As Rene Dubos (1959, 110) observed decades ago, "To ward off disease or recover health, men [as well as women and children] as a rule find it easier to depend on the healers than to attempt the more difficult task of living wisely." The price of this attitude is partially reflected in the causes of death in the United States. Ranked from highest to lowest by the Centers for Disease Control and Prevention (CDC 2005), the ten leading causes are heart disease, cancer, stroke, chronic lower respiratory diseases, accidents, diabetes, pneumonia/influenza, Alzheimer's disease, nephritis/nephritic syn-drome/nephrosis, and septicemia.
Behaviors—including choices about the use of tobacco and alcohol, diet and exercise, illicit drug use, sexual behavior, and violence—and genetic predispositions influence many of these causes of death and help explain the pattern. Furthermore, underlying the behavioral factors and choices are such root factors as stress, depression, anger, hopelessness, and emptiness, which are exacerbated by economic and social conditions. In short, behaviors are heavily reflected in the diseases that kill and debilitate Americans.
Science has shown that changes in behaviors can change the pattern of causes of death. The death rate from heart disease, for example, has declined dramatically in recent decades. Although aggressive early treatment has played a role in reducing this rate, better control of several behavioral risk factors—including cigarette smoking, elevated blood pressure, elevated levels of cholesterol, poor diet and lack of exercise, and elevated stress—explain much ofthis improvement. Even with this impressive improvement, however, heart disease remains the most common cause of death and will continue to be a significant cause for the foreseeable future. Cancer death rates continue to grow, with much of the increase attributable to lung cancer, a type of cancer that is strongly correlated with behavior. The Real World of Health Policy: Smokefree Laws describes the extent ofstate and local laws intended to restrict where smoking is allowed.
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