Chapter 1: Understanding America’s Health Crisis

Despite investing over $4 trillion in healthcare—almost 20% of our GDP—Americans are not as healthy as one would expect. Recent findings reveal a concerning state of health among the population.

According to a comprehensive study by the CDC, which monitored 55,081 Americans from 1999 to 2018 through the National Health and Nutrition Examination Survey, cardiometabolic health is not just poor; it is declining.

The criteria for what constitutes good health are quite reasonable: not being obese, maintaining normal blood sugar and cholesterol levels, having regulated blood pressure, and not suffering from cardiovascular diseases. Alarmingly, only 6.8% of participants in the 2017–2018 survey met these standards, indicating a steep downward trend.

Let’s pause to reflect on this: Americans are faring poorly in terms of health.

Disparities are evident as African Americans and Mexican Americans generally perform worse than white participants, and men are at a disadvantage compared to women. Education and income levels further highlight these inequalities; less educated and lower-income individuals showed poorer health metrics. However, even among well-educated, affluent white individuals, the health outcomes are unsatisfactory.

A significant point to note is that the survey did not consider factors such as exercise, dietary habits, stress levels, or sleep quality. When these are factored in, alongside the declining rates of tobacco use (now below 15%) and excessive alcohol consumption, it paints a grim picture. Many Americans are left wondering why they develop chronic conditions like diabetes, heart disease, or cancer.

The study authors concluded that "the findings underscore the urgent need for national clinical and public health interventions aimed at improving both cardiometabolic health and health equity."

An editorial titled "Failing Cardiovascular Health: A Population Code Blue?" in the Journal of Cardiology emphasizes that the worsening cardiometabolic profile should not be surprising given the prevalence of an obesogenic lifestyle—characterized by unhealthy diets, lack of physical activity, poor sleep, and excessive screen time. The authors express concern that the emerging metaverse could further decrease physical activity and exacerbate obesity.

Restoring positive cardiovascular health will not happen spontaneously; it requires a concerted effort from every healthcare professional and public health policy advocate on three levels: personal, clinical, and community.

In my previous article titled "Follow the Money in Healthcare — It Will Lead You to Chronic Diseases," a reader, Jo Lis, highlighted the critical importance of lifestyle changes to prevent chronic disease, emphasizing sensible eating and regular exercise. She pointed out that while we know what to do, many of us fail to consistently adhere to these practices. Food is crucial in this equation, and understanding what constitutes a healthy diet is often misunderstood. The push for processed foods, driven by profit motives, only perpetuates chronic diseases.

Since industry and government support may not be forthcoming, it falls on individuals to take charge of their health. The American Heart Association (AHA) introduced "Life’s Essential 8," updated in June 2022, as a guideline for assessing health and promoting wellness. This update aims to shift the focus from merely treating diseases to fostering overall health throughout life.

Chapter 2: Life's Essential 8 — A New Paradigm for Health

The American Heart Association's "Life's Essential 8" consists of four health behaviors—diet, physical activity, tobacco use, and sleep—and four health factors—BMI, blood lipids, blood glucose, and blood pressure. These metrics are crucial for assessing cardiovascular health.

Research indicates a strong connection between achieving ideal cardiovascular health metrics and reduced rates of cardiovascular disease and overall mortality. Thus, employing the Life’s Essential 8 framework can effectively guide wellness strategies and chronic disease prevention.

Social determinants and psychological well-being are increasingly recognized as critical components of health. Elements such as education, employment, and community resources significantly influence overall health and cardiovascular outcomes. Mental health factors like anxiety and depression can detract from well-being, while positivity, gratitude, and a sense of purpose can enhance health.

Sleep has recently gained attention for its importance in managing stress and inflammation, both of which are vital in preventing chronic diseases. Unfortunately, the odds seem stacked against us, particularly concerning food choices.

While individual responsibility is essential, support from the food industry, healthcare providers, and government is also necessary. Currently, efforts to promote healthy eating habits have been minimal, as profit motives often hinder meaningful change.

Ultimately, the responsibility lies with each of us. By focusing on healthy lifestyle choices, we can improve our health and longevity. The AHA provides valuable resources that can guide us on this journey.

The latest CDC study found that fewer than 1% of Americans maintain an ideal diet. Therefore, your immediate focus should be on improving your eating habits. You don’t have to be perfect; small changes can yield significant benefits. Aim to reduce sugar and refined flour consumption while incorporating more whole foods into your diet. Embrace fresh fruits, vegetables, whole grains, nuts, and healthy fats.

This approach will not only enhance your health but also empower you to tackle other important factors like exercise, stress management, and quality sleep. By understanding the financial implications of health, you can save significantly in the long run by avoiding chronic illnesses.

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Stephen C Schimpff, MD, MACP, is a semi-retired internist, professor of medicine, former CEO of the University of Maryland Medical Center, and author of "Longevity Decoded — The 7 Keys to Healthy Aging."