What We Should Be Afraid Of

By Tom Farley

I don’t believe people should spend much time worrying about health risks.  Certainly, every day’s news give us plenty to fear, scaring us about risks ranging from pesticides to concussions.  But we all have plenty of other important problems to deal with, and we all need time just to relax and enjoy life.  So we have to set some priorities. 

What are the health risks that matter the most? If you only read the headlines, you might think of terrorism, murder, floods, or earthquakes. And those are terrifying, but they’re rare.

As the ranking below shows, the leading killers today are chronic diseases, like heart disease, cancers, chronic lung disease, and diabetes.  These aren’t just what we die from, they’re also what we live with – the conditions that compel us to take medicines and that interfere with our daily lives. And because so many of us live with them for so long, chronic diseases are also the biggest drivers of our country’s crushing health care costs.

For the most part, doctors can’t cure these chronic diseases.  There aren’t medicines that can fix congestive heart failure or diabetes or Alzheimer’s disease.

On the other hand, chronic diseases are preventable.  Just a few risk factors underlie many of the most important ones.  Smoking increases the risk not just of lung cancer but also chronic lung disease (emphysema and chronic bronchitis), ischemic heart disease, and cerebrovascular disease (stroke).  A diet high in saturated fat, salt, and sugar increases the risk of heart disease, stroke, and diabetes. We can get a more actionable understanding of our biggest health problems, then, by looking at a ranking of risk factors that lead to the diseases that kill us. 

There is no standard method to count how many deaths we can attribute to each risk factor, but a few research groups have come up with their own approaches.  My favorite is from the Institute of Health Metrics and Evaluation, which estimated the number of deaths from various risk factors for the entire world.  On their rich interactive website, the results from the United States look like this:

Deaths per year

Deaths per year

There is uncertainty to their methods, so some will quibble with the specific numbers and even some of the rankings, but the leading killers in the U.S. are clearly dietary risks (in all of the many ways that diets can be unhealthy) and smoking.  Not much further down is physical inactivity; in between are high body mass index (i.e. obesity), high blood pressure, and high fasting plasma glucose (i.e. pre-diabetes), which themselves stem mainly from an unhealthy diet and physical inactivity.  After that come air pollution (the most important direct environmental risk) and alcohol use.

So today’s biggest killers are unhealthy diet, smoking, physical inactivity, air pollution, and alcohol use.  Those are the risks worth thinking about personally.  And if we want to reach A Healthy America, or even just bend the curve on health care costs, those are the risks our whole society should focus on the most.