*This is an archive page. The links are no longer being updated. 1993.09.15 : Latest Annual Report Card on Nation's Health Contact: NCHS Press (301) 436-7551/436-7135 September 15, 1993 The United States continues to make progress against chronic disease and premature death, but the nation is falling far short of many health goals, including those to reduce health disparities among racial and ethnic groups, HHS Secretary Donna E. Shalala said today. In releasing, Health, United States, 1992, the latest annual report card on the nation's health, Secretary Shalala said the findings reinforce the need for national health care reform. "Where could you find a better argument for health reform than in the sharp differences in health by income, race and education?" Secretary Shalala said. "Many Americans can't afford or can't obtain the care they need to prevent illness and maintain good health. It's unfair to our citizens, and unwise as a nation, to fail to deliver basic services because of an individual's ability to pay or a family's health insurance coverage." Death rates are lowest in the more affluent suburbs as compared to inner city and rural areas, and the gap is widening. Black infant mortality is more than twice the white rate, and again the gap is increasing. According to the U.S. Census Current Population Survey, some 21 percent of blacks and 32 percent of Hispanics were uninsured in 1991, compared with 11 percent of white nonHispanics. An estimated 37 million Americans have no health insurance, up from 31 million in 1987. Also released today was the first evaluation of Healthy People 2000, the national effort to meet more than 300 health objectives by the year 2000. The evaluation shows progress in lowering infant mortality and reducing risk factors like smoking and high cholesterol. However, the evaluation also shows no progress or regression in homicide rates, prenatal care for many women, and low birth weight, especially among black infants. The head of the Public Health Service, HHS Assistant Secretary for Health Philip R. Lee, M.D., said, "Many health problems are rooted in poverty and hit hardest at those least able to protect themselves. Through health reform and public health outreach and education, we must reach those in need with both the right health care and the right health message. That's the only way we'll meet the health goals set for all Americans in Healthy People 2000." The Public Health Service coordinates the year 2000 program which seeks to increase the span of healthy life, reduce disparities in health among Americans, and achieve access to preventive services for all Americans. The report uses current and trend statistics to track health in America over the past decades and look toward the future. The progress shown in the report is most notable in the area of chronic disease and chronic disease risk factors. Findings include: -- Life expectancy at birth increased by almost two years in the past decade and now stands at 75.5 years for the average American. -- Infant mortality reached a record low in 1992 of 8.5 per 1,000 live births. Provisional data for 1992 show a decline of 4 percent from the previous year and a dramatic decline since 1970, when there were 20 deaths per 1,000 live births. The year 2000 objective is to reduce infant deaths to 7 per 1,000 or less by the year 2000. -- Between 1980 and 1990, the age-adjusted death rate for heart disease, the leading cause of death for men and women, declined 25 percent, continuing the downward trend of the 1970s. -- Stroke, the third leading cause of death, dropped 32 percent over the past decade. -- Key risk factors such as smoking and cholesterol also improved. In 1991 as in 1990, about a quarter of adults were smokers, down from 37 percent in the mid-1970s. Policies which prohibit or severely restrict smoking at the workplace have more than doubled from 27 percent of worksites with 50 employees or more in 1985 to 59 percent in 1992. -- Cholesterol levels have also declined over the past decade and the data through 1991 show that only 20 percent of Americans have high cholesterol compared to 26 percent a decade earlier, essentially reaching the Healthy People 2000 target. -- The latest national data on health habits and risk factors show that about a quarter of adults exercise moderately five or more times a week but only about 14 percent have vigorous physical activity. Worksite fitness programs may help. In 1991, 83 percent of large companies had fitness programs for their employees. -- Motor vehicle crash-related deaths have declined, due in part to an almost 20 percent drop in alcohol-related motor vehicle death rates from 1987 to 1991. Increased use of seat belts (up from 42 percent in 1988 to 59 percent in 1991) is also a factor. In 1991, 41 states had seat belt use laws compared to 33 states in 1989. Provisional data show that motor vehicle deaths continued to decline in *This is an archive page. The links are no longer being updated. 1992. The report finds, however, that some serious health problems have not improved or have become worse. Homicide rates have increased since the mid-'80s, reflecting the rise in firearm- related mortality. The firearm death rate in 1990 was highest for those 15-24 years of age. The rate increased more for this age group than any other, up 50 percent from 1985 to 1990. According to provisional data for 1991 the homicide rate has continued to rise and homicide was ranked as the 10th leading cause of death for all Americans in 1991. Several important indicators of maternal and child health also showed setbacks or no improvement during the 1980s. Low birth weight, a significant factor in infant mortality, has been generally stable at about 7 percent of all births, but very low birth weight has been increasing. For black infants there was an 18 percent increase in very low birth weight compared with a 6 percent increase for white infants between 1980 and 1990. The rise in very low birth weight infants parallels the increase in preterm births (less than 37 weeks gestation) over the past decade as well as the continued rise in births to unmarried mothers and the recent jump in teen births. As in 1980, about a quarter of the women who gave birth in 1990 failed to receive prenatal care in the first three months of their pregnancy. Unmarried mothers and teen-age mothers are the least likely to receive timely prenatal care. Teen mothers, in addition, gain too little weight during their pregnancies -- another cause of very low birth weight. Provisional data indicate that AIDS, ranked 9th in 1991, increased again in 1992 to become the 8th leading cause of death. The death rate for AIDS increased by nearly 60 percent from 1987 to 1989 but has increased at a less rapid pace since then, up 10 percent from 1991 to *This is an archive page. The links are no longer being updated. 1992. AIDS was the 15th leading cause of death in 1987. In response to the growing interest in comparing health in urban and rural America, the report examines age-adjusted mortality rates by urbanization. The suburbs have the lowest death rates. Death rates in rural counties are 12 percent higher and in large core metropolitan counties, 19 percent higher. Moreover, during the '80s death rates declined by 10 percent in the suburbs but only by half as much in the inner cities. In a first-time analysis for this annual report, death rates were examined by education. A strong relationship was shown between educational level and mortality. Death rates in 1989-90 for men and women aged 25-44 without a high school education were about three times the rates for college graduates. Among middle aged men and women there was about a two-fold difference. Educational level may reflect increased awareness and ability to follow health and medical advice, more favorable living circumstances, and better access to health care. Regarding differences in risk of disease and death by race and ethnicity, the report found that Asian Americans had the lowest death rates for many of the major causes of death while black Americans had higher death rates for many of those causes. For example, in 1988-90, Asians 45 years and over had the lowest age-adjusted death rate for heart disease, about 25 percent lower than the rate for Hispanics and American Indians, close to half the rate for white persons, and 63 percent lower than that for blacks. Looking at the 15-24 age group the report found the highest suicide rates for American Indian youth who also had the highest rates for motor vehicle crash-related deaths. The highest homicide rates were reported for black teen-agers and young adults. The report tracks the patterns in health care utilization, health resources and expenditures. In 1991, just over half of all surgery performed in short-stay hospitals was on an outpatient basis, three times the level in 1980. Since the mid-1980s, admissions to hospitals decreased by 8 percent while outpatient visits grew by 38 percent. While the hospital discharge rate from nonfederal short-stay hospitals declined by 4 percent between 1988 and 1991, the discharge rate for HIV infection increased by 69 percent. In 1991, health spending in the United States accounted for a larger share of gross domestic product--13.2 percent of GDP-- than in any other industrialized country and the gap has been widening. GDP increased by 2.8 percent but national health expenditures rose by 11.4 percent between 1990 and 1991. The National Center for Health Statistics, which prepared the report, is part of the Centers for Disease Control and Prevention within the U.S. Public Health Service, Department of Health and Human Services. Copies of the report can be purchased from the Superintendent of Documents, Government Printing Office, Washington, D.C. 20402. Request stock number 017-022-01218-9; price $29. A pocket version with highlights of the report is available free from NCHS, 6525 Belcrest Road, Hyattsville, Md. 20782.