The Longevity Top 10

Dr. W. M. Bortz II




Q: As a 70-year-old, I am aware that my future life expectancy is vastly brighter than that of a 70-year-old a century ago. To what do you attribute this major gain, not only in life quantity but life quality as well?

A: The U.S. Centers for Disease Control and Prevention (CDC), the prestigious government health complex in Atlanta, Ga., recently nominated its list of 10 accomplishments that have led to the greater than 30-year life expectancy in the last 100 years, a gain incidentally that has not been even remotely approached before, nor will it again. But it is a huge gain nonetheless, and you and I and the billions of our earth cousins are the immediate beneficiaries of it.

       The Top 10 list is as follows:

bulletControl of infectious disease.
bulletHighway safety.
bulletSafer workplaces.
bulletVaccine development and use.
bulletDecline in vascular disease (heart attack and stroke).
bulletBetter nutrition.
bulletImprovement in perinatal health.
bulletFamily planning.
bulletWater fluoridation.
bulletIdentification of tobacco as a major health hazard.

The CDC observes that these and related advances in public health are the proximate causes of 25 of the 30 gained years of life.
      At the dawn of our century eight of the top 10 killers in America were infectious diseases; tuberculosis, meningitis, pneumonia, syphilis and scarlet fever dominated the obituaries. Antibiotics have been critical to the treatment of these and other acute infections. Now the top killers are the chronic diseases. Further, improved sanitation and cleaner drinking water have virtually eliminated diseases such as typhoid fever and cholera.
      Also, there has been a dramatic drop in traffic-caused fatalities. Despite a huge increase in miles and hours spent on the highway, often at high speeds, the nation's highway deaths are at an all-time low. Probably the horse and buggy was more dangerous per mile driven than today's freeway pattern. The National Highway Traffic Safety Administration — under the watch of its wonder director, Dr. Ricardo Martinez — has led effective campaigns on using seat belts, motorcycle helmets, air bags and safety seats, and has decreased drinking and driving. Cars and highways, too, are redesigned for safety.
      And the workplace is becoming safer, too. Deaths from mining, construction, transportation and heavy industry mishaps have declined by 40 percent just in the last 20 years. Work-related conditions such as asbestosis, miner's lung and silicosis are controlled by better recognition of inhalation precaution. Job injuries caused by a lack of good protocols have diminished dramatically as all industries have become super-aware of work site disability and death.
      At the start of this century, there were five vaccines available that were not very widely used; today, there are 30 vaccines, most in wide usage. As a result, polio and smallpox have been totally eradicated. Just ponder the glory of such a boast for a second. Additionally, other vaccine-susceptible diseases are controlled, and we're not through yet.

      One of our wonderments is the huge decrease in our No. 1 contemporary killer: artery disease. Each survey exhibits a further reduction. Whereas the heart surgeons have played their part, most of this fall is a result of stricter management of risk factors, such as lessened smoking, better blood pressure control, lower cholesterol levels, and for some, increased physical activity patterns. Although this domain still has a long way to go, heart disease and stroke deaths have fallen by more than 50 percent in the last 30 years.
      Knowledge and implementation of our nation's nutrition has improved greatly in 100 years. Not only is food contamination largely a thing of the past, but food nutritional value is markedly better. Knowledge of the importance of the micronutrients — such as calcium and folate and iron — has been a major bonus. Food fortification and improved economic status have combined to diminish hunger in the United States.
      Healthier babies and healthier mothers are a happy byproduct of this century. The horror stories of perinatal misadventure of just a few decades ago have been replaced by confident and healthful birthing and early life well-being. Maternal mortality has decreased 99 percent in this century, infant mortality 90 percent.
      The role of enlightened family planning, although it still has a ways to go, has given hope to increased numbers of wanted pregnancies and intact families. Teenage pregnancy is down. Smaller families are the rule. The use of condoms has decreased AIDS and other sexually transmitted diseases. The social and economic roles of women are vastly different as we exit this century than they were at the onset.
      Fluoridation of drinking water is now 55 years old. This practice, which is available to more than half of the U.S. population, has resulted in a 60 percent to 70 percent reduction in tooth decay in children and in adults. As a 69-year-old, I lament its lack of availability to my generation, but celebrate its use with our nine grandchildren whose teeth lack all the fillings I display.
      The 1964 Surgeon General's report on the risk of smoking has steadily gained momentum until now the social norm is totally different. Work and public places are off limits. Planes, thankfully, are smoke-free. Unfortunately, we still suffer some 1,100 smoking-caused deaths daily, according to the CDC — nearly the equivalent of three 747's crashing each day. But we are learning. More and more people are stopping, fewer are starting, and millions of smoking-related deaths are being prevented.
      Note that these 10 categories all have to do with disease prevention and health promotion. They are simple, cheap, universally available and effective. What medication can make that claim? Yet despite this argument, nearly the entirety of our nation's 1.5 trillion dollar per year medical cost outlay goes to curative effort. Please take this as a plea for diversion of a portion of this huge outlay to preventing illness.


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