Introduction: Global Health Trends
A research center at the University of Washington found that, perhaps for the first time in human history, the obesity-related death rate is higher than the malnutrition rate. Translation: More people die from obesity-related diseases than from lack of food. In an editorial last month, a major newspaper claimed that this was good news. (Chicago Tribune, Live Longer, With a Catch: Increased Life Expectancy, Despite Some Unhealthy Choices, December 26, 2012).
I may be missing something, but this doesn’t sound like news that could set off a ticker parade celebrating human progress. The research group cited, 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 more accurately reflects the health of the population. This could be a very effective way of guiding 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 choice, but it seems relevant to the IHME investigation that the Chicago Tribute found good news. For one thing, it lasts much longer on too much food than on too little food; for another, overconsumption is more satisfying, at least until the multiple adverse consequences of doing so manifest and the suffering begins. Fortunately, these extremes are not the only candidates for better mortality indicators in the classification of healthy populations. Before suggesting a better indicator of health status cause of death – for a city, state or nation, a summary of the IHME study seems appropriate.
Chronic disease advances, infectious disease recedes
The IHME report showed a worldwide trend of older people increasingly dying from heart disease and cancer. These factors are considered diseases 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 (i.e., the United Nations) concerned with the health status of the population should not be the promotion of conditions in which death rates from heart disease and cancer dominate (I am not suggesting this is the case either).
The 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? In order to collect 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 up this cause of death. Why not have an insufficient exercise indicator? We know that laziness kills. It’s a shame there is no 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 modern and important REAL welfare general, some or all of your parts they will fail, eventually. When this happens, you will die. But what will go first? Something will, you know, even if you live your life as a fitness model, having incredible luck regarding random events while benefiting from great genetics. (Needless to add, but I’ll do it anyway, there are no such general models of REAL important well-being. Life is such that, while good genes, good luck with random fate, and great lifestyles are all possible, no one ever cares. anything remotely close to a life that embodies the hypothetical very model of a very general important very modern REAL well-being ideal. I know you knew that.)
So think about it. What might a medical/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, based on observations, local legislation, etc. Autopsies and other tests are commonly performed to determine the cause of death.
Let’s agree that you wouldn’t want the cause to be hunger/malnutrition or, for that matter, heart disease or other chronic conditions brought on 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 sedentary lifestyle either.
So what?
An Alternative Indicator of REAL Well-being: Completion
How about a new cause of death, one that indicates that 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 farewell note) that would 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, mind you), 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 them to a proper end, following a lifestyle course (while waiting for the best genetics and genetic opportunities). random). ) which will get an entry of completion on my death certificate.
That would be a better cause as far as I’m concerned than any other I can think of. In fact, if I could, I would frame it.
First steps towards completion
Maybe it’s time to develop a general decision support tool that helps people determine when the time is right.
Let’s start right away with readings on existential philosophy and discussions with others, especially those who have pondered on 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 disconnect. There is too much history with this phrase associated with sad and medical situations of ending the lives of others that no longer seem viable.
Think about completing something like this: that moment when we gleefully take the proverbial bull by the horns and, with a smile on our face and joy in our hearts, with gratitude to family and dear friends gained along the way, give to those horns a firm but epic and triumphant clenching and firing of the life well lived.