A Morbid Subject
You may not have heard about compressed morbidity, but it’s an important concept related to health and quality of life. James Fries, a professor of medicine at Stanford University School of Medicine, was the first to discuss compressed morbidity or the idea that we can compress the time horizon between the onset of chronic illness or disability and the time in which we die.
This concept sounds, well, morbid, I know, but the idea is important to those who want to live a long, healthy, productive life and spend as little time as possible ill or disabled at the end of life. We should live our lives in a way that allows us to be as healthy as possible for as long as possible and then die of natural causes after a brief illness. While there is a long list of things that influence the compression of our morbidity, I’m going to discuss just a few here.
Geography. This week, a study made media headlines by identifying your life expectancy based on where you live. There was a whopping 20.1 year difference between the best and worst places. The longevity inequality by state is really striking: some states have a life expectancy similar to very low-income countries around the world. For example, Minnesota has high life expectancy, on par with the United Kingdom. At the other extreme, Mississippi has a life expectancy on par with Syria. The recently published study, predicts life expectancy by county. The counties with lowest life expectancy are located in South and North Dakota, the lower half of Mississippi, eastern Kentucky, and southwestern West Virginia. The good news for Coloradoans – residents of counties in central Colorado can expect to live the longest!
Socioeconomic status. (SES) is a combined total measure of economic and social position, income, education, and occupation. Scientific literature has demonstrated that socioeconomic factors directly contribute to the development of disease. In fact, education and income are considered a risk factor for heart disease, independent of any other risks. It seems obvious that if people can’t afford to buy organic foods or fresh produce, they will opt for cheaper food that will make them fatter and sicker.
Education. Education is part of SES, but is also an independent factor in our quality of life. Americans with more education live longer, healthier lives than those with fewer years of schooling. But why does education matter so much to health? The link is tied closely to income and to the skills and opportunities that people have to lead healthy lives. Health conditions and unhealthy behaviors can have an effect on educational outcomes and those families without the means or opportunity for education are much more likely to have unhealthy behaviors and chronic health conditions.
What does all this mean? All of the things we do to take care of our health are important to our quality of life as well as our longevity. Risk factors — obesity, lack of exercise, smoking, hypertension, and diabetes – explain about three quarters of the variation in longevity across the U.S. The rest is all about our ability to choose where we live, our history and our ability to make the most out of our future.