" issue, but a socioeconomic and ethnic one as well. The life expectancy among affluent whites — 77.9 years of age — competes well with most countries in Asia and Europe. However, the life expectancy of black males averages 69 years, lower than in Cuba, Iran and Syria.

Perhaps the most alarming statistic of all is that the United States has a higher rate of infant mortality than most other developed countries. Here, the United States ranks 41st behind most developed Asian countries, Europe and Cuba. The average infant mortality in the United States is 6.8 deaths per 1,000 births. However, infant mortality among blacks is 13.7 deaths per thousand births. Before you start pointing to infant deaths as the main cause of our lowered life expectancy, realize that even when excluding deaths during the first year of life, America still ranks 42nd.

So why the declining rank of life expectancy in the United States? First, the National Center for Health Statistics now tracks information from many more countries than it did 20 years ago. However, I do not think this detracts from the fact that most developed countries are doing much better than we are.

In an interview on British Broadcasting Corp., Dr. Robert Butler, president of the International Longevity Center, blames the decline in life expectancy on disparities in socioeconomic status, the lack of access to quality health care and the fact that so many Americans are uninsured.

He points out that a black man in New York, Baltimore or Washington has a lower life expectancy than a man living in Bangladesh. He puts much of the blame on commercial health insurance with its massive overhead for marketing, claims adjustment, administrative costs and salaries for senior executives. Butler urges immediate and substantive health care reform — reducing the number of uninsured Americans, improving access to care and eradicating reduced longevity among minorities and the poor.

Although I often complain about America's focus on acute, high-technology care, this is clearly not a contributing factor in our poor longevity ranking. When it comes to major surgery of any kind, including open heart, abdominal or cancer, the United States ranks at or near the top. Similarly, we rank high in treatment of cancer by chemotherapy or radiotherapy. Clearly, an American with cancer will likely have a better outcome than a Bangladeshi with cancer.

But the huge investment in acute care comes at a cost that is much more than financial. Most medical student training concentrates almost exclusively on managing acute illnesses and serious medical problems. Doctors flock to these exciting and well-reimbursed fields at the expense of primary and preventive care, fields in which lack of physicians is approaching crisis levels. It is not surprising, therefore, that the quality of primary and preventive care and the management of chronic diseases leave much to be desired.

There is another likely culprit in America's low ranking in longevity — unhealthful lifestyle choices such as eating poorly, being sedentary and smoking, all of which contribute significantly to a higher risk of obesity, heart disease, high blood pressure, diabetes and cancer. This in turn leads to a lowered life expectancy.

For a nation with the resources of the United States, disparities in health care, high infant mortality and an inability to address the obesity, diabetic and heart disease epidemics should always remain center stage in the debate over our nation's priorities and the use of its precious resources.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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