The biggest problem in healthcare may not be what you think.
This is an introduction to a talk I will give to physicians about preventive cardiology updates, but I thought it might be of interest to our audience of people interested in improving their health or increasing their Healthspan.
Chronic diseases are the biggest healthcare problem in America.
And yes, I’m aware there is a pandemic going on right now that has shocked our entire healthcare and economic system. But let me explain why I still think chronic diseases are even more critical during this time of COVID.
The CDC tells us that six out of 10 adults in the United States now have a chronic disease. So, 120 – 140 million adults have a chronic disease. And 4 in 10 have at least two chronic diseases.
Chronic disease is also the biggest driver of healthcare cost; 80 to 90% of healthcare dollars are now spent on those with chronic disease.
So what do we mean by chronic disease?
The ones that are the most common, doctors call cardio-metabolic disease. This may not be a term you’re familiar with, but you’ll understand what I mean when we talk about the actual conditions. These are the 21st-century epidemics.
- High blood pressure
- High cholesterol
- Unhealthy weight.
These diseases are affecting up to 160 million adults in the United States. These are so important because these diseases are the primary drivers of the problems that are killing us. Things like heart disease, stroke, cancer, kidney disease, dementia, and yes, even COVID because those people that are most vulnerable from COVID are the ones that have these conditions.
What’s shocking about this is we have a problem affecting the majority of our adult population. And yet, we already know what works to prevent and treat these illnesses. I’ll show you some simple concepts, seven simple things that research has shown can decrease coronary artery disease, blockages in heart arteries by up to 80%. Decrease chronic kidney disease by 60%. Decrease stroke by half and reduce dementia and cancer by about a third.
So, to set the stage, we arguably have the biggest problem in healthcare – chronic disease – that affects most of us, even though we know how to get rid of it, prevent it, and treat it.
And yet, somehow, we’re not doing it.
So, what are those simple things? Well, the American Heart Association calls them Life’s Simple Seven:
- Normal cholesterol level
- Not smoking
- Normal body weight
- Normal blood sugar
- Eating a healthy diet
- Being physically active
- Normal blood pressure
When somebody can optimize all seven of these things, they can lower their risk of heart attacks, stroke, cancer, dementia, and early death by up to 80%.
So how are we doing as healthcare in helping people get these results?
- Not smoking. Smoking has decreased about 25% over the last decade. Yet still, 38 million people smoke in the United States.
- Helping people achieve a normal weight. I don’t think this is a surprise to anybody. We’re doing poorly. Over 70% of people in America now are overweight or obese when we use BMI to measure that, the average body mass index in the United States is 29.1.
- Blood sugar control. There’s been a 750% increase in diabetes in my lifetime. We also have newer, although not brand new, medications called SGLT2 inhibitors that have a mortality benefit, meaning that when people take these medicines with diabetes, they live longer than the people that don’t take these medicines. Any doctor will tell you we don’t have many treatments that have a proven mortality benefit to them. Yet, only 5 to 6% of eligible for these medications are taking them.
- Helping people eat a healthy diet. About 60% of our diet is ultra-processed foods. Research shows that prcessed foods are strong drivers of our current cardiometabolic disease epidemics.
- Being physically active. Less than 25% of people meet the minimum weekly physical activity requirements. That’s 150 minutes of moderate activity or 75 minutes of vigorous exercise a week.
- Normal blood pressure. Despite knowing how to treat blood pressure with effective cheap medications, only 43% of the population with high blood pressure has it under control.
- Normal cholesterol levels. Only 55% of people eligible for statins (another medication with a proven mortality benefit) are taking them.
Now you can understand why this problem, even though we have answers and solutions to it, continues to be one of the biggest healthcare problems. It’s killing us. Total heart disease deaths have been on the rise since about 2011. The CDC says that our maximum lifespan age occurred in 2014 and has dropped every year since, primarily because of these epidemics of cardio-metabolic diseases. And during COVID, it’s going to be even worse.
There are about 2,000 preventable deaths a day from these diseases, about four fully loaded 747s going down every day. And in this time of the pandemic, those numbers are dramatically higher.
So how are we going to solve this problem? How will we do a better job of giving people the treatment they need?
One of the concepts being considered is a new specialty in Cardio-metabolic diseases, a specialty that combines cardiology, endocrinology, and nephrology. I think this could be a start, but there are opportunities we can start implementing now that can help save lives, and in our next videos, we will talk about ideas on improving high blood pressure, cholesterol, blood sugars, fish oil, or omega 3 fatty acids, and the most significant opportunity, lifestyle change.