United States of Poor Health: Reflections on Fourth of July 2018

United States of Poor Health: Reflections on Fourth of July 2018


            Exactly this day 242 years ago, with the signing of the “Declaration of Independence”, a young and idealistic Republic was founded with the premise that “All men are created equal” and are endowed with the “unalienable rights” of Life, Liberty, and the pursuit of happiness. It is worth taking stock of the current state of health of this rather remarkable country, which has so believed in its exceptionalism.


            As I write this, as part of the celebration, 285 million pounds of fireworks, costing over a billion dollars will light up the skies, temporarily raising airborne pollution by about 42% - hardly a responsible statement against one of the biggest threats of this century – Climate Warming.

Amidst these Fourth of July celebrations, nearly 700 people will head to hospital Emergency Rooms with fire injuries, and about seven may die. While these seven unnatural deaths are seven too many, the nation’s annual toll from gun violence presents a truly shocking picture: 61,331 gun incidents, 344 mass shootings, 31,197 injuries, 15,549 gun-related deaths of whom 737 are children aged 0-11 years and 3232 are teenagers aged 12-17 years. (Gun Violence Archive, 2017)  The US leads the world with the highest number of people incarcerated – nearly, 2.3 million people are in jails, the majority presumed innocent, and some race minority groups disproportionately represented. (Prison Policy Initiative) 

While almost all of the countries of the world are experiencing rapidly increasing life expectancy, the US for two years in a row has experienced a decline in life expectancy.  The shocking news is that the population most affected by this trend of declining life expectancy is adult White males. Factors such as the Opioid and substance abuse epidemic, poor mental health, homicides and suicides seem to be driving these excess deaths. Furthermore, the gaps in life expectancy between the richest and poorest Americans is now over 14 years – with the poorest in the US having life expectancy similar to people in Malawi. The US with 26.4 female deaths per 100,000 live births has the highest maternal mortality rate among all rich countries, and is among a handful of countries worldwide where maternal mortality rates are increasing.

More than two-thirds of Americans are overweight or obese, and yet, diet continues to be dominated by commercial forces favoring fast food, high corn, high-sugar, and heavy meat consumption.  Americans gorged nearly 100 billion pounds of red meat in 2017. Each year, nearly 20 billion Hot Dogs are eaten, almost 155 million on Fourth of July alone when the nation merrily indulges in celebratory picnics and barbecues, quite oblivious to the health and environmental effects of heavy meat consumption.

            For a country that has achieved so much in its brief history, the current state of health presents grave threats. Despite spending over 17% of its GDP on healthcare, the country’s health, on average, is among the poorest across all high-income countries. Furthermore, vast disparities in health persist and expand: the poorest counties have 8-10 fold rates of cardiovascular mortality and diabetes incidence compared to the richest counties in the country. Only a fraction of these variations is explained by healthcare factors, while sociopolitical factors, such as poverty, unemployment, crime, explain the largest proportion of health disparities. According to the Economist, in the 2016 US Presidential elections, the strongest area-level predictor of voter preference was poor health, even after accounting for demography, race, income, and unemployment. The areas with the poorest health voted for the candidate who won.  Presidential candidate Trump in 2016 blamed immigrants for causing White unemployment and used that message to win votes. Yet, counties with high immigrant populations have low unemployment and poverty rates, and generally better health for all Americans.


            This Fourth of July, Americans need to wake up from their illusion of exceptionalism, and face the facts of the country’s declining health in all seriousness.  That would be true patriotism.