In 2017, the United States exceeded a serious threshold: the average life expectancy has decreased for the third consecutive year.(1) At first glance, the decline in life expectancy looks like a blip. Other developed nations also experienced a decline in 2015, caused in part by severe flu strains and less effective vaccines.(2)
However, most other developed countries have come back with longer life expectancies in 2016. The United States is not. Furthermore, the decline in life expectancy in 2015 took place differently in our country. Among Americans, it was concentrated in people under the age of 65, while in other developed countries, it occurred among the elderly. When death occurs in those who are younger, there is a greater impact on life expectancy measures overall.(2)
Even more alarming, the decline in life expectancy in the United States fits into a long-term pattern. In 1960, Americans had the highest average life expectancy in the world, and they were 2.4 years longer than average in the countries of the Organization for Economic Cooperation and Development (OECD).(3) However, in the 80s, the rest of the developed world reached. In 1998, the average life expectancy in the United States fell below the OECD average and reached a plateau in 2012. Americans now live on average 1.5 years less than the OECD average.(3)
What matters the difference? Perhaps the most familiar health statistics that separates the United States from the rest of the world is its high rate of obesity. Already in 2005, the researchers predicted that if the prevalence of obesity continued to increase, it would begin to affect life expectancy in the first half of this century.(4)
Mortality related to obesity has in fact increased in 2015 in the United States, but the same has done most of the causes of death linked to nonousity. For men in particular, much more than the increase is attributable to "external" causes, defined as accidents, violence and other environmental factors.(4)
Death of despair
The researchers have now identified a model called "deaths from despair" that includes drug overdoses, alcohol-related deaths and suicide. Mortality rates for all these causes have increased over the past 15 years, especially for white men aged 45 to 54 years.(4)
Within this deadly constellation, opioid abuse has received the greatest attention. The easy availability of fentanyl plays an important role, as does the casual attitude that many doctors take towards the prescription of opioids.
To reduce the deaths of despair, we first need policies to combat these causes and offer help to those who have remained outside the American dream.
The equally disturbing spiral of suicide has also attracted the attention of the newspapers, particularly when celebrities like Anthony Bourdain take their own lives. My life has been plagued by multiple suicides, and last year I offered my opinions on what sports doctors can do to stem the situation.
The increase in alcohol abuse has not received as much attention, but it is well documented. After prohibition ended in 1933, the age-adjusted mortality rate from liver cirrhosis in the United States steadily increased to reach a peak of 18.1 deaths per 100,000 people in 1973. It then declined steadily for three decades until 2006. However , in that year it began to rise again, reaching 13.2 deaths per 100,000 people in 2015.(5)
These deaths of despair disproportionately affect middle-aged white Americans, particularly in rural counties and regions where manufacturing jobs have disappeared. As a recent editorial in TheBMJ stressed, these economic trends result in a loss of social cohesion, as well as greater social isolation and hardship. Parallel trends towards weaker educational performance and a growing gap between rich and poor.(3)
Sports doctors cannot reverse this trend on their own. To reduce the deaths of despair, we first need policies to combat the causes and offer help to those who have remained outside the American dream. This may include better support for education, a wider distribution of economic opportunities and greater availability of health and mental health resources, particularly in distressed populations. As opinion leaders in our communities, sports doctors must speak in support of these policies.
Decode the genetics of survival
When I look around, I see a nation of humans moving away from their evolutionary path. Instead of adapting better to our environment, we are doing the opposite. Understanding how it happened is a necessary first step to address the health of our patients.
For most of the time that life existed on earth, which is estimated to be at least 3.5 billion years old, our ancestors were prey. It was not until about 2.6 million years ago that the first humans began developing stone tools and brains large enough to become predators.(6) They evolved into Homo sapiens between 200,000 and 300,000 years ago and, over the past 300 years, have adopted an industrial lifestyle with relative abundance of high-energy food and sedentary occupations.(7)
(W) and must activate the genes of our athletic ancestors.
Most diseases derive from an interaction between genes and the environment. We now live in a very different environment from the one we evolved from, and research in the field of epigenetics shows that our genes are expressing differently accordingly.
