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1992.06.25 :  Report -- Health, United States

Contact:  Sandra Smith (301) 436-7551 
June 25, 1992

     HHS Secretary Louis W. Sullivan, M.D., today released the
government's annual health status report, as well as results of the
nation's first decade-long effort to achieve specific disease
prevention and health promotion objectives.
     In releasing Health, United States, 1991 and Prevention
Profile, Secretary Sullivan said progress was made in two-thirds of
the targeted areas during the 1980s.  For most of the remainder,
there were inadequate data to measure results.
     He called the long term goal-setting effort "a successful
first installment" and said new objectives for the year 2000,
already established in HHS' "Healthy People 2000" initiative, are
more comprehensive and better refined than those of the first
effort.
     "When these goals were set in 1979, as the first prevention
program for the nation, the hope was that the public could be sold
on prevention as the most effective means of improving health, and
that has happened," Dr. Sullivan said.  "For the 1990s, we are
enlisting an unprecedented array of public and private
organizations at every level to make disease prevention a dominant
feature of health and medical care in America."
     The report shows childhood mortality dropped 23 percent from
1977 to 1989, surpassing the 1990 goal, largely by reducing
unintentional injury deaths (the leading cause of death for
children), including those from motor vehicle crashes, drowning and
fires.    
     The death rate for adults also reached a record low in 1989. 

     "These results show the potential for focused disease
prevention efforts," Secretary Sullivan said.  "For example, the
progress in preventing deaths of children owes much to the use of
car safety seats -- and we can credit changes in personal lifestyle
for the decline in mortality among America's adults.  When our
citizens hear a clear, consistent health message, they respond." 

     However, the Secretary said, "There is still much to be done
to improve health in our country."  In particular, he pointed to
disparities in minority health which continued or worsened in the
1980s; the rising homicide rate in recent years; and the epidemic
of HIV infection, unknown as the decade began, but now a world-wide
public health problem of unprecedented magnitude.
         
     The 1990 HHS Objectives set 226 targets in 15 priority areas
such as high blood pressure control, injury prevention, improved
nutrition, and physical fitness and exercise.  The Prevention
Profile outlines progress in reaching those targets:  For 32
percent of the objectives the targets were reached or exceeded; in
another 30 percent there was progress.  For 15 percent there was no
progress or there was movement backward, and for 23 percent there
was inadequate data to measure results.

     Using key health indicators the report indicates progress in
a number of areas, including 24 percent reduction in cigarette
smoking and 28 percent reduction in auto fatalities among children.

     Infant mortality reached the goal of 9.0 deaths per 1,000 live
births.  Provisional data for 1991 show continued improvement to a
rate of 8.9.

     Mortality for adults from ages 25-64 declined from a rate of
532.9 per 100,000 in 1977 to reach the goal of 400 per 100,000 by
1989.  Factors contributing to the decline include a drop in
cigarette smoking and better control of hypertension and
cholesterol, as well as a shift in the overall age composition of
this group.  A decline in injury deaths was an important factor for
those under age 55.

     At the same time, the report shows specific problem areas,
including a 79 percent increase in the incidence of syphilis and
28,000 measles cases reported in 1990, twice the number in 1980 and
an eight-fold increase over 1988.  

     In addition, data over the 10-year period show a continuing
disparity in minority health.  During the 1980s, the gap widened
between white and black Americans in infant mortality and life
expectancy.  While the infant mortality rate for black babies born
in 1989 dropped to 18.6 deaths per 1,000 live births, the rate for
white infants has declined faster than that for blacks to reach a
rate of 8.1 in 1989.

     Overall life expectancy at birth increased from 74.9 to 75.3
years between 1988 and 1989.  Life expectancy for black males was
64.8 years, continuing the downward trend observed since 1984. 
Life expectancy for black females was 73.5 years, up slightly from
the previous year.  Provisional 1990 data show an increase in life
expectancy for black males and black females. 

     The report also documented a rising death rate among teen-
agers and young adults.  After declining in the early 1980s, the
death rate for those aged 15-24 leveled off and then increased,
primarily due to an upturn in homicide among young black men.  
Between 1985 and 1989, homicides were up 74 percent among black
males aged 15-24, to reach the highest level ever for those in this
age group.  Throughout the decade suicide was on the rise,
increasing about 10 percent among people aged 15-24 from 1978 to
1989.

     Overall, between 1970 and 1989 the age-adjusted death rate for
heart disease declined by 39 percent.  In 1989, heart disease
mortality was almost twice as great for white males as for white
females and almost 60 percent greater for black males than for
black females.  During this same period, deaths from stroke
declined 58 percent and at about the same rate for white and black
persons of both sexes.  

     In 1989, the HIV death rate for black men was three times that
for white men and the death rate for black women nine times that
for white women.  The proportion of people with AIDS who were women
almost doubled from 6 to 11 percent between 1984 and 1990. 

      "The 1990 objectives taught us that we need to target the
priority problems of minority populations," said Assistant
Secretary for Health James Mason, M.D., who heads the Public Health
Service.  "And while heart disease and stroke deaths are down to
unprecedented levels, we still lose too many Americans -- and too
frequently at the younger ages -- to injury, violence, and HIV." 
Injury is the leading cause of death for Americans 25-44 years of
age; and in 1989, AIDS overtook heart disease as the third leading
cause of death for this group.
  
     Other highlights from the report released today: 

     --  Some 23 million Americans, almost 10 percent of the
noninstitutionalized population, said they were in fair or poor
health in 1990.  Black Americans were almost twice as likely as
white persons to assess their health as fair or poor, 15 compared
to 8 percent.   

     --  About 26 percent of the American population 25 years of
age and over smoked in 1990:  28 percent of men and 23 percent of
women.  Men and women who did not finish high school were two to
three times more likely to smoke than college graduates.  

     --  About one-quarter of American adults are overweight. 
About 46 percent of overweight men and 61 percent of overweight
women reported trying to lose weight in 1990.  Among the overweight
men and women trying to lose weight about half were using both diet
and exercise. 

     --  In 1991, an estimated 175,000 new cases of breast cancer
were diagnosed among women.  Breast cancer is the leading type of
cancer for females with an incidence rate more than twice as high
as lung cancer.  Survival depends upon early diagnosis and
treatment.  In 1990 about 47 percent of women aged 50 years and
over had received a clinical breast examination and mammogram
within the past two years.  

     --   Workdays lost to occupational injuries are up, an average
annual rise of 4 percent from 1983 to 1989.  Rates of workdays lost
are highest among the construction, mining and transportation
industries.  

     Health, United States, 1991 and Prevention Profile also
reports on a changing health care environment.  Between 1985 and
1990, the number of persons employed in the health service industry
grew by 19 percent compared with 9 percent for all other
industries.  

     The report documents the continued shift to outpatient
surgery, with about half of the surgeries now performed on an
ambulatory basis.  And between 1980 and 1988 the number of
psychiatric beds in state and county mental hospitals fell 32
percent while beds in private psychiatric hospitals more than
doubled.    

     The health care worker has changed.  The nursing profession
moved to higher levels of training between 1981 and 1989 with the
percent of hospital nursing staff who are registered nurses
increasing from 55 to 65 percent and a corresponding drop in
licensed practical nurses and ancillary nursing personnel. 

     Health, United States, 1991 and Prevention Profile was
prepared by the National Center for Health Statistics, part of the
Centers for Disease Control within the U.S. Public Health Service.

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