US at ‘moment of reckoning’ on heart disease, public health

05 November 2022

2 minutes of reading



Khalif R. Inaugural Session: Moving Science into Public Health: Lessons Learned. Presented at: American Heart Association Scientific Sessions; November 5-7, 2022; Chicago (hybrid meeting).

Khalif is an FDA employee.

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CHICAGO — The U.S. is at a “tipping point” regarding heart disease and other public health issues, and catastrophic consequences will follow if improvements are not made, the FDA commissioner said.

“As a hearty American people, we have a moment of reckoning right now,” Robert Califf, MD, MACC, FDA commissioner, said during a presentation at the American Heart Association’s Scientific Sessions. “We need to do something more than what we’re doing now and something different, because what we’re doing now is stagnant and not working as it should.”

Healthcare in America

The US is at a “tipping point” regarding heart disease and other public health issues, and catastrophic consequences will follow if improvements are not made.
Source: Adobe Stock

Calif, who is a cardiologist, said the U.S. is the leading innovator in biomedical science and technology, but that hasn’t improved the health of most Americans at the individual or population level.

Robert Calif

“We are failing in the implementation phase in the US,” he said. “Cardiovascular disease is at the tip of the spear.”

He said the U.S. spends more on health care but has a lower life expectancy than most developed nations, noting that the gap in life expectancy between the U.S. and comparable countries has existed since at least 2010 but has worsened in 2020 , the first year of the COVID-19 pandemic. He noted that the latest data on life expectancy showed that China had overtaken the US in terms of life expectancy.

Poor rural counties have the lowest life expectancy in the U.S., he said, noting that death rates have been higher in rural counties than in urban counties since the 1990s, and the gap is widening.

“If you had told me in 1984 that urban people would play more sports than country people, I would have said you were crazy,” Califf said.

The life expectancy problem is driven by conditions “that we pretty much know what to do with — obesity, diabetes, blood pressure and cigarette smoking,” Califf said. “However, we spend so much of our money and energy on things that have little return, and we don’t focus on those things that make such a big difference.”

He said: “We are largely unmotivated to do something about the problem of common chronic diseases, but it will be overwhelming if we don’t do something. If you take the current risk factor profile of our teenagers, we’re headed for big problems in 20 to 30 years if we don’t do something different.

The medical community needs to renew its evidence-generating system around what is known to work, including information about the social determinants of health, Calif said, noting that “we shouldn’t just focus on things that are high-tech and bring in the most revenue for American hospitals.”

The challenge is particularly difficult because of the ease with which misinformation spreads on social media, Calif said.

“I believe that each of us should, when we get up each morning, take a moment to fight this huge problem that we used to not call disinformation,” he said. “I go around saying that misinformation is the leading cause of death right now in the US. There is no way to prove this, but I truly believe it is. This is not just naive misinformation. In fact, there are bad actors purposefully trying to influence the average person to get them to do something [that] are negative for their health. We actually had snake oil salesmen in the good old days…but they had no way to reach billions of people. But now, just one snake oil salesman can instantly reach billions of people on the Internet. I don’t know of anyone having a plan to successfully handle this. This is an urgent issue that we all need to address.”

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