Americans Becoming Sicker: Make the Right Diagnosis

By Richard J. Jackson, MD, MPH

In medicine, when a patient is getting sicker despite increasing medicine and treatment, the doctor must find why the therapy seems useless.  What else is going on? What can work better?  One of the first things a medical student learns is: “Make the (Right) Diagnosis”.  If you are not correctly treating the underlying disease, you make the patient worse.

 In 1990 the US spent 12% of its GDP on medical care; we now spend 18%.   We have research that can create robots for surgery and genetic sequences for all.  Yet, we have doubled adult obesity and diabetes rates, created an epidemic in children of “adult” diabetes, and quadrupled the use of antidepressants in young adults.

The CDC monitors the health of Americans over time using portable clinics to visit and examine a solid sample of the American people.  This article in JAMA Internal Medicine [due out 3.00pm Monday, February 4, 2013], validates what primary care clinicians already know: Americans are unwell and rapidly becoming sicker,  and “care as usual” is failing clinically and financially. In less than one generation, comparable groups of middle aged Americans (ages 46-64) have gone from 32% saying they are “in excellent health” down to 13%.  The portion needing canes and wheelchairs has doubled, and over half of us get no physical activity, up from 17% since 1990. 

The patient, the United States, is getting sicker and the usual medical treatments are failing. It is time to step back to make a better diagnosis—what is the underlying disease?  I suggest that in the US we have created isolating environments, high in calories and low in walking and physical activity.  Every doctor knows what does not work: merely telling patients to eat less and move more.  It is time to create environments, physical and social, educational and commercial, that promote health, not disease.  Sometimes in medicine we need to watch and wait, but with this epidemic for America, that time is long past.

Dick Jackson

Richard J Jackson MD MPH
Professor/Chair, Envl Health Sci
UCLA Fielding School of Public Health
CHS Rm56-070   650 Charles Young Drive S,
Los Angeles, CA 90095-1772   
(310) 206 8522  

Ed: For a copy of the new report, “U.S. Health in International Perspective: Shorter Lives, Poorer Health,” and to see video of "US health in international perspective" visit

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