And now for some good news on health

When it comes to health concerns, the COVID-19 pandemic is top of mind for most people right now. And that’s for good reason.

But there is some very good non-COVID health news that may not be getting the attention it deserves. According to the CDC, the rates of six of the top 10 causes of death in this country, which account for about three-quarters of all deaths, have been declining. That’s remarkable. And these improvements are occurring despite an aging population and an obesity epidemic that affects several health conditions.

Six positive health trends

Let’s look at the trends in these conditions and their rank as causes of death in the US:

• Heart disease (#1) and stroke (#5): Deaths due to cardiovascular disease, including heart attacks and stroke, fell by about 36% between 2000 and 2014. The decline for heart disease since 2014 appears to have continued through 2018. After leveling off for several years, stroke-related deaths dropped again (by 1.3%) from 2017 to 2018.
• Cancer (#2): The drop in cancer deaths was about 2% between 2017 and 2018. Over the last 25 years it has dropped by 29%.
• Unintentional injuries (#3), including drug overdoses, and chronic lower respiratory diseases (#4), such as emphysema and asthma: Each of these categories dropped by nearly 3% from 2017 to 2018.
• Alzheimer’s disease (#6): Deaths fell 1.6%, even though the prevalence of this devastating illness is increasing.

The cholesterol connection

Another positive trend is that cholesterol levels across the US population have been moving in the right direction over the last 20 years. About 18% of Americans had a high total cholesterol in 1999; as of 2018, just 10.5% had high levels. Meanwhile, about 22% of the population had low HDL (“good”) cholesterol; that number fell to 16% in 2018. Because high total cholesterol and low HDL cholesterol are risk factors for cardiovascular disease, these improvements may at least partly explain why cardiovascular disease mortality rates are falling.

And fewer people are smoking

There’s also good news with respect to the popularity of cigarette smoking. According to the CDC, the percent of the population that smokes cigarettes is dropping significantly. In 2017 it fell to 14%, an all-time low since such statistics have been collected. This represents a steady drop from 2006, when nearly 21% of people were smokers.

Over time, fewer smokers means lower rates of smoking-related illness, including several of the top 10 causes of death like chronic lung disease, lung cancer, and cardiovascular disease.

Notably, this survey did not include vaping, which has been rapidly gaining popularity in recent years. Some former cigarette smokers are now vaping, as are many adolescents and young adults. So the good news about falling smoking rates could be at least partially offset by potential negative health consequences of vaping, including e-cigarette or vaping-associated lung injury (EVALI).

What about life expectancy?

Life expectancy in the US was estimated to be 78.7 years in 2018, a small increase from 78.6 years in 2017. Between 2014 and 2017 life expectancy had been falling in the US, largely due to suicide and unintentional injury (especially drug overdoses). While the improvement in 2018 is small, it’s still welcome news to see estimated longevity tick upward.

Some caveats

It’s worth emphasizing that the data that demonstrate these positive health trends are at least a year or two old. And, importantly, improvements in life expectancy and certain causes of death are not shared equally among all groups of people: those living in poverty and a number of ethnic and racial groups have experienced less health improvement than the population as a whole.

In addition, these trends preceded the COVID-19 pandemic, a disease that has quickly become a leading cause of death. In fact, as of April 7th, 2020, COVID-19 was the number one cause of death in the US when the number of deaths per day (rather than the yearly number) were considered.

And of course, focusing only on causes of death does not provide a complete picture of a nation’s health. Disability and quality of life are essential measures of health as well, and for many people these are more important than longevity.

The bottom line

The good news is real and reason to celebrate. Yet there is plenty of room for improvement in the health of Americans, especially for four causes of death that are not falling: influenza and pneumonia, suicide, diabetes, and kidney disease. And there is no guarantee that the positive trends will continue. My hope is that we can figure out how to make even more progress more quickly, and to extend that progress more evenly throughout the population.

Follow me on Twitter @RobShmerling

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