Physical fitness depends on more than daily exercise and a healthy diet. Access to safe housing, good schools and decent jobs is also important.

Si-Gal/Getty Images

hide title

switch subtitles

Si-Gal/Getty Images

Physical fitness depends on more than daily exercise and a healthy diet. Access to safe housing, good schools and decent jobs is also important.

Si-Gal/Getty Images

When COVID-19 hit, Americans watched the news in horror as the death toll continued to mount, with thousands dying in multiple waves every day. Deaths from viruses have been sudden and tragic, but today we are living in a slow-moving pandemic that brings a tragic daily loss of life — from preventable chronic diseases.

These deaths are often hidden in plain sight. For example, nearly a thousand deaths every day are linked to diet-related diseases—heart disease, type 2 diabetes complications, and liver disease. Diet has now surpassed smoking as the leading cause of death globally. Long-term stress fueled by poverty and racism also contributes to an increase in preventable deaths.

Deaths from chronic disease are less dramatic, but the tragedy is that despite having the most advanced healthcare system in the world – great doctors, top hospitals, many medical breakthroughs – America as a country is not getting healthier .

The pandemic has been a wake-up call in many ways. American life expectancy has declined during the pandemic, a historic deterioration. While life expectancy rebounded in countries around the world in the year following the vaccine, the United States did not. This is especially true for Native Americans, whose life expectancy fell to 65.2 years in 2021.

As this life expectancy tracker shows, differences can be seen within ZIP codes within the same state. If you take a fairly wealthy zip code—for example, 08542 in Princeton, NJ—people who live there can expect to live to 90. Meanwhile, in less affluent Camden, New Jersey, the average life expectancy is much lower—about 74 years—a stark reminder that where you live affects how long you live.

While access to health insurance and good medical care is important, lack of access to basics, such as finding a job or a safe place to live and go to school, does not ensure good health. In fact, many studies have shown that poor health is driven by key social determinants, such as stress, trauma, social isolation, racism, poverty, and lack of access to healthy food and other resources. For many Americans, the system often works against their efforts to stay healthy. So, how can you make the healthy choice the easy choice?

This year, NPR is running a series of stories titled “Living Better: How Americans Are Getting Back to Health.” We’ll tell the stories of communities and individuals bucking the trend by improving people’s health outcomes and lives. We’ll share great new ideas worth spreading, and smart policies worth funding. The series begins with a set of stories about children because childhood is where health and health disparities begin.

There is plenty of evidence that adopting a healthier diet and incorporating exercise into your life can help reduce your risk of disease. For example, results from the Diabetes Prevention Study 20 years ago showed that dietary and lifestyle changes were more effective than the leading drug metformin in reducing the risk of developing diabetes in high-risk groups.

Long-term follow-up suggests that the benefits can be sustained. The challenge is that the incidence of obesity and diabetes continues to rise. So what’s the best way to motivate, educate, and empower people to follow advice for better eating and other healthy habits? One approach is to expand the program in a community setting, such as incorporating the DPP program into the YMCA.

In addition, many healthcare providers are experimenting with ways to support healthy behaviors by offering medically tailored meals or prescribing fruits and vegetables, with the aim of incorporating food into healthcare for the treatment or prevention of diet-related diseases. It’s part of a growing “food is medicine” movement, and at a White House meeting last year, the Biden administration announced more than $8 billion in private and public sector commitments to advance its agenda of ending food insecurity and boosting nutrition and health.

Another way is to use our understanding of human behavior. Our habits are contagious. There is overwhelming evidence that the people closest to us influence our day-to-day choices. Positivity spreads when you are surrounded by happy people. If you quit smoking, your spouse or roommate is more likely to quit too. Working with friends or family to improve your diet can improve your chances of success. Social media habits are also contagious.

Our reporting explores all the means by which health is affected at the individual level and within communities. Despite the challenges and obstacles to physical health, there are reasons for optimism and things we can do to thrive.