If Stephen Curry misses a free throw with the game on the line in the NBA finals, everyone will say he choked.
If the two highest-paid teams in Major League Baseball this year (the Los Angeles Dodgers and New York Yankees) fail to make the playoffs, no one will congratulate them on a job well done.
When life expectancy among a group of Americans unexpectedly drops, some look to blame the U.S. healthcare system, which is indisputedly the most expensive in the world and has centers of excellence that are the Stephen Currys of global health.
Last week, the Centers for Disease Control and Prevention released new data showing that white women on average lived shorter lives in 2014 compared to 2013. It was just a blip—down to 81.1 years from 81.2. But most experts agreed it was a worrisome harbinger of what awaits other groups suffering the ill-effects of our increasingly unequal society.
The downward move in this core health indicator confirmed independent research published last November by Nobel Prize winner Angus Deaton and his wife, Anne Case, both professors of economics at Princeton University. Their data showed a shocking increase in mortality rates during the 2000s for white men and women between the ages of 45 and 54 with less than a college education. Legal and illegal drugs, alcohol and suicide were to blame, they concluded.
The future doesn't bode well for a quick turnaround. The obesity epidemic, which has shown signs recently of ending its upward march, still hasn't been reversed in any meaningful way. Obesity can slice up to 14 years off life expectancy, according to a study published two years ago in PLOS Medicine. People who are merely overweight face 2½ times the risk of early mortality, compared to people of normal weight.
Here's the really scary part: Two-thirds of U.S. adults are either obese or overweight. It's not just because they eat too much—although many do and have poor diets to boot. Rather, it is because many Americans don't get enough exercise. The study found that the number of women who never exercise jumped to 52% of the population in 2010, compared to just 19% in 1988.
Healthcare leaders over the past several years have been grappling with a new concept called population health management. For most, it means developing strategies for taking care of a group of people for whom a healthcare system or insurer are financially at risk.
Too many readmissions within 30 days of an initial hospital stay? Identify those most likely to return and make phone calls, send in the home health aides, and provide some basic social services to ensure they stay on their meds, make their follow-up clinical visits and have a refrigerator stocked with decent food.
Such strategies didn't make sense in a world where every medical intervention was reimbursed under fee-for-service medicine. The sicker people got, the more healthcare providers gave and the more money they made. Now, with all Medicare money subject to a haircut for excess readmissions, they do.
But that vision of population health management barely touches the underlying causes of ill health in our society. We need a much broader definition that tackles the social causes of chronic diseases.
We often complain about the fact that more than 17% of our economy is devoted to healthcare—more than any other country in the world. But, as Elizabeth Bradley of Yale University and Lauren Taylor revealed in their 2013 book The American Health Care Paradox, the U.S. is dead last among 11 advanced industrial nations in spending for social services like education, family support, jobs programs and housing.
Indeed, if you add up healthcare and social-service spending, the U.S. falls to the middle of the pack among advanced industrial nations in total health and human-service spending as a share of gross domestic product. The implication is clear: By spending more on alleviating the social causes of ill health, other countries wind up spending much less on caring for the sick.
A more engaged healthcare system can be part of the solution for avoiding America's coming decline in longevity. But it will hardly be sufficient.
