1. Pfeifer, Gail M. MA, RN

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According to the Human Development Report 2005, published by the United Nations Development Programme, the United States ranked 29th in life expectancy among 177 countries. Life expectancy at birth in the United States is 77.4 years, just behind countries like the United Arab Emirates (78 years), Chile (77.9 years), and Costa Rica (78.2 years) and just ahead of Cuba (77.3 years). (View the report online at


How can this be, one wonders, when, according to the Centers for Medicare and Medicaid Services, U.S. national health expenditures approached $5,000 per capita in 2000 and are projected to increase to $9,000 by the end of 2010? (By comparison, Chile's national health expenditures were $642 per capita in 2002, and Cuba's were $236, according to the World Health Organization.) It seems that there may be several answers to that question-and several factors involved in the failure of high health care spending to translate into longer life spans.



In a 2005 report, Olshansky and colleagues predict that obesity alone will cause life expectancy estimates to level off or even decline. The authors point to the deleterious effects of obesity, which include increased risk of cardiovascular disease, cancer, and type 2 diabetes. A trend toward the increased prevalence of type 2 diabetes in children and adolescents in the United States, as noted by the Centers for Disease Control and Prevention, supports the authors' concerns about the relationship of obesity with subsequent development of diabetes and potential reductions in longevity.



Threats of an influenza pandemic and mutations of the avian influenza A H5N1 virus that would permit human-to-human transmission have been widely covered in the media. But real threats to longevity already exist in antibiotic-resistant pathogens, as well as in new infectious diseases such as West Nile virus. And although HIV, malaria, and tuberculosis have been brought under control, to varying degrees, in the United States, they remain significant problems.


An aging population.

The percentage of U.S. residents older than age 65 could reach 20% of the total population by 2030. With aging comes increases in mortality rates, particularly from cancer and cardiovascular and respiratory diseases.


Olshansky and colleagues offer a dire warning: "Unless effective population-level interventions to reduce obesity are developed, the steady rise in life expectancy observed in the modern era may soon come to an end and the youth[s] of today may, on average, live less healthy and possibly even shorter lives than their parents."


The question is whether the disturbing findings will spur the United States to take a closer look at how it spends its health care dollars.

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Olshansky, et al. N Engl J Med 2005; 352(11):1138-45.