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Are We Healthier Now Than in 1900?

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This month, the New England Journal of Medicine released an illuminating illustration charting causes of death in 1900 versus today. Unsurprisingly, a century ago, society was afflicted with many more ailments. Not only are people now living longer, they are dying of fewer things.

Heart disease and cancer top the charts for most common causes of death, each year claiming 19,290,000 and 18,580,000 lives, respectively. While those numbers are devastating, at least 20,220,000 people are no longer dying from pneumonia and influenza with each passing year.

In a 1912 NEJM editorial, the author offered the following meditation on the future of medicine:

Perhaps in 1993, when all the preventable diseases have been eradicated, when the nature and cure of cancer have been discovered, and when eugenics has superseded evolution in the elimination of the unfit, our successors will look back at these pages with an even greater measure of superiority.

Sure, while we haven't succeeded in curing cancer, the past 100 years have seen a staggering number of superior medical advancements. With groundbreaking vaccines, diagnostic tools and advanced medical devices, we have all but eliminated a bulk of the ailments that plagued society merely decades ago. However, with this progress, we have also fallen victim to a new subset of maladies.

As the chart indicates, diabetes -- once not even on the spectrum -- now claims an estimated 2,230,000 lives annually. The number one offender, heart disease, has skyrocketed from fourth place at 13,740,000 deaths in 1900, to the aforementioned 19,290,000 in 2010. The thing is, curbing these tragically high mortality rates might not even require superior innovations as much as a simple healthy diet -- and more physical activity.

Myriad diseases, ranging from heart disease to diabetes, are inextricably linked to obesity. Obesity is, without a doubt, the industrialized world's leading public health epidemic. More than two-thirds of Americans are overweight or obese. According to the Childhood Obesity Foundation, 59 per cent of Canadians are overweight or obese and, like in the United States, obesity rates in children have almost tripled in the past 25 years. Even France, a stereotypically thin country, has seen its obesity rate rise from 8.5 per cent in 1997 to 14.5 per cent today.

Obesity poses both direct and indirect costs on individuals and the society in which they live. In Canada, the cost associated with obesity was estimated at $1.6 billion in direct costs and $2.7 billion in indirect costs (Katzmarzyk and Janssen). Americans fare even worse: according to a recent Lehigh University study, 21 per cent of U.S. medical expenses (about $190 billion annually) are obesity-related.

In recognizing both the epidemic's public health and economic threats, government officials have sought to use unconventional policy levers to curb escalating obesity rates. New York City's Mayor Bloomberg recently announced the ban of supersize sodas containing thousands of calories in each sucrose-filled bucket. While Bloomberg's ban enraged the general public, some medical experts believe it is both necessary and inevitable, emphasizing the need for not just treatment, but proactive prevention.

But proactive prevention of obesity extends beyond draconian legislative bans. As is evidenced by Nixon's ongoing 40-year-old "War on Drugs," illegalization of publically and personally destructive activities is not sufficient. People still do drugs.

Equally as insufficient are policies banking exclusively on rational human action. The fact of the matter is, humans are often irrational, hyperbolic discounters, electing to enjoy marginal pleasure now, rather than forgo it for an enormous future payout. You won't have much luck in dissuading the ravenous 300-pounder from eating the deliciously greasy pizza pie with a lecture on trans fats and bad calories. Similarly, showing the habitual smoker images of lungs blackened by cigarettes will not suffice as a universal motive to quit. Ditto for the high-schooler who is now pregnant because she had unprotected sex, despite her years in Health Ed.

Unfortunately, humans are often short-sighted and self-destructive. It would be great if sheer willpower were enough to combat life's many temptations, but it's very clearly not. Offsetting rising obesity rates and overhauling individual behavior on a national level necessitates multilateral action, from consumers up to policymakers.

Policymakers cannot and will not remain complacent as the needles on both the national scale and healthcare tab continue to tick upward. Admittedly unconventional, the government action to promote a healthier public lifestyle will not stop at Bloomberg's soda ban, so get those Big Macs and jumbo-sized pizzas while the gettin's good!