Preventive Medicine: One health measure to rule them all

Dr. David Katz

Dr. David Katz

This week, I am coining a new term: vigevity. Self-evidently, perhaps, this is the combination of vitality and longevity. We’ll see whether or not the term catches on. Either way, it is the one health measure to rule them all. It is what truly matters; the prize. We are letting that prize slip away.

We have long known that rates of chronic disease were rising in the U.S. and around much of the world. Far worse than just a rise in the prevalence of chronic diseases — heart disease, dementia, diabetes — is the downward drift in average age of onset. That is perhaps starkest for diabetes.

When I went to medical school, the two varieties of diabetes mellitus were “juvenile onset,” and “adult onset.” Only since then — during the last quarter century, more or less — has that terminology become first quaint, then obsolete and abandoned. The routine terms are now “type 1” for the variety that is an auto-immune condition requiring insulin, and “type 2” for the variety generally presaged by obesity and insulin resistance. The latter variety was formerly “adult onset” but occurs routinely in children now, propagated by an epidemic of childhood obesity we simply haven’t bothered to fix, however we may wail and wring our hands.

The above bespeaks a loss of life from years — a siphoning away of our collective, precious vitality. Now comes word from a new CDC report that we are losing years from life as well in the U.S., experiencing for the first time since World War I a steady decline in life expectancy. Vigevity is the health measure that matters most, and vigevity in the U.S. is in decline.

The fall in life expectancy is driven largely, and tragically, by the opioid crisis compounded by increases in suicide. But these are really the symptoms of a disease with deeper roots. A vast literature on the social determinants of health highlights the dire ramifications of relative disadvantage and disaffection. The vast and ever-growing divide between the affluent and indigent — the have-it-alls and the have-next-to-nothings — is toxic to health.

Lack of early, reliable access to medical care is toxic to health, too, as it allows problems readily treated in their early stages to advance and become potentially calamitous. The past year, again reflecting the policies, politics, and priorities of our culture in this moment, saw a rise of 300,000 in the population of medically uninsured children in our country.

Nor should we overlook the most momentous, if thus far still inchoate threat to vigevity, not just in the U.S. but globally: climate change. Around the world, that toll is almost certainly high already. Here in the U.S., where it is reflected in the scattered casualties of fires and floods, hurricanes and tornadoes — it is unlikely yet to exert much influence on our nation’s vital statistics. That will certainly change. But even now, when we acknowledge that there is no true vitality, and thus no true vigevity, absent hope and confidence in the future, we have cause to pause and reflect on the damage to human health mediated by aggregating damage to our planet. Constant worry is toxic to health. Despondency is toxic to health.

Why invoke vigevity, and then chronicle the doom and gloom of our current epidemiology? Because we tend only to manage what we measure. We should, therefore, measure what matters.

Even in the CDC report establishing the declines in life expectancy, the “causes” of death were arguably mischaracterized or overlooked. The report lists conditions, heart disease, cancer, dementia, diabetes, etc., as the causes of our mortality, and declining longevity. But fully 25 years ago, these factors were declared “effects” rather than causes. The true, root causes of premature death are the modifiable exposures and practices that propagate these conditions, with poor diet, lack of physical activity, and tobacco use in their vanguard. Even despite the terrible toll of opioids, depression, despair, and suicide, diet is the single leading cause of premature death in America today.

I hold out the hope that we might decide to measure what matters, and manage what we measure. Until we do, we, and our children, will continue the unnecessary surrender of years from our lives, and life from our years. We will keep relinquishing the prize.