How healthy is the U.S.?

• Author: Feinleib, Manning
• Position: Americans' health status - Chairman's Agenda: Managing Health Care Costs

An overview of the societal environment and health trends that underlie the management of health care costs.

The Twentieth Century has seen dramatic improvements in the longevity and health status of Americans. Yet, these very achievements in our nation's health have bred the problems that now face our health care systems.

Since 1900, the life expectancy of American has grown by 28.1 years, from 47.3 to a record-breaking 75.4 years in 1990. During that time, the mortality rate for all age groups dropped precipitously. For example, in the early 1900s, one baby in 10 died before its first birthday; now 99% of all infants survive.

Controlling Infectious Disease

The control of communicable diseases and advances in nutrition were two major contributors to health improvements during the first half of this century. Many infectious diseases came under control through effective sanitation ranging from sewage systems to clean food and water, from anti-spitting laws to washing hands. The development and use of effective immunizations reduced dreaded childhood illness dramatically. With the near-miraculous development of

antibiotics and other effective therapies later in the century, what had previously been life-threatening emergencies became short-term tractable episodes.

Improved Nutrition and Food Supply

Scientific research identified the causes, and led to the potential elimination, of virtually all nutritional deficiencies. Improvements in agricultural and food processing technology, and in transportation and distribution methods, made an adequate and nutritious diet available to most Americans wherever they lived. This produced not only general improvement in the growth and development of the muscles and bones of children but probably also of the nervous system, vascular system, and immune system, which promoted longevity and vitality in older persons.

Technological Advances in Medicine

The victories against pestilence and inadequate nutrition were coupled, during the second half of the century, with extraordinary progress in medical sciences and technologies which cured the illnesses and relieved the sufferings of countless Americans. To take only one, but very significant, example, premature babies that a generation or two ago would almost automatically be given up for dead at the moment of birth now survive to healthy and productive adulthood with normal life expectancies.

Aging Population

These gains have not been achieved without a grave...