Introduction: Global Health Trends
A research center at the University of Washington has found that, perhaps for the first time in human history, the death rate related to obesity is higher than the rate of malnutrition. Translation: More people die from obesity-related diseases than from lack of food. In an editorial last month, a major newspaper proclaimed that this was good news. (Chicago Tribune, Living Longer, With a Catch: Life Expectancy Rising, Despite Some Unhealthy Choices, December 26, 2012).
I may be missing something, but this doesn’t sound like news that could trigger a ticker-tape parade celebrating human progress. The cited research group, the Institute for Health Metrics and Evaluation (IHME), is funded by the Bill and Melinda Gates Foundation and the state of Washington. Its mission is to improve the health of the population by providing the best possible evidence to guide health policy. I think the next IHME project should study and identify the cause of death that most accurately reflects the health of the population. This could be a very effective way to guide health policy.
What IS a good cause of death?
Most people, myself included, believe that it is better to die of gluttony and satiety than of malnutrition and starvation. It’s not a great pick, but it seems relevant to the IHME investigation that the Chicago Tribute called good news. For one thing, you last much longer eating too much than eating too little; for another, excess consumption is more satisfying, at least until the multiple adverse consequences of doing so manifest themselves and suffering begins. Fortunately, these extremes are not the only candidates for better indicators of mortality in the classification of healthy populations. Before suggesting a better indicator of cause of death health status – for a city, state or nation – a summary of the IHME study seems appropriate.
Chronic disease advances, infectious disease regresses
The IHME report showed a global trend of older people increasingly dying from heart disease and cancer. These factors are considered ailments of rich countries, since both causes of death are associated with survival in the last decades of life. This only happens when nations manage to reduce the incidence of infectious and communicable diseases. Such mortality factors (for example, diarrhoea, tuberculosis, malaria and diseases) are dramatically lower than two decades ago thanks to advances in sanitation, greater availability of medicines and more extensive and effective vaccination campaigns. In addition, the standard of living has improved. Increased food supplies reduce the incidence of malnutrition.
While all of this is good and encouraging, it seems fair to point out that the goal of IMHE researchers and others (ie the United Nations) concerned with the health status of the population should not be to promote conditions in which death rates from heart disease and cancer predominate (I am not suggesting that this is the case either).
best cause of death
Given that everyone will die at some point, sooner or later, and most prefer later, which cause of death best reflects the well-being of the population? For the purpose of collecting data on global health trends, which cause best reflects the positive quality of life experienced?
I think the first thing we can agree on is that starvation/malnutrition rates are definitely not optimal for this purpose. The second point of agreement might be that neither is the death rate from heart disease! But cancer!
And that?
AIDS? This cause accounts for fewer deaths than a decade ago, but still claims 1.5 million lives worldwide each year. Cancer? Tens of millions still die from lifestyle choices like tobacco use. Diabetes? IMHE researchers still estimate that dietary abuse claims six million lives a year. Sedentary? I made this cause of death up. Why not have an indicator of insufficient exercise? We know that laziness kills. It’s a shame there isn’t a vaccine for exercise aversion.
Cause of death in your case
Even if you have extraordinary random luck throughout life and are favored by nature with fabulous genes and live from cradle to old age exceptionally as a model of a major modern REAL wellness general, some or all of your They will eventually fail. When this happens, you will die. But what will go first? Something will, you know, even if you live your life as a wellness model, with incredible luck regarding random events while benefiting from great genetics. (Needless to add, but I’ll do it anyway, there are no such REAL important general models of well-being. Life is such that while good genes, good luck with random fate, and great lifestyles are possible, no one knows comes close to anything remotely resembling a life that embodies the very hypothetical very model of a very modern very general important REAL ideal of well-being. I know you knew that.)
So think about it. What might a medical examiner/coroner enter at some point in the future on your death certificate as the cause?
There are several broad categories of causes of death now available for physicians to enter on death certificates. These include accidental, violent/homicide, natural, or undetermined/unexplained. Doctors have different ways of determining the cause of death, depending on observations, local legislation, etc. Autopsies and other tests are commonly done to determine the cause of death.
Let’s agree that you don’t want the cause to be hunger/malnutrition or, for that matter, heart disease or other chronic conditions caused by morbid obesity. Also, if you’re like me, and you must be in some way to read this, you probably don’t want the entry on your death certificate to be AIDS, diabetes, or a sedentary lifestyle either.
So what?
An Alternative Indicator of REAL Wellbeing: Completion
How about a new cause of death, one that indicates the deceased decided enough was enough, a cause we might call completion? This would indicate that there was sufficient information or other evidence available at the time and place of your death (eg, a goodbye note) to allow the physician signing your death certificate to consent that you, the decedent, died believing that he had crossed the finish line of life, having gone the distance and determined that there was no point in going any further.
Of course, before completion can catch on locally, let alone globally, a great deal of study (IMHE, please note), discussion, and reflection (pun intended) will need to be done. Also, you can be sure that there will be resistance based on religion, which will have to be overcome. Personally, I’m going to do my part to achieve a much improved mortality-based indicator of health status by living out the days I have left and putting an appropriate end to them, following a lifestyle course (while waiting for the best genetics and genetic opportunities). random). ) that will get a completion entry on my death certificate.
That would be a better cause as far as I’m concerned than anything else I can think of. In fact, if I could, I would frame it.
First steps towards completion
Perhaps it is time to develop a general decision support tool that helps people determine when the time is right.
Let us begin immediately with readings on existential philosophy and discussions with others, especially those who have pondered this great subject. Let’s be careful about the metaphors we use to communicate the issues involved. For example, let’s not talk so much about when or even if to unplug. There is too much history with this phrase associated with sad and medical situations of ending the lives of others who no longer seem viable.
Let’s think about completing something like this: that moment when we joyfully take the proverbial bull by the horns and, with a smile on our face and joy in our hearts, with gratitude to the family and dear friends gained along the way, we give those horns a firm but epic and triumphant squeeze and farewell to life well lived.