Elsevier

Preventive Medicine

Volume 68, November 2014, Pages 5-10
Preventive Medicine

Behavior change and reducing health disparities

https://doi.org/10.1016/j.ypmed.2014.04.014Get rights and content

Abstract

The mission of the National Institutes of Health,"... is science in pursuit of fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability". A wide range of factors contribute to longer life and to less illness. Although estimates vary, most analyses suggest that only about 10% of the variation in health outcome is attributable to medical care. Further, medical care is most effective in addressing and preventing infectious disease and acute illnesses. Recent large randomized clinical trials often fail to demonstrate that medical care lengthens life expectancy. International comparisons suggest that life expectancy in the United States is increasing, but the rate of increase is falling behind that of other wealthy countries. Strategies for improving health outcomes include better dissemination and implementation of proven evidence-based interventions. Further, reduction of services that use resources but do not offer health benefits must be considered. The final section of this paper reviews evidence relevant to factors outside the health care system that may enhance life expectancy and reduce illness and the disability. The relationship between educational attainment and life expectancy is used as a case example. The potential of behavioral and social interventions for increasing life expectancy may be orders of magnitude greater than traditional medial interventions. However, considerably more research is necessary in order to provide persuasive evidence for the benefits of these programs.

Section snippets

US life expectancy in international perspective

International studies of life expectancy have gained particular attention in the last few years. These studies tend to show that the life expectancy advantage experienced by American citizens has been on the decline. One study from the National Research Council considered current life expectancy for 50-year-old women between the years 1955 and 2010 (Crimmins et al., 2011). Current life expectancy is the number of years of life on average remaining once a milestone age has been reached. So,

Conclusions

International studies suggest that the rate of increase in life expectancy for Americans is falling behind other rich countries. Despite remarkable improvements in medical and surgical therapies, we must also confront limitations of medical science. Most estimates suggest that medical care accounts for only a small portion of the variation in life expectancy. Behavioral and social factors are likely to play a substantial role in determining how long we live.

We are only at the early stages of

Conflict of interest statement

This paper was completed when the author was an employee of the National Institutes of Health. The opinions expressed herein and the interpretation and reporting of these data are the responsibility of the author and in no way should be seen as an official recommendation, interpretation, or policy of the National Institutes of Health or the US Government.

References (38)

  • T.B. Drueke et al.

    Normalization of hemoglobin level in patients with chronic kidney disease and anemia

    N. Engl. J. Med.

    (2006)
  • S. Galea et al.

    Estimated deaths attributable to social factors in the United States

    Am. J. Public Health

    (2011)
  • D. Gordon et al.

    Publication of trials funded by the National Heart, Lung, and Blood Institute

    N. Engl. J. Med.

    (2013)
  • P.C. Gotzsche et al.

    Screening for breast cancer with mammography

    Cochrane Database Syst. Rev.

    (2013)
  • D.L. Hoyert et al.

    Deaths: Preliminary data for 2011

    Natl. Vital Stat. Rep.

    (2012)
  • W.B. Kannel et al.

    Factors of risk in the development of coronary heart disease—six year follow-up experience. The Framingham Study

    Ann. Intern. Med.

    (1961)
  • R.M. Kaplan

    Health outcome models for policy analysis

    Health Psychol.

    (1989)
  • R.M. Kaplan

    Behavior as the central outcome in health care

    Am. Psychol.

    (1990)
  • R.M. Kaplan

    The Ziggy theorem: Toward an outcomes-focused health psychology

    Health Psychol.

    (1994)
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