The Secret to Long Life

Former assistant surgeon general Dr. Douglas Kamerow tells us what is the most significant factor for longevity. Hint: It's not what you eat or how much you exercise.

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MICHELE NORRIS, host:

We've been airing a series of commentaries from people who are rejecting conventional wisdom. It's called Au Contraire. And it's with that in mind and all those New Year's resolutions you may be making that we hear from Douglas Kamerow. He's a former assistant surgeon general of the United States. And he has some thoughts on the secret to a longer life.

Dr. DOUGLAS KAMEROW (Former U.S. Assistant Surgeon General): I know what you're thinking. Here comes another harangue about diet and exercise and smoking. All the stuff you should and shouldn't be doing next year. Time to turn the radio to another station. But bear with me. We'll get to the advice, which may surprise you in a minute. But first, a question. What's killing Americans?

You can probably name the so-called leading causes of death; they haven't changed in years: number one, heart disease; number two, cancer; three, stroke; four, chronic lung disease, and so on. Everybody knows that, except that everyone is wrong. Those are not the leading causes of death. Those are the leading diseases that doctors write down on death certificates, not what was really responsible.

Fifteen years ago, two public health service doctors, Michael McGinnis and William Foege, calculated what they called the actual causes of death based on what led to the death certificate diagnoses. For instance, what's a risk factor that's common to all the top four - heart and lung disease, cancer and stroke? You guessed it - smoking. This is where we got the idea that some of the leading causes of death are actually risky behaviors. When McGinnis and Foege did the math, it turned out that the real leading cause of death in America is smoking - 430,000 deaths per year. Second, bad diet and lack of exercise - more than 350,000 deaths. And third, alcohol use - almost 100,000.

So the answer must be clear. We need to eliminate tobacco or get everyone to exercise or rid the world of Twinkies. Well, each of those would certainly help, but none of them is the answer to this question - what's the single factor that best predicts longevity? It's not whether you smoke. It's not diet or exercise. It's not access to health care or getting the right screening tests or shots. It's not even wealth or race. Most experts are convinced that education, the number of years spent in school, has the most direct causal effect on how long people live.

And this is true around the world, in rich countries and poor countries alike. The problem for us in medicine is that the secret to longer life is nothing we can do anything about. Sure, we can help around the margins with our nicotine replacement patches, our cholesterol medicines, our screening tests. We can give expert care to the sick and relieve suffering, and we should. But for every year spent in school, life expectancy is extended 18 months. So the bottom line is, it's not the economy, stupid. It's not even risky behaviors. It is education, and that should be at the top of our agenda for 2008.

NORRIS: Family physician Douglas Kamerow is a former assistant surgeon general. He's now a health services researcher and a columnist. He lives in Maryland.

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