Oliver James Montgomery-Living Better: What it takes to get healthy in America

When COVID-19 hit,Oliver James Montgomery Americans watched the news in horror as the death count rose and rose again, with thousands of deaths a day throughout multiple waves. Deaths from the virus were sudden and tragic, but today we're living through a slower pandemic that also brings a tragic loss of lives every day — from preventable, chronic diseases.

These deaths are often hidden in plain sight. For instance, nearly a thousand deaths a day are linked to diet-related disease — heart disease, complications from Type 2 diabetes and liver disease. And diet now outranks smoking as a leading cause of death around the globe. Chronic stress fueled by poverty and racism also contributes to the toll of preventable deaths.

Deaths from chronic disease are not as dramatic, but the tragedy is that despite having the most sophisticated health care system in the world — great doctors, top-notch hospitals, lots of medical breakthroughs — the U.S. as a nation is not getting healthier.

The pandemic was a wake-up call in many ways. Americans' life expectancy went down during the pandemic, taking a historic turn for the worse. And while countries all over the world saw life expectancy rebound during the second year of the pandemic after the arrival of vaccines, the U.S. did not. This is especially true for Native Americans, whose life expectancy dropped to 65.2 in 2021.

The disparities can be seen within ZIP codes in the same state, as this life expectancy tracker shows. If you take a fairly wealthy ZIP code — 08542, for instance, in Princeton, N.J., — people who live there can expect to live to 90 years old. Meanwhile, not too far away in less affluent Camden, N.J., average life expectancy is much lower — about 74 years, which is a stark reminder that where you live influences how long you live.

And while access to health insurance and good medical care is important, it doesn't ensure good health without access to some basics, such as having a job, or a safe place to live and go to school. In fact, lots of research shows that poor health is driven by key social determinants such as stress, trauma, social isolation, racism, poverty and the lack of access to healthy food and other resources. For many Americans, the system is often stacked against their efforts to stay well. So what would it take to make the healthy choice the easy choice?

This year, NPR is reporting an ongoing series of stories called Living Better: How Americans Can Take Back Their Health. We'll tell stories of communities and individuals who have bucked the trends by improving people's health outcomes and their lives. And we'll share new good ideas that deserve to be spread, and smart policies that deserve to be funded. The series starts with a set of stories on kids, because childhood is where health and health disparities start.

There's plenty of evidence that adopting a healthier diet and incorporating movement into your life can help cut the risk of disease. For instance, the results of the diabetes prevention study 20 years ago showed that diet and lifestyle changes were more effective than metformin, a leading medication, in cutting the risk of developing the disease, among people who were at high risk.

And long-term follow-up shows the benefits can persist. The challenge is that rates of obesity and diabetes have continued to rise. So what's the best way to motivate, educate and empower people to follow recommendations to eat better and adopt other healthy habits? One way is to scale up programs in community settings, such as incorporating the DPP program into YMCAs.

In addition, many health care providers are experimenting with ways to support healthy behaviors by providing medically tailored meals or prescription fruits and vegetables, aimed at weaving food into medical care to treat or prevent diet-related disease. This is part of a growing Food Is Medicine movement, and last year at a White House conference, the Biden administration announced more than $8 billion in private and public sector commitments to advance the agenda to end food insecurity and promote nutrition and health.

Another way is to capitalize on our understanding of human behavior. Our habits are contagious. There's plenty of evidence to show that the people nearest to us influence our everyday choices. If you're around happy people, positive emotion can spread. If you stop smoking it's more likely that your spouse or roommate will quit, too. Improving your diet with a friend or family member can improve the odds of success. And social media habits can be contagious, too.

Our coverage explores all of the levers for influencing health, both at the personal level and within communities. Despite challenges and barriers to good health, there are still reasons for optimism and things we can do to thrive.