Health Problems in the United States

Americans today face health many concerns that were not prevalent a century ago. Several factors contribute to the emergence of these modern health challenges, many of which are chronic conditions linked to preventable causes, such as daily behaviors and unhealthy lifestyle choices. Examining wellness practices, life expectancy trends, and Social Determinants of Health can offer valuable insights into strategies for reducing disease risk and enhancing overall quality of life.

Life Expectancy at Birth

Life expectancy is a measure often used to gauge the overall health of a population. Life expectancy at birth represents the average number of years that a group of infants would live if the group were to experience the age-specific death rates present in the year of birth. Differences in life expectancy among various demographic subpopulations, including racial and ethnic groups, may reflect differences in a range of factors such as socioeconomic status, access to medical care, and the prevalence of specific risk factors in a particular subpopulation.

Leading Causes of Death

In 1975, the five leading causes of death were heart disease, cancer, stroke, unintentional injuries, and influenza and pneumonia. In 2019, the five leading causes of death were heart disease, cancer, accidents chronic lower respiratory diseases, and stroke. Throughout 1975–2020, heart disease and cancer remained the top two leading causes of death.

Determinants of Health

Determinants of health (DOH) are the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age. These conditions include a wide set of forces and systems that shape daily life such as economic policies and systems, development agendas, social norms, social policies, and political systems. These factors may be biological, socioeconomic, psychosocial, behavioral, or social in nature.

Policymaking

Policies at the local, state, and federal level affect individual and population health. Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products.

Some policies affect entire populations over extended periods of time while simultaneously helping to change individual behavior. For example, the 1966 Highway Safety Act and the National Traffic and Motor Vehicle Safety Act authorized the Federal Government to set and regulate standards for motor vehicles and highways. This led to an increase in safety standards for cars, including seat belts, which in turn reduced rates of injuries and deaths from motor vehicle accidents.

Social Factors

Social determinants of health reflect the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age. Also known as social and physical determinants of health, they impact a wide range of health, functioning, and quality-of-life outcomes.

Examples of social determinants include:

• Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods

• Social norms and attitudes, such as discrimination
• Exposure to crime, violence, and social disorder, such as the presence of trash
• Social support and social interactions
• Exposure to mass media and emerging technologies, such as the Internet or cell
  phones
• Socioeconomic conditions, such as concentrated poverty
• Quality schools
• Transportation options
• Public safety
• Residential segregation

Examples of physical determinants include:

• Natural environment, such as plants, weather, or climate change
• Built environment, such as buildings or transportation
• Worksites, schools, and recreational settings
• Housing, homes, and neighborhoods
• Exposure to toxic substances and other physical hazards
• Physical barriers, especially for people with disabilities
• Aesthetic elements, such as good lighting, trees, or benches

Poor health outcomes are often made worse by the interaction between individuals and their social and physical environment. For example, millions of people in the United States live in places that have unhealthy levels of ozone or other air pollutants. In counties where ozone pollution is high, there is often a higher prevalence of asthma in both adults and children compared with state and national averages. Poor air quality can worsen asthma symptoms, especially in children.

Health Services

Both access to health services and the quality of health services can impact health. Healthy People 2020 directly addresses access to health services as a topic area and incorporates quality of health services throughout a number of topic areas.

Lack of access, or limited access, to health services greatly impacts an individual’s health status. For example, when individuals do not have health insurance, they are less likely to participate in preventive care and are more likely to delay medical treatment.

Barriers to accessing health services include:

• Lack of availability
• High cost
• Lack of insurance coverage
• Limited language access

These barriers to accessing health services lead to:

• Unmet health needs
• Delays in receiving appropriate care
• Inability to get preventive services
• Hospitalizations that could have been prevented

Individual Behavior

Individual behavior also plays a role in health outcomes. For example, if an individual quits smoking, his or her risk of developing heart disease is greatly reduced.
Many public health and health care interventions focus on changing individual behaviors such as substance abuse, diet, and physical activity. Positive changes in individual behavior can reduce the rates of chronic disease in this country.

Examples of individual behavior determinants of health include:

• Diet
• Physical activity
• Alcohol, cigarette, and other drug use
• Hand washing

Biology and Genetics

Some biological and genetic factors affect specific populations more than others. For example, older adults are biologically prone to being in poorer health then adolescents due to the physical and cognitive effects of aging.

Sickle cell disease is a common example of a genetic determinant of health. Sickle cell is a condition that people inherit when both parents carry the gene for sickle cell. The gene is most common in people with ancestors from West African countries, Mediterranean countries, South or Central American countries, Caribbean islands, India, and Saudi Arabia.

Examples of biological and genetic social determinants of health include:

• Age
• Sex
• HIV status
• Inherited conditions, such as sickle-cell anemia, hemophilia, and cystic fibrosis
• Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and ovarian cancer
• Family history of heart disease

Health Disparities

Although the term disparities is often interpreted to mean racial or ethnic disparities, many dimensions of disparity exist in the United States, particularly in health. If a health outcome is seen to a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health.

For all Americans, other influences on health include the availability of and access to:

• High-quality education
• Nutritious food
• Decent and safe housing
• Affordable, reliable public transportation
• Culturally sensitive health care providers
• Health insurance
• Clean water and non-polluted air

Throughout the next decade, Healthy People 2020 will assess health disparities in the U.S. population by tracking rates of illness, death, chronic conditions, behaviors, and other types of outcomes in relation to demographic factors including:

• Race and ethnicity
• Gender
• Sexual identity and orientation
• Disability status or special health care needs
• Geographic location (rural and urban)