We have known for a long time that if you practice more, you are less likely to succumb to modern predators of heart disease and cancer. The novelty is that we are starting to understand these processes at the molecular level. For example, increasing evidence suggests that methylation of DNA resulting from exercise can trigger tumor suppression.(8,9)
As I discussed in my book The Win Within: Capture your victorious spirit,(10) we must activate the genes of our athletic ancestors. Just as our ancestors ran and jumped to win the size of an impala for dinner, now we have to run and jump to win the grace of feeling healthier and living longer. We must take responsibility for understanding these systems and how we can manage them.
This is true from the point of view of patients, who must take responsibility for their lifestyle choices and from the point of view of health professionals, who must understand the contribution of patients' genes to their survival. For example, c & # 39; is a gene called OPRM1 which is associated with post-surgical pain and codes for the opioid receptor and endorphin.(11) Variations of this gene affect the patient's response to opioid drugs and susceptibility to chronic pain and fibromyalgia and offer an opportunity for intervention.(12)
Similarly, the same genetic mutation that causes sickle-cell anemia also confers protection against malaria. Understanding this mechanism can lead to new therapies for both conditions.(13)
The burgeoning field of epigenetics is constantly contributing to these understandings. Mechanisms exist to survive and adapt. We need to understand what these mechanisms are and we have encountered few. It's like finding an icon on your computer that gives you more memory when you use it.
The disconnection between our current environment and that from which our minds have evolved helps to explain the constellation of desperation-related mortality – depression, suicide and substance abuse – which seems to drive the recent decline in American life expectancy .
Allow patients to reverse this trend
How can sports doctors deal with this moral crisis? Return to the principle of empowering people to discover that the secrets are within them.
It is not as simple as being kind and motivating for all our patients. For some, it is their genetic lot that they are depressed by a lack of neurotransmitters and must be treated in a pharmaceutical way. Yet there are countless others who have problems with positivism and despair because they are surrounded by negative images and frustrations. We can help them through inspiration, education, communication and awareness and encouraging them to undertake spiritual journeys.
To achieve this kind of leadership, we need to start with our self-assessment and self-awareness, continue with empathy and social skills and finally arrive at a diagnosis that leads to treatment. Even when our patients are in the most terrible circumstances, positivism and motivation can help them.
Claudius Galen (130-210 AD) was a botanist, a surgeon and perhaps the first team doctor in the world because his athletes were gladiators in the Roman Colosseum. He also wrote the first book on the philosophy of medicine. He felt that humans were not made for pleasure, that he called licentiousness, because we had to be workers and adapters and not simply sit in Roman baths by putting food in our mouths. Rome had reached the peak of its power just before its birth, and was already beginning its long, slow decline.(14)
These writings echo in our time, with automation and outsourcing that make significant work scarce and the gap between rich and poor widens.
For me, the Kennedys have expressed the true concept of empowerment. "Some men see things as they are and ask why," said Robert F. Kennedy. "I dream of things that never existed and I ask why not."
"Don't ask what your country can do for you," said John F. Kennedy. "Ask what you can do for your country".
Together with Martin Luther King Jr, who dreamed of his famous dream, these men gave people a reason to believe. They came forward at a time when the world was sinking in the Cold War and when the civil rights movement was starting. Today we lack leaders who can unite us in this powerful way, whether it is President Donald Trump or President of the House of Representatives of the United States, Nancy Pelosi. None of today's leaders is truly inspirational, and I think this is another important reason for the death of despair that is lowering our life expectancy.
It's not just about getting up and doing something for your country; it's a question of how you see yourself contributing to the largest human population. Humans succeed only by working as a team. Biologists have great terms for this phenomenon: mutualism, commensalism and symbiosis. When you take humans and put them together as a TEAM, Together ISEvery individual Achieves Mmineral. The problem is when people are excluded. This is what leads to depression, and that's when we succumb to human diseases like depression and alcoholism.
I believe that sports doctors can play a key role in bringing back the health of our country. No one understands the relationship of motivation and health better than those of our profession. In these times, we face a crisis in both. Although none of us can fill the void left by our political leaders, we can make a difference every day by raising the spirit of our patients, our teams and our communities. Let's take a step forward to help everyone regain a sense of purpose that will lead to better exercise, nutrition and self-care.
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