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Estimating the Contributions of Lifestyle-Related Factors to Preventable Death: A Workshop Summary
Moderator: Dr. Harvey Fineberg
This workshop is designed to enrich understanding of the contribution of lifestyle-related factors to preventable death and guide public policy designed to combat such death and related disease. While most of the presentations will address measurement and interpretation, the workshop’s broader purpose is to raise questions about the role of preventable death as a driving force in public health.
The term “preventable death” is somewhat of a misnomer, for no death is truly preventable. The real questions concern death’s timing and cause. The answers tell us whether death occurs prematurely—and, if so, what can be done to prolong life through behavior change or public policy.
The topic of preventable death poses questions that are partly philosophical, partly logical, partