Did you notice the typo in the title of this article? I put it there on purpose. This article is a discussion about the underlying factors that contribute to the leading causes of death in the United States and how preventable many of these deaths really are.

When we think of our nation’s leading causes of death, we may immediately think of heart disease, cancer, stroke, and diabetes, to name just a few. Indeed, according to CDC statistics, heart disease kills just over 614,000 people per year, and ranks as our top killer. Additionally, cancer takes just under 592,000 lives, strokes kill over 133,000 people, and diabetes complications lead to about 76,500 deaths.

However, these deadly conditions are actually more like “effects” than causes. While it’s true that these illnesses do deliver the final lethal blow, the death is really just the final step in a process that took years or even decades to develop. In order to make progress in preventing these untimely deaths, we must put the focus on the true causes: the underlying factors that lead to these illnesses in the first place.

The medical industry puts so much emphasis on the management of the diseases themselves that we have lost sight of the the old aphorism that “an ounce of prevention is worth a pound of cure.” You may be surprised to learn that these underlying factors, or actual “causes” of death, are almost entirely within your control.

In 1993, the Journal of the American Medical Association, better known as JAMA, published an important study entitled, “Actual Causes of Death in the United States.” For their study, researchers surveyed articles, government reports, vital statistics compilations, and surveillance data published between 1977 and 1993. About ten years later in 2004, JAMA released an updated study, this time using CDC mortality data from the year 2000, and articles published between 1980 and 2002.

In both of these studies, researchers concluded that certain modifiable risk factors are our nation’s leading causes of death, regardless of the actual condition that a person died from. Based on their methodology, the researchers singled out ten risk factors. Looking at the 2004 results, the first four risk factors are especially notable:

Tobacco: This public health nightmare is our top killer, and was responsible for 435,000 deaths in the year 2000. This number was up from 400,000 in 1993, despite a host of public health interventions. While it’s no secret that tobacco is addictive, it’s each individual’s choice whether or not to smoke, and there are plenty of quitting resources available.

Poor diet and physical inactivity (grouped together): Right behind tobacco, poor diet and sedentary behavior killed 400,000 people in 2000. These numbers were up from 300,000 in 1990. It’s apparent that our nation’s reliance on convenient processed and packaged foods (not to mention those junk food drive thrus), and our horrible habit of sitting around for much of the day, are killing us.

Alcohol consumption: Alcohol abuse killed 85,000 people in the year 2000. This risk factor was actually down from 100,000 people in 1993, so that’s encouraging. However, it seems that as with tobacco, many people do not put down the bottle until it is too late.

The remaining modifiable risk factors identified by JAMA were:

– Microbial agents
– Toxic agents
– Motor vehicle crashes
– Firearms
– Risky sexual behaviors
– Illicit use of drugs

Now, not all of these remaining factors are within our control: car crashes, for example, can happen no matter how careful you are. However, risky sexual behaviors and illicit use of drugs are certainly within our discretion.

Based on their results, the study authors concluded:

“We found that about half of all deaths in the United States in 2000 could be attributed to a limited number of largely preventable behaviors and exposures.”

The study authors also observed:

“These analyses show that smoking remains the leading cause of mortality. However, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and aging population, argue persuasively that the need to establish a more preventive orientation in the US health care and public health systems has become more urgent.”

This focus on prevention is urgent, indeed. Think about it: these things are in our control. If we choose to avoid tobacco, eat healthy, move around, and limit our consumption of alcohol, we can quite literally save ourselves from premature death. If half of the actual causes of death are mostly within our control, then it’s time we start to exercise that control.

It’s a matter of life or death… let’s choose to live.

– Dr. Joshua Levitt