The most recent federal figures from Healthy People 2010 show that between 1999 and 2002, while overall life expectancy rose a bit, one key aspect of Americans' "healthy life expectancy" — the years we can expect to be free of chronic disorders such as diabetes, heart disease and hypertension — actually dropped. And it dropped from close to 49 years down to a mere 47.5.
47.5??? That's all the good years we can expect to have before we turn into eternal patients???
At the risk of alienating some of our younger readers, I have to confess that my "disease-free life expectancy" must, at this point, be measured in negative years. If I hew to the average, I'm out of good time. I can expect a diagnosis any day now. A bit panicked, I got in touch with Dr. Welch, hoping he could give me hope for a few more healthy years. He did.
The important point, he said, is the juxtaposition of the two figures: Overall life expectancy rising, but "healthy life expectancy" dropping. "So people are living longer. but the period of time that they live without having a diagnosis is shorter."
If you look at the main six diagnoses that the healthy life expectancy includes, he said, the bar for diagnosing five of them has dropped significantly in recent years, whether because cut-offs for blood sugar levels have been lowered in diabetes or because increasingly sophisticated imaging picks up smaller cancers.
The shorter "healthy life" statistic may seem to suggest "that people are in fact sicker," he said, but "the alternative explanation is much simpler: we live longer; we're healthier; but we’re increasingly likely to be labeled as sick, and that’s the fundamental problem I’m dealing with in the book."
"The threshholds to say that we’re somehow abnormal are falling, and it’s part of a culture that sees early diagnosis as the solution to all our health care problems — but in fact it’s a recipe for all of us to be told we’re sick!" he said.
"And you have to ask the question whether this relentless desire to find things wrong with people is in fact a good thing for a health care system to do. Because part of health, to me, is about measurement and it is about disease, but part of it is also about a state of mind, and a sense of resilience and optimism. We have to begin to ask, 'Are we at risk of taking some of that health away in our desire to find things wrong, even with the best of intentions?'"
I'll stop there, and note only that Gil Welch is a professor at the Dartmouth Institute for Health Policy and Clinical Practice as well as a practicing physician, and that "Overdiagnosed: Making People Sick in the Pursuit of Health," comes out from Beacon Press on Jan. 18.
And meanwhile, I think I may put off my next medical check-up a bit — I want to finish the book first, to figure out how to digest whatever diagnosis may await me....
p.s. An additional note of hope: When the government looks at years free of disease, it does include asthma, so perhaps the rise in asthma has pulled the healthy life expectancy down? Here's the official definition: "Expected years free of selected chronic diseases is defined as the average number of years a person can expect to live without developing one or more of the following selected conditions for which nationally representative data are available annually: arthritis, asthma, cancer, diabetes, heart disease, high blood pressure, kidney disease, or stroke."
This program aired on November 9, 2010. The audio for this program is not available.