Toward Improved Quality of Life

Health

J. MICHAEL MCGINNIS

Toward Improved Quality of Life

Thomas Jefferson was unequivocal: “Without health, there is no happiness. An attention to health, then, should take the place of every other object.” During the past two decades, the association of health and quality of life has been underscored by developments that not only have meant better health for individuals but also have positioned the United States on the doorstep of transformational change in notions of good health and how it is determined. It has become clear that health is not just a matter of biology and medical care, but of behavior, of environment, and of social conditions. Along with these insights have come important new opportunities and priorities.

The most basic measure of progress–vital statistics records of death rates for the nation’s prominent health threats–provides a first-order indication of the trends (see figure 1). Between 1980 and 2000, age-adjusted death rates for heart disease declined by 37 percent, cancer by 4 percent, stroke by 40 percent, and injuries by 26 percent. This is good news, and it is substantially attributable to progress in prevention.

The medical care system misses very few opportunities to treat disease after it occurs, yet daily misses countless opportunities for prevention.

In that same period, however, some conditions have become more prevalent, with the age-adjusted death rate from diabetes increasing by 39 percent, influenza and pneumonia by 8 percent, chronic lung disease by 49 percent, kidney disease by 21 percent, and septicemia by 88 percent. The death rate from Alzheimer’s disease rose from 1.1 deaths per 100,000 people in 1980 to 18 deaths per 100,000 people in 2000. HIV/AIDS, not even known as a condition until June 1981, leapt onto the list of the 10 leading causes of death, ranking eighth at its highest rate in 1995, and then, in the face of aggressive countermeasures, dropping by 70 percent in the past six years and falling off the list. Overall, life expectancy increased by 4 years for men and 2.5 years for women, reaching 74.1 years for men and 79.5 years for women in 2000.

As life expectancy increases and population ages, issues of quality of life have become ever more compelling. There is good news on this front as well. In 2000, the proportion of people over age 65 grew to 12.6 percent, up from 11.3 percent in 1980, and is expected to reach 20 percent by 2030. Yet, as the population ages, disability among older people is declining. Mortality dropped by about 1 percent per year among older people during the past two decades, and disability rates declined even more, by about 2 percent per year. The proportion of older people living in institutions declined to 4.2 percent in 1999 from 6.8 percent in 1982.