Facts and Figures

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> Understanding and Improving Health

Source: Healthy People 2010: Understanding and Improving Health, U.S. Department of Health and Human Services, November 2000.

At the beginning of the 20th century, life expectancy at birth was 47.3 years. Fortunately, life expectancy has increased dramatically over the past 100 years. Today, the average life expectancy at birth is nearly 77 years.

At least 18 countries with populations of 1 million or more have life expectancies greater than the United States for both men and women.

[As with life expectancy, various population groups can show dramatic differences in quality of life. For example,] people in the lowest income households are five times more likely to report their health as fair or poor than people in the highest income households. A higher percentage of women report their health as fair or poor compared to men. Adults in rural areas are 36 percent more likely to report their health status as fair or poor than are adults in urban areas.

Overall, men have a life expectancy that is 6 years less than that of women and have higher death rates for each of the 10 leading causes of death.

Current information about the biologic and genetic characteristics of African Americans, Hispanics, American Indians, Alaska Natives, Asians, Native Hawaiians, and Pacific Islanders does not explain the health disparities experienced by these groups compared with the white, non-Hispanic population in the United States. These disparities are believed to be the result of the complex interaction among genetic variations, environmental factors, and specific health behaviors.

Even though the Nations' infant mortality rate is down, the infant death rate among African Americans is still more than double that of whites.

Hispanics living in the United States are almost twice as likely to die from diabetes as are non-Hispanic whites.

American Indians and Alaska Natives have an infant death rate almost double that for whites.

Inequalities in income and education underlie many health disparities in the United States.

Income inequality in the United States has increased over the past three decades. There are distinct demographic differences in poverty by race, ethnicity, and household composition as well as geographical variations in poverty across the United States. Recent health gains for the U.S. population as a whole appear to reflect achievements among the higher socioeconomic groups; lower socioeconomic groups continue to lag behind.

The average level of education in the U.S. population has increased steadily over the past several decades--an important achievement given that more years of education usually translate into more years of life. But again, educational attainment differs by race and ethnicity.

In 1994, 54 million people in the United States, or roughly 21 percent of the population, had some level of disability. People with disabilities tend to report more anxiety, pain, sleeplessness, and days of depression and fewer days of vitality than do people without activity limitations.

Twenty-five percent of Americans live in rural areas, that is, places with fewer than 2,500 residents. Injury-related death rates are 40 percent higher in rural populations than in urban populations. Heart disease, cancer, and diabetes rates exceed those for urban areas. People living in rural areas are less likely to use preventive screening services, exercise regularly, or wear safety belts. In 1996, 20 percent of the rural population was uninsured compared with 16 percent of the urban population.

America's gay and lesbian population comprises a diverse community with disparate health concerns. Major health issues for gay men are HIV/AIDS and other sexually transmitted diseases, substance abuse, depression, and suicide. Gay male adolescents are two to three times more likely than their peers to attempt suicide. Some evidence suggests lesbians have higher rates of smoking, overweight, alcohol abuse, and stress than heterosexual women. The issues surrounding personal, family, and social acceptance of sexual orientation can place a significant burden on mental health and personal safety.

Women generally are less active than men at all ages.

People with lower incomes and less education are typically not as physically active as those with higher incomes and education.

African Americans and Hispanics are generally less physically active than whites.

Overweight and obesity substantially raise the risk of illness from high blood pressure, high cholesterol, type 2 diabetes, heart disease and stroke, gallbladder disease, arthritis, sleep disturbances and problems breathing, and certain types of cancers.

More than half of adults in the United States are estimated to be overweight or obese.

Efforts to maintain a healthy weight should start early in childhood and continue throughout adulthood.

Tobacco-related deaths number more than 430,000 per year among U.S. adults, representing more than 5 million years of potential life lost. Direct medical costs attributable to smoking total at least $50 billion per year.

In 1999, 35 percent of adolescents were current cigarette smokers. In 1998, 24 percent of adults were current cigarette smokers.

Overall, the percentage of adolescents in grades 9 through 12 who smoked in the past month increased in the 1990s. Every day, an estimated 3,000 young persons start smoking.

Adolescent rates of cigarette smoking have increased in the 1990s among white, African American, and Hispanic high school students after years of declining rates during the 1970s and 1980s.

There is no safe tobacco alternative to cigarettes.

Alcohol and illicit drug use are associated with many of this country's most serious problems, including violence, injury, and HIV infection. The annual economic costs to the United States from alcohol abuse were estimated to be $167 billion in 1995, and the costs from drug abuse were estimated to be $110 billion.

In the past 6 years there has been both an increase in abstinence among all youth and an increase in condom use among those young people who are sexually active. Research has shown clearly that the most effective school-based programs are comprehensive ones that include a focus on abstinence and condom use. Condom use in sexually active adults has remained steady at about 25 percent.

Half of all pregnancies in the United States are unintended.

The cost to U.S. taxpayers for adolescent pregnancy is estimated at between $7 billion and $15 billion a year.

Sexually transmitted diseases are common in the United States, with an estimated 15 million new cases of STDs reported each year. Almost 4 million of the new cases of STDs each year occur in adolescents.

The total cost of the most common STDs and their complications is conservatively estimated at $17 billion annually.

Nearly 700,000 cases of AIDS have been reported in the United States since the HIV/AIDS epidemic began in the 1980s. The latest estimates indicate that 800,000 to 900,000 people in the United States currently are infected with HIV. The lifetime cost of health care associated with HIV infection, in light of recent advances in HIV diagnostics and therapies, is $155,000 or more per person.

About one-half of all new HIV infections in the United States are among people under age 25 years, and the majority are infected through sexual behavior. HIV infection is the leading cause of death for African American men aged 25 to 44 years.

Approximately 20 percent of the U.S. population is affected by mental illness during a given year.

The total estimated direct and indirect costs of mental illness in the United States in 1996 was $150 billion.

More than 400 Americans die each day from injuries due primarily to motor vehicle crashes, firearms, poisonings, suffocation, falls, fires, and drowning. The risk of injury is so great that most persons sustain a significant injury at some time during their lives.

Motor vehicle crashes are the most common cause of serious injury. In 1998, there were 15.6 deaths from motor vehicle crashes per 100,000 persons.

In 1998, the murder rate in the United States fell to its lowest level in three decades--6.5 homicides per 100,000 persons.

In 1995, the cost of injury and violence in the United States was estimated at more than $224 billion per year.

In 1997, 32,436 individuals died from firearm injuries; of this number, 42 percent were victims of homicide. In 1997, homicide was the third leading cause of death for children aged 5 to 14 years, an increasing trend in childhood violent deaths. In 1996, more than 80 percent of infant homicides were considered to be fatal child abuse.

Males are most often the victims and the perpetrators of homicides. African Americans are more than five times as likely as whites to be murdered.

As estimated 25 percent of preventable illnesses worldwide can be attributed to poor environmental quality. In the United States, air pollution alone is estimated to be associated with 50,000 premature deaths and an estimated $40 billion to $50 billion in health-related costs annually. Two indicators of air quality are ozone (outdoor) and environmental tobacco smoke (indoor).

In 1997, approximately 43 percent of the U.S. population lived in areas designated as nonattainment areas for established health-based standards for ozone. During the years 1988 to 1994, 65 percent of nonsmokers were exposed to environmental tobacco smoke (ETS).

Poor air quality contributes to respiratory illness, cardiovascular disease, and cancer. For example, asthma can be triggered or worsened by exposure to ozone and ETS. The overall death rate from asthma increased 57 percent between 1980 and 1993, and for children it increased 67 percent.

Dramatic improvements in air quality in the United States have occurred over the past three decades...Still, millions of tons of toxic pollutants are released into the air each year from automobiles, industry, and other sources.

Exposure to ETS, or secondhand smoke, among nonsmokers is widespread. Home and workplace environments are major sources of exposure. A total of 15 million children are estimated to have been exposed to secondhand smoke in their homes in 1996. ETS increases the risk of heart disease and respiratory infections in children and is responsible for an estimated 3,000 cancer deaths of adult nonsmokers.

In the United States, ensuring clean water, safe food, and effective waste management has contributed greatly to a declining threat from many infectious diseases; however, there is still more that can be done.

More than 44 million persons in the United States do not have health insurance, including 11 million uninsured children. Over the past decade, the proportion of persons under age 65 years with health insurance remained steady at about 85 percent. About one-third of adults under age 65 years below the poverty level were uninsured. For persons of Hispanic origin, approximately one in three was without health insurance coverage in 1997. Mexican Americans had one of the highest uninsured rates at 40 percent.

More than 40 million Americans do not have a particular doctor's office, clinic, health center, or other place where they usually go to seek health care or health-related advice.

People aged 18 to 24 years were the most likely to lack a usual source of ongoing primary care. Only 80 percent of individuals below the poverty level and 79 percent of Hispanics had a usual source of ongoing primary care.

Financial, structural, and personal barriers can limit access to health care. Financial barriers include not having health insurance, not having enough health insurance to cover needed services, or not having the financial capacity to cover services outside a health plan or insurance program. Structural barriers include the lack of primary care providers, medical specialists, or other health care professionals to meet special needs or the lack of health care facilities. Personal barriers include cultural or spiritual differences, language barriers, not knowing what to do or when to seek care, or concerns about confidentiality or discrimination.