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Americans could narrow the life‐expectancy gap between the United States and other countries by adopting a healthier lifestyle. It is estimated that sticking to five low‐risk lifestyle‐related factors could prolong life expectancy at age 50 years by 14.0 and 12.2 years for female and male US adults, respectively, compared with individuals who adopted zero low‐risk lifestyle factor (Li et al., 2018). The five lifestyle related factors include diet, smoking, physical activity, alcohol consumption, and body mass index (BMI). Unhealthy lifestyles counterbalance the gain in life expectancy, particularly the increasing obesity epidemic and decreasing physical activity levels. Three‐quarters of premature CVD deaths and half of premature cancer deaths in the U.S. could be attributed to lack of adherence to a low‐risk lifestyle (Li et al., 2018). Prevention should be a top priority for national health policy, and preventive care should be an integral part of the US health care system. A healthy diet pattern, moderate alcohol consumption, nonsmoking, a normal weight, and regular physical activity are each associated with a low risk of premature mortality. Smoking is a strong independent risk factor of cancer, diabetes mellitus, CVDs, and mortality (Li et al., 2018). Physical activity and weight control significantly reduce risks of diabetes mellitus, cardiac disease, and breast cancer. Changing lifestyles is the most cost‐effective way to prevent illness and increase quality of life, yet it seems to be the most difficult for Americans. Note other factors that can both increase and decrease utilization, as listed in Table 2.6.

Table 2.6 Forces that Affect Overall Health Care Utilization

Force	Factors that may decrease health services utilization	Factors that may increase health services utilization
Financial incentives that reward practitioners and hospitals for performance (e.g., pay for performance (P4P) programs that reward quality practice)	Changes in clinician practice patterns (e.g., encouraging patient self‐care and healthy lifestyles; reduced length of hospital stay)	Changes in clinician practice patterns (e.g., more aggressive treatment of the elderly)
Increased accountability for performance	Consensus documents or guidelines that recommend decreases in utilization	Consensus documents or guidelines that recommend increases in utilization
Technological advances in the biological and clinical sciences	Better understanding of the risk factors of diseases and prevention initiatives (e.g., smoking‐prevention programs, cholesterol‐lowering drugs)	New procedures and technologies (e.g., hip replacement, stent insertion, magnetic resonance imaging (MRI)) New drugs, expanded use of existing drugs Increased supply of services (e.g., ambulatory surgery centers, assisted living residences)
Increase in chronic illness	Aging of the population Discovery and implementation of treatments that cure or eliminate diseases Public health and sanitation advances (e.g., quality standards for food and water distribution)	Growing elderly population:more functional limitations associated with agingmore illness associated with agingmore deaths among the increased number of elderly (the elderly are correlated with high utilization of services)
Increased ethnic and cultural diversity of the population	Lack of insurance coverage Low income	Growth in national population Efforts to eliminate disparities in access and outcomes
Changes in the supply and education of health professionals	Decreased supply (e.g., hospital closures, large numbers of nursing and medical practitioners and nurses retiring) Shifts to other sites of care may cause declines in utilization of staff at the original sites:as technology allows shifts (e.g., ambulatory surgery)as alternative sites of care become available (e.g., assisted living)	Increase in chronic conditions Growth in national population
Social morbidity (e.g., increased AIDS, drugs, violence, disasters)	Disparities in access to health services and outcomes	New health problems (e.g., HIV/AIDS, bioterrorism, earthquakes)
Access to patient information	Changes in consumer preferences (e.g., home birthing, more self‐care, alternative medicine)	Changes in consumer demand
Globalization and expansion of the world economy	Growth in uninsured population	Growth in national population
Cost control and competition for limited resources	Insurance payer pressures to reduce costs	Increased health insurance coverage Consumer and employee pressures for more comprehensive insurance coverage Changes in consumer preferences and demand (e.g., cosmetic surgery, hip and knee replacements, direct marketing of pharmaceuticals)

Source: Adapted from Bernstein, A. B., Hing, E., Moss, A. J., Allen, K. F., Siller, A. B., Tiggle, R. B. (2003). Health care in America: Trends in utilization. Hyattsville, MD: National Center for Health Statistics; and Shortell, S. M., & Kaluzny, A. D. (2006). Health care management (5th ed.). Clifton Park, NY: Delmar Cengage Learning. And CDC. (2018). National Center for Health Statistics. Health, United States, 2017: With special feature on mortality.. National Center for Health Statistics. Health, United States, 2017: With special feature on mortality. Retrieved from www.cdc.gov/nchs/data/hus/hus17.pdf