Eyes Wide Shut -- The Longevity Question -- December 8, 2016

This is one of those "aha" moments.

Read through this NPR article about the "decrease" in US longevity. Read it slowly, maybe re-read it again.

Think about it. Try to think why "the overall US death rate has increased for the first time in a decade."

Analysts say they are a loss to explain this. My understanding is that this "study" is accomplished on an annual basis.

This is what caught my attention, these two paragraphs:

Still, he believes the data from 2015 are worth paying attention to. Over that year, the overall death rate increased from 724.6 per 100,000 people to 733.1 per 100,000.
While that's not a lot, it was enough to cause the overall life expectancy to fall slightly.

That's only happened a few times in the past 50 years. The dip in 1993, for example, was due to high death rates from AIDS, flu, homicide and accidental deaths that year.

Then this:

Most notably, the overall death rate for Americans increased because mortality from heart disease and stroke increased after declining for years. Deaths were also up from Alzheimer's disease, respiratory disease, kidney disease and diabetes. More Americans also died from unintentional injuries and suicide. In all, the decline was driven by increases in deaths from eight of the top 10 leading causes of death in the U.S.

Other than unintentional injuries and suicide, almost every cause of death listed -- Alzheimers, heart disease, stroke, diabetes, etc. -- is directly related to:

• regular check-ups at the clinic with a health care provider
• filling prescriptions for prescribed medications
• taking prescribed medications
• follow-up with health care provider

In the past year, there has been no major break-through in any major category of illness to have affected the outcome of any of these chronic diseases.

The "obesity finally catching up with us" is a politically correct answer; if that was accurate, the researchers would have sorted that out. At least I would hope they would. The obesity issue has been studied for a decade or longer now.

Longevity is directly related to managing one's chronic conditions and regular monitoring by a health care provider.

In 1993, the dip in longevity was due to AIDS, flu, homicide, and accidental deaths.

If the researchers are unable to find a cause, one would assume homicides and accidental deaths were not the cause. We know that AIDS and flu were not implicated in 2015.

So, you have to ask yourself: what was the one thing that was different in 2015 than in previous years?

The answer is fairly simple. Anne Case and Irma Elo came the closest without suggesting outright the reason.

I'll come back to this later with my two cents worth.

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HINT

This may be a "bridge too far" when trying to explain "longevity issue." If I had more time and was more articulate I might be better able to explain what I'm thinking.

Some years ago I ran across an interesting book that discussed where businesses have their most difficulties or challenges. It's at the seams or at the boundaries where tasks end/start.

Within a "stovepipe" things tend to go pretty well. It's when one "stovepipe" has to interact with another "stovepipe" that problems develop.

See this link: https://www.diva-portal.org/smash/get/diva2:26299/FULLTEXT01.pdf.

In physics, scientists understand and can define the three phases of water very well: the ice phase, the liquid phase, and the gas phase. What is difficult is to explain or define what is going on when water moves from one phase to the next.

What is difficult to explain or define is what happens as matter transitions from one phase to another.

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ANSWER

To get to the answer -- why the dip in US longevity in this report?

One must first ask the right question: what was different about 2015 than 2014, or 2013, 0r 2012, or  2011?

Again, the "aha" moment from the article:

In 2015, the overall death rate increased from 724.6 per 100,000 people to 733.1 per 100,000.

While that's not a lot, it was enough to cause the overall life expectancy to fall slightly.

That's only happened a few times in the past 50 years. The dip in 1993, for example, was due to high death rates from AIDS, flu, homicide and accidental deaths that year.

So, what was it in 2015 that caused the overall death rate to increase? I'm going to leave out homicide and accidental deaths because, to me, they seem like a bit of red herring; the article did not focus on those two (homicides, accidents); and, there were six other diseases on the list that all had something in common.

In 2015, unlike 1993, there was no one-time "event" to explain the increased death rate. There was no flu epidemic; there was no "new AIDS." One knows that because if there had been, the researchers would have figured that out, pointed that out. But no smoking gun was found.

Six top causes of death all have something in common. They are all chronic. They are all well understood. They are all behavioral-related. They can all be managed well. These are not mysterious diseases: heart disease, hypertension, diabetes, respiratory disease, or kidney disease.

Alzheimer's is the only exception to the others, but it is like the others in that good medical/nursing care will prolong the life of those who suffer from is.

So what changed in 2015 for folks with the common, chronic diseases?

Behavior changed.

It was not ObamaCare per se, but it was related to ObamaCare.

The last leg of the three-legged stool called ObamaCare was the employer mandate. That mandate was delayed until 2015/2016. At the same time, insurance companies were dropping out of the insurance pool. Large groups of people were waking up each day in 2015 finding that their health insurance had been dropped, and they had to look for a new health insurance program. I think folks will remember the stories about folks saying they would pay the IRS penalty rather than buying expensive health care insurance.

That takes us to answer. People with chronic diseases that are well understood, behavioral-related and which can be managed well need to:

• keep routine visits with their health care providers
• fill their prescriptions
• take their medication
• check into assisted living facilities if necessary

But in 2015, the safety net dropped out from under those with chronic diseases not because of ObamaCare but because of the transition to a new way of providing medical care in this country. 

This takes me back to the "stovepipe" discussion or the "three different phases of matter" discussion.

 During the move from one "stovepipe" of medical care (pre-ObamaCare) to another "stovepipe" of medical care, bad things happened. Losing healthcare insurance for a year or two, and folks quit seeing their doctor, quit filling their prescriptions, quit taking their medications, and failed to get the nursing and medical care that in general they needed and prolonged their lives.

Talking to an internal medicine physician friend who has a very, very successful clinic in southern Los Angeles and Las Vegas, NV, he tells me his biggest challenge is to get patients with chronic disease to take their medication. Period. Dot.

This is not rocket science.

It is very likely the "longevity" issue will remain an issue until US healthcare policy is back to an even keel. With GOP ready to scuttle Obamacare look for continued stores on US longevity dropping.