Reversing the decline of health in the US

This transcript has been lightly edited for clarity

Introduction:  In a series of articles in The Lancet, IHME faculty and researchers have outlined the dire state of health in the United States, highlighting an obesity epidemic, huge disparities between ethnicities and races, as well forecasts suggesting the US will continue to struggle, compared to other high-income countries, unless something is done urgently. The series culminated with a Viewpoint article in The Lancet.

Christopher Murray: In this Viewpoint, we go farther than those papers and try to speculate on the ways we can achieve progress.

The first thing that we emphasize is, using the relationships well-established in the literature, documented in the Global Burden of Disease as well, is that education, from the beginning – even before children go to school – so early child development, elementary, secondary school education, college education, are critical determinants not only of your income, but also of your health. And so efforts to address educational disparities are going to be a critical part of the solution to our poor performance as a nation in terms of health, particularly addressing the widening gap in education that has emerged between boys and girls, where there’s really an alarming difference between college completion for girls compared to boys, with boys really falling behind. 

Secondly, we need a radical solution to deal with overweight and obesity. Every year it gets worse. There’s no indication anywhere in the US of progress on overweight and obesity, nor is there any indication of any progress anywhere in the world actually on overweight and obesity. So we really need to rethink both diet and physical activity, and how they combine to lead to this overweight and obesity epidemic.

And that’s going to require both policy innovation as well as the sort of research and evaluation to track what’s actually working. 

Third, there’s further behavioral risk modification that’s required for the US to catch up. We need to address tobacco, drug use, as well as high blood pressure, which is related to diet, as we just said before, but can also be addressed through individuals with high blood pressure tackling some of the drivers as well as taking their medication for high blood pressure.

But key to success is not necessarily more health care but the targeted efforts at these behavioral factors, which will include health care, but not only health care. All of the strategies that we could imagine for addressing overweight and obesity, high blood pressure, tobacco and drug use, there is a role to be played by the health services, and that’s why we believe that universal health coverage, making sure that everyone has financial, cultural, and physical access to health care, is going to be part of a robust solution to the poor outcomes in the US.

And then the last observation in our viewpoint is that solutions in a highly diverse nation like the US need to be contextualized. They need to reflect the values, goals, aspirations of different communities, and a one-size-fits-all strategy, even for the same problem, whether it’s high blood pressure or overweight and obesity, is unlikely to succeed. And so we need to work with the community to achieve these outcomes that we all aspire to.

So while we see in the forecast things getting worse in the US, not better, we remain optimistic that there is a route forward if we can really grasp these key drivers, underlying social determinants, and take on the big risk factors that we’ve identified in these studies. Thank you.