This week, I am coining a new term: vigevity. Self-evidently, perhaps, this is the combination of vitality and longevity. I suppose “longality” might also serve, but I like vigevity better to represent the combination of years in life, plus life in years. We’ll see whether or not the term catches on. Either way, though, it is the one health measure to rule them all. It is what truly matters; the prize.
We are letting that prize slip away.
We have long known that rates of chronic disease were rising in the U.S., and around much of the world. Far worse than just a rise in the prevalence of chronic diseases- heart disease, dementia, diabetes- is the downward drift in average age of onset. That is perhaps starkest for diabetes.
When I went to medical school, the two varieties of diabetes mellitus were “juvenile onset,” and “adult onset.” Only since then- during the last quarter century, more or less- has that terminology become first quaint, then obsolete and abandoned. The routine terms are now “type 1” for the variety that is an auto-immune condition requiring insulin, and “type 2” for the variety generally presaged by obesity and insulin resistance. The latter variety was formerly “adult onset” but occurs routinely in children now, propagated by an epidemic of childhood obesity we simply haven’t bothered to fix, however we may wail and wring our hands.
The above bespeaks a loss of life from years- a siphoning away of our collective, precious vitality. Now comes word from a new CDC report that we are losing years from life as well in the U.S., experiencing for the first time since World War I a steady decline in life expectancy. Vigevity is the health measure that matters most, and vigevity in the U.S. is in decline.
The fall in life expectancy is driven largely, and tragically, by the opioid crisis compounded by increases in suicide. But these are really the symptoms of a disease with deeper roots. A vast literature on the social determinants of health highlights the dire ramifications of relative disadvantage and disaffection. The racism, xenophobia, and diverse renunciations of anyone deemed “other” that currently prevail in our culture are toxic to health. The vast and ever-growing divide between the affluent and indigent - the have-it-alls and the have-next-to-nothings - is toxic to health.
Lack of early, reliable access to medical care is toxic to health, too, as it allows problems readily treated in their early stages to advance and become potentially calamitous. The past year, again reflecting the policies, politics, and priorities of our culture in this moment, saw a rise of 300,000 in the population of medically uninsured children in our country.
Nor should we overlook the most momentous, if thus far still inchoate threat to vigevity, not just in the U.S. but globally: climate change. Around the world, that toll is almost certainly high already. Here in the U.S., where it is reflected in the scattered casualties of fires and floods, hurricanes and tornadoes- it is unlikely yet to exert much influence on our nation’s vital statistics. That will certainly change. But even now, when we acknowledge that there is no true vitality, and thus no true vigevity, absent hope and confidence in the future, we have cause to pause and reflect on the damage to human health mediated by aggregating damage to our planet. Constant worry is toxic to health. Despondency is toxic to health.
Why invoke vigevity, and then chronicle the doom and gloom of our current epidemiology? Because we tend only to manage what we measure. We should, therefore, measure what matters.
Even in the CDC report establishing the declines in life expectancy, the “causes” of death were arguably mischaracterized or overlooked. The report lists conditions- heart disease, cancer, dementia, diabetes, etc. - as the causes of our mortality, and declining longevity. But fully 25 years ago, these factors were declared “effects” rather than causes. The true, root causes of premature death are the modifiable exposures and practices that propagate these conditions - with poor diet, lack of physical activity, and tobacco use in their vanguard.
Even despite the terrible toll of opioids, depression, despair, and suicide - diet is the single leading cause of premature death in America today. There are vast troves of data establishing that, and equally vast troves of data establishing the basic dietary theme required to set things right. Instead, we treat each diverting triviality as a reason for further procrastination.
In my prior column, I pointed out the absurdity in all of this with a comparison to exercise research, and an appeal to logic and even just sense. Imagine the study of, say, ten jumping jacks daily. One research group tests this in highly fit individuals, who exercise routinely and often - and declares no discernible benefit. Another tests it in couch-bound septuagenarians, and finds clear benefit. The competing headlines get their respective media obeisance, and promulgate the view that we are so hopelessly confused about the benefits of physical activity that… no one should bother.
Preposterous, right? Except that America’s relationship to diet runs on exactly such nonsense, and thus dismissively - on Dunkin’, on Coca Cola, on pepperoni, and on multi-colored marshmallows as part of a child’s complete breakfast. A culture that fails to apply any sense to science is being sold just the kind of junk it deserves.
We focus on effects, while largely ignoring causes fully subject to our individual and collective will. We pose silly research questions about short-term effects, to generate buzz and hype and gimmicky diversions, while neglecting the reliable means to the genuine prize that have fully stood the tests of both trials and time. We debate the most contentious details with grave intensity, and blithely overlook the vast expanse of common ground, and the promise to which it is fertile.
Vigevity is the one health measure to rule them all because it acknowledges implicitly that health, per se, is not the prize. The prize is the best possible life, and the fullest measure of it. Health is just means to those enviable ends.
We do not routinely direct our collective will at the true, root causes of our decline. We do not reliably measure and prioritize what truly matters most. We are all complicit in a culture that practices apathy in the place of outrage, passive aggression in the place of meaningful action, polarization to the far corners of common ground where the choices are reduced to nanny, or ninny. We devote the most intense, if fleeting, media attention to the most useless research findings, because those of greatest value are too familiar to be interesting. The health of America runs on ever-shifting soundbites.
I hold out the hope that we might decide to measure what matters, and manage what we measure. Until we do, we - and our children - will continue the unnecessary surrender of years from our lives, and life from our years. We will keep relinquishing the prize.
David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.