Among the things he said in the speech I heard was a statement that really struck me at the time, and that has stayed with me. He said--there will ALWAYS be 10 leading causes of death.
Health policy people (which I was at the time) love to look at statistical analyses and compute things such as life expectancy, leading causes of death, and so on. A cheery lot! Health policy people look at the epidemiology of health issues--what is happening, why is it happening, what are the causes. Knowing these things helps you design interventions.
When Governor Lamm said--there will always be 10 leading causes of death--a virtual light bulb went on over my head. Of course! Throughout all of history, people have died--and if you had the statistics, you could compute what caused those deaths.
Over time, the reasons, of course, have shifted. For example, in 1900 the leading causes of death (according the CDC) were:
1. pneumonia & influenza
4. diseases of the heart
5. intracranial lesions (stroke)
7. accidents (excluding motor-vehicle)
The average life expectancy was 49.2 years.
In the year 2006, the list shows evidence of medical advances, as communicable diseases such as diphtheria are largely controlled by immunizations, chronic diseases such as diabetes are understood, and antibiotics help with lethal effects of bacterial infections.
1. heart disease
4. chronic respiratory diseases
7. Alzheimer's disease
8. influenza and pneumonia
And the average life expectancy has risen to 78.1 years.
It is striking that many of the same causes are there; the positions have switched around. The other big change is that the top diseases are those that usually take a life time to accumulate and end up causing death.
If we would go further down the list, you would find that suicide is the 11th leading cause, and homicide the 15th.
The placement of these two causes of death--entirely preventable--brings me to what it is that health policy people really want to focus on. Death, of course, is not preventable. I am reminded of the scriptural saying: it is appointed unto man once to die. Death is a condition of life.
What is preventable is UNTIMELY death. If you listen to health policy talk long enough, you might hear the term that sounds like "yipple." Don't go running to the dictionary--it is an acronym: YPLL=years of productive life lost. So it is not death that should be challenged, but untimely death. We should put our greatest effort in reducing those deaths that are preventable.
My--you must be thinking along about now--what is it with KGMom? Yes, the subject of death has been on my mind. The death of our church sexton reminds me of the unpredictability of death. But I can't think of a better way to die. Jim lived a long, productive joy-filled life. He spent the last days of his life with his family, enjoying a vacation. There was no painful lingering--he was here one moment, and then gone.
I promised a comment or two on Governor Lamm's outrageous statement that old people have a duty to die. He was not advocating involuntary euthanasia. He was simply arguing for the best use of scarce health resources. Since death is certain, he reasoned, public money should not be spent on ever more costly health resources to treat the diseases that are the eventual causes of death in people of extremely advanced years. I suspect, he might have thought it poor use of health resources to perform heart surgery on Dr. Michael DeBakey at age 97. DeBakey had turned down having surgery, but when he became "unresponsive" a surgical team performed surgery anyway. He took 8 months to recuperate, at a cost of $1 million. He was eventually "returned to good health" and lived two more years.
Why Dr. DeBakey? Well, he pioneered open heart surgery. No doubt his colleaguess felt they couldn't let him die of heart disease. But his case really raises difficult questions.
As we continue to debate health care coverage in the U.S., it is instructive to remember--people die. People have to die. It is a condition of life. We should place our emphasis on preventing untimely deaths, not place our emphasis on prolonging lives beyond a reasonable life span.