Over the past year, there have been several reports indicating America's health status has taken a turn for the worse.
Life expectancy for white women took a small but unexpected dip in 2014, the Centers for Disease Control and Prevention reported last April. And nearly a year ago, a paper from two leading economists revealed that life expectancy for whites has been declining for nearly two decades, with almost all of the decrease concentrated among men and women without a college education.
The causes, they reported, had nothing to do with increased rates of heart disease or cancer. Rather, the data revealed sharp increases in suicides and drug-related deaths among less-educated whites.
The social decay in some areas that are driving those numbers helps explain the anger shaping this year's presidential election. But legitimate concern for the economic status of those left behind by deindustrialization has overshadowed the somewhat brighter picture of overall health painted by the latest CDC National Health Interview Survey of 35,000 Americans, which was released last week. On virtually every indicator—with the sole exceptions of the related issues of obesity and diabetes—the U.S. is better off or the same today as we were 10 or 20 years ago.
On this annual self-evaluation of health, exactly two-thirds of Americans reported that they are in either excellent or very good health. That measure has increased by nearly a full percentage point over the past decade. Obviously, we still have work to do. It remains nearly 2 points below where we were in the late 1990s. The number of uninsured has declined sharply because of the Affordable Care Act. The CDC reports that in January to March of this year, that number fell to 8.6% of the population, down from 9.1% the previous year and 16% in 2010.
As a result, access to healthcare continues to improve for most Americans. This year, 87.5% of respondents indicated they had a regular place to go for medical care, statistically unchanged from the previous year but up from 85.4% in 2010—the year the ACA passed. In addition, the number of people reporting they didn't obtain needed care for financial reasons, which increased from 4.3% in 1999 to 6.9% in 2010, was back to 4.3% this year.
The nation has made substantial progress in tackling one of the biggest contributors to ill health. Smokers represented just 15.3% of the population in 2016, statistically no different from the previous year but down from the nearly 25% smoking rate of the late 1990s. Drinking, on the other hand, was up modestly during the Obama years after declining during the Bush years.
The one area where the survey revealed worsening conditions was in the related rates of obesity and diabetes. Nearly 31% of respondents said they were obese, slightly higher than the year before and significantly higher than the 20% self-reported rate in 1997.
It's not as if first lady Michelle Obama's physical activity campaign hasn't had an impact. Based on questions about their leisure-time activities, the number of adults meeting the federal government's physical activity guidelines stood at just a shade under 50% this year, more than 2 percentage points higher than 2015 and sharply higher than the 41% who engaged in routine physical exercise a decade ago.
It must be our diets. Despite the increase in physical activity, the diabetes rate stood at 9.2% this year, an insignificant tick down from the previous year but 4 full percentage points higher than where it stood in 1997.
In a commentary in the New England Journal of Medicine last week, Democratic presidential nominee Hillary Clinton outlined a healthcare agenda for her prospective administration. Republican nominee Donald Trump was invited but chose not to reply.
Nowhere did she mention gun violence, opioid addiction or obesity-driven diabetes, the three major public health scourges of our time. It's incumbent on the next administration to focus on prevention in these three key arenas as we move beyond the sterile debate over repealing the ACA to improving public health.