50 Years Of American Health Choices: Smoking Gains Offset By Getting Fatter

Feeling optimistic? Then you may see the moral of this story as, "Yay, public health efforts! They can wield amazing power and save many lives."

In more of a glass-half-empty mood? Then your takeaway may be, "If it's not one thing, it's another." Or perhaps, that public health must play an eternal game of Whack-a-Mole.

The story itself: The National Bureau of Economic Research just sent over word of a new working paper that looks at American health behaviors and their effects over 50 years, from 1960 to 2010. It examined six behaviors: obesity, smoking, heavy drinking, unsafe driving, firearms, and poison or overdoses. What most struck me: Though we're generally living longer, our health gains from shunning cigarettes and safer driving are all but erased by the rise in obesity and drug overdoses. Sigh. From the summary:

...The authors find that the gains associated with declines in smoking, motor vehicle fatalities, and heavy drinking are essentially offset by the losses arising from rising obesity and misuse of firearms and poisonous substances. Valued in dollar terms, there is a near zero net gain in health from public health and behavioral changes over the past fifty years. However, the analysis includes a mix of some risk factors that have been aggressively addressed through public health and behavioral changes over a long period (smoking, unsafe driving), and others that are in the earlier stages of being addressed and have proven challenging (obesity, prescription drug addiction).
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The authors conclude "our study demonstrates the enormous benefits of public health and behavioral change in improving population health, underscoring the importance of continued advances in these areas of research and practice."

I asked Harvard health economist David Cutler, who co-authored the report, what he'd want the public's takeaway to be (and included a plea to help me beat down my own cynicism.) His e-mailed response:

There are some who see this as ‘glass mostly empty’ – i.e., if it’s not one thing, it’s another. But remember how hard these changes are. Quitting smoking is very difficult, and yet millions of people have done it. Reducing caloric intake is very difficult, though weights finally seem to be stabilizing. The difficulty of these interventions makes the successes particularly notable.

Readers, your own thoughts? Read the full paper here and the summary here.