Nieman, David C. Dr.PH, FACSM
David C. Nieman, Dr.PH, FACSM, is professor and director of the Human Performance Laboratory, Appalachian State University, in Boone, North Carolina, an active researcher, and author of several textbooks on health and fitness.
Q: Is there anything good about health and fitness in America? It seems that every time I turn on the TV or read the newspaper, I learn something more about how unhealthy we are.
A: I agree with you-the media certainly focuses on our health and fitness shortcomings. Let me give you a list of what I consider to be the "good news" about our nation's health.
* Life expectancy is at an all time high. Life expectancy or the number of years one is expected to live at birth has increased from about 47 years in 1900 to a current 77.6 years, the highest ever in U.S. history (1). Most of this increase is attributable to widespread vaccination programs, control of infectious diseases from cleaner water and improved sanitation, safer and healthier foods, safer workplaces and motor vehicles, a decline in deaths from coronary heart disease and stroke, and a decrease in tobacco use.
* Heart disease death rates are falling. Stroke and coronary heart disease death rates reached epidemic levels about 50 years ago but have been falling ever since (2). Since 1950, the American death rate for stroke decreased 70%, and for heart disease, 55%. This is one of the greatest health success stories of the past half-century and is due to improvements in American health habits and medical care.
* Cancer death rates also are falling. Cancer death rates decreased during the 1990s after decades of concern over increases (3). As with heart disease, much of the decrease is due to improvements in lifestyles (especially better diets and less smoking) and an emphasis on early screening for cancer. The American Cancer Society promotes that 75% of all cancer deaths are preventable.
* Cigarette smoking has decreased. In 1965, 52% of men and 33% of women smoked. Now only 22.5% of all Americans smoke (25% among males, 20% for females) (1). The U.S. government's goal for 2010 is a smoking prevalence of 12% (4). To reach this goal, we must continue to support legislative initiatives, improvements in school health and physical education, and strategies to make smoking socially unacceptable.
* Diets have improved. Fat intake has decreased from over 40% of total calories in the 1960s to a current 33% of calories (2). Americans are consuming more poultry, fish, and low-fat dairy products, and less beef, pork, eggs, and whole milk.
* Alcohol consumption has fallen. Since the 1980s, alcohol intake has decreased due in part to the public's increasing awareness of alcohol's associated dangers (1).
* Blood cholesterol levels are down. Prevalence of high blood cholesterol (defined as >240 mg/dL), another risk factor for heart disease, has fallen from 32% in the 1960s to a current 19% (2). This improvement is linked to a reduced consumption of animal saturated fats including butter, beef fat, and pork fat. Nearly three in four American adults have had their cholesterol checked within the previous five years, up from just one in three during the mid-1980s. Two national health objectives for 2010 are to reduce to 17% the proportion of adults with high total blood cholesterol levels and to increase to 80% the proportion of adults who had their blood cholesterol checked during the preceding five years. Figure 1 provides a state by state comparison of progress towards the 2010 cholesterol screening goal.Despite these successes, some important health-related areas still need improvement.
* Obesity is at epidemic levels. Too many American adults, about 65%, are overweight and obese (1). Despite a nationwide obsession with ideal body weight, government studies over the past 40 years have shown that Americans are losing the war, especially among the poor and minority groups. Among our youth, the prevalence of overweight is rising strongly. Our chief public health challenge of this century will be countering the epidemic of obesity.
* Too few American young people and adults exercise regularly. About three in four adults do not engage in sufficient exercise despite the common knowledge that inactivity is related to heart disease, certain types of cancer, obesity, osteoporosis, and frailty in old age (1, 2).
* Disease risk factors are still too widely prevalent among both adults and adolescents. About one in four Americans smoke, one in three have high blood pressure, and one in five have high blood cholesterol (1, 2). About two in three adolescents have two or more of five major risk factors for chronic disease, and these often remain into adulthood.
* Mental stress levels are high. About 6 in 10 American adults report that they experience moderate to high levels of stress, posing one of the greatest health challenges for the next century (1, 2). One in five suffer from a mental disorder including anxiety disorders and depression. The fast pace of life, economic pressures, job dissatisfaction, and multiple other factors are to blame.
Overall, I am both optimistic and pessimistic about our health future. I am very pleased that Americans are slowly but surely reducing tobacco use and working towards a smoke-free society. On the other hand, if we do not counter the obesity epidemic, much of the health and fitness gains of the past half-century will be wiped out. Striving for leanness and fitness throughout adulthood is our primary challenge and the best strategy to prevent disease and further lengthen life expectancy.
1. National Center for Health Statistics. Health, United States, 2004.
Hyattsville, MD: 2004. Available at www.cdc.gov/nchs
2. American Heart Association. Heart Disease and Stroke Statistics-2005 Update.
Dallas: American Heart Association, 2005.
3. American Cancer Society. Cancer Facts & Figures-2005.
Atlanta: American Cancer Society, 2005.