Living longer AND living healthy

American Heart Association (AHA) President Robert A. Harrington says that the life expectancy has gone up in recent years. Still, he points out, improved life expectancy doesn’t translate to improved health in all cases. According to him, “Not all those years are healthy ones as the effects of chronic illnesses are increasingly impacting the quality of life of people at a much younger age than in the past.”

The response to these uncomfortable statistics by the AHA is an advisory by its President, published in the journal Circulation, that recommends goals towards which national and international health-related organizations and ministries should strive. These are titled the 2030 Impact Goals, and the aim is to empower healthy living for a larger part of the lifespan, for all people in the US and in the world.

The challenge

A new report from the AHA– the Heart & Stroke Statistics - 2020 Update – shows an encouraging drop in the number of deaths occurring as a result of stroke and heart disease (clubbed together as cardiovascular disease (CVD). However, it also reveals that the slope of this downturn has become shallower in the last few years.

A more disconcerting finding is that after almost 100 years of effort to improve cardiovascular health, including the prevention and control of heart disease and stroke, better medical treatments and more healthy lifestyles and behaviors, poor health is currently more prevalent and is beginning younger, due to the poor management of risk factors for CVD. It is against this background that the Impact Goals are to be seen.

The US Goal may be stated as an increase in the number of healthy years of life that can be expected from the current 66 years to 68 years or more by 2030, in an equitable manner.

The International Goal is an increase in worldwide expectancy of healthy years of life from the current 64 years to 67 or more years by 2030, in an equitable manner.

How to monitor progress

The advisory recommends the use of the health measure called the Health-Adjusted Life Expectancy (HALE) metric, also called Healthy Life Expectancy, which assesses the number of healthy years an individual may expect to live. This includes the impact of physical and mental health conditions and captures the overall state of health over the whole lifetime of the person depending on the environmental and other risk factors.

Positive and negative trends

All over the USA, adults are becoming more active, eating healthier food, smoking less, and have better control of their cholesterol. However, at the same time, other areas are showing a negative trend. Young people are showing unhealthy trends which means that the generations of the future will be at higher risk for greater major health issues.  

• Obesity: About 40% of adults and 19% of young people are obese and the rates are rising
• Exercise and physical activity: Not even one in three students have a physical education class every day. Only about a quarter (26%) are moderately or vigorously physically active every day.
• High blood sugar: Over the period 1990 to 2017, despite a wealth of glucose-regulating drugs and equipment, there has been an increase in the number of diabetic males by 130%, which means their number has more than doubled; for women it is slightly less, but still more than double the previous number, at 121%.
• Smoking: The rate of smoking in the US is at an all-time low for adolescents and has also decreased among adults. However, more and more youngsters are taking to vaping, and globally, there were over 930 million smokers in 2015, higher than before. When demarcated by sex, income and location, it is found that 80% or more of smokers are in the less industrialized and less developed countries of the world, and most are male.

This shows the existence of a basic inequality in the level of health enjoyed by different populations based on age, race, location and sex. And in fact, advisory author John Warner says, “Disparities exist even to that level — from one block of a city to another. To improve individual health, we must make the environments where we live, work, learn and play equitably supportive of healthy behaviors. We also need to help people better understand the impact their communities have in driving choices for health and well-being.”

The importance of choices

In theory, most people want to make choices that will help them live longer and more healthy lives. No less than 93% of people in a recent Harris Poll conducted on behalf of the AHA said that a long and healthy life was an important goal and that everyone deserved this. On the other hand, many of them don’t know how their behavior impacts their health. Only less than half of the people polled said their behavior definitely paid back on their health and wellbeing. And only a third strongly believed their health choices were affected by or supported by their surroundings.

On the other hand, Harrington strongly believes that to make healthy life a reality, it should be easier and more affordable to choose healthy behaviors and lifestyles. “We need to make healthy choices the easy ones, make healthcare accessible and affordable and we need to get better at stopping preventable diseases before they start.”

He pleads emotionally for affordable healthcare: “Sometimes parents are more worried about whether they can feed their children anything, much less whether it’s healthy or not. If you’re living with high blood pressure, you shouldn’t have to worry about choosing between whether to pay rent or buy your medicine.”

Making healthy choices realistic

Harrington says that there needs to be teamwork between many stakeholders to drive this process of achieving the 2030 healthy lifespan goals – including local neighborhoods and worldwide governments alike. In addition, there needs to be work towards prevention of chronic disease on both a primary and secondary level. Public health administrators need to work towards population-level policies. Moreover, healthcare systems must be set in place that are not only effective but also easy to use for the population, and affordable. And most importantly, individuals need to take ownership of their lifestyle and behavior.

Along with measuring the trends of healthy behavior, accurate and useful reporting and analysis of health data will be crucial to monitor the progress towards these goals. For this reason, the AHA has already released its advice on how to carry out surveillance for CVD globally.

Many of these efforts are already ongoing but recruiting new blood will be critical to enhancing the reach and the effectiveness of the program, says Harrington. He envisages a double-pronged approach to this: “We’ll be inviting more people to the table, but even more importantly, we’re asking likeminded stakeholders to invite us in — let us help be a catalyst bringing together elements that can create a healthier world for everyone.”

In his description of their goals, he says, “In every country, in every city and village, we want everyone of all ages and backgrounds to be healthy. This is so much more than just wanting people to live to a ripe old age, we want them to live healthier, longer.”