Preventable Illness at Core of U.S. Health Costs

John Smith, from a health care perspective, is a typical American.

He is a 56-year-old white male living in a suburban city in the United States. He has been an on-again, off-again smoker throughout his life but recently quit -- something he is proud of.

He is 5 feet 9 inches tall and weighs 190 pounds, and he knows he could probably stand to lose a few pounds. Scientists would calculate his body mass index at 28, a classification that qualifies him as overweight.

As John Smith prepares for retirement, he also realizes that 18 percent of his income goes toward health care costs, and he wonders why he is paying so much.

John Smith is not real. But he does represent the type of average American over age 50 examined in a study published this week by researchers at Emory University's School of Public Health.

And according to the study, it may be Americans' own habits that are driving health care costs in the United States.

The average American spends more than $6,000 each year on health care -- the highest amount in the world and twice as much as Europeans spend. In the past, the most common reasons cited for this difference were increased access to medical providers, higher use of advanced technologies, and higher prices for services.

However, the study in this week's issue of the journal Health Affairs suggests that Americans' obesity and smoking habits may be partly to blame, and may be costing Americans $100 billion to $150 billion per year.

Chronic Ills Mean Costly Care

Researchers examined the rates of 10 of the most common and costly chronic illnesses among those over age 50. The illnesses included diabetes, hypertension, arthritis, heart disease, high cholesterol, chronic lung disease, asthma, osteoporosis, stroke and cancer.

Overall, the rates were significantly higher in the United States than in Europe. In most cases, Americans were also more likely to receive medications for the same medical diagnosis.

The researchers also looked for potential reasons to explain why Americans have higher rates of disease than Europeans. One glaring finding from the study was that obesity and smoking were more prevalent in the United States.

Thirty-three percent of Americans were obese, compared with only 17 percent of Europeans. In addition, 53 percent of Americans had smoked at some point in their lives, compared with 43 percent of Europeans.

In addition, every chronic illness closely linked to obesity or smoking was more common in the United States.

Lead study author Kenneth Thorpe, a professor of health policy at Emory's Rollins School of Public Health and former deputy assistant secretary of Health and Human Services, said that some of the findings were surprising.

"We had some idea of what we would find," said Thorpe. "We knew that obesity and smoking rates would be higher in the U.S. But the extent of the differences, especially with some of the chronic illnesses such as hypertension, heart disease and diabetes, was higher than we anticipated."

According to the study, Americans were more than 50 percent more likely to have high blood pressure or diabetes, almost twice as likely to have heart disease, and 2½ times more likely to have arthritis.

This added burden of disease has led to higher health costs overall. If the United States could improve its population's health to have the same levels of chronic illness as Europeans do, Americans would save between $1,200 and $1,750 per year each on medical bills, the researchers found.

All told, the higher rates of disease are costing Americans between $100 billion and $150 billion per year, or 13 percent to 19 percent of total health care spending for those age 50 and over.

According to Thorpe, these findings could have a significant impact on strategies to control health care costs in America.

"If you are going to craft effective interventions," said Thorpe, "you have to understand where we are spending the money and what is driving costs over time."

Good for the Body, Good for Bankroll

The good news, Thorpe said, is that many of the differences in the study are likely due to reversible causes -- causes Americans have control over. "The underpinnings of our findings deal with modifiable factors such as weight, exercise and smoking."

Some experts believe that the relatively poor performance by Americans may become an instigator for personal change.

"What's new is that other people like us are healthier," said Dr. David Katz, associate professor of public health at Yale University. "Europeans are doing better, and we are doing worse. This relatively bad performance might be a motivator."

Others, however, say the findings show that large-scale changes are needed. "A normal weight and healthy lifestyle is very clearly a huge health benefit, especially regarding chronic diseases," said Keith Ayoob, associate professor of pediatrics at Albert Einstein College of Medicine. "There needs to be a national call to action to address prevention and treatment of obesity and cessation of smoking."

Dr. George Blackburn, associate professor of nutrition at Harvard Medical School, had a much more targeted message to the readers of Thorpe's study.

"Figure out a motivator to eat less, eat healthy and exercise," he said. "We could save a lot of money if we had a healthier lifestyle. It would be more fun, and it would feel and taste good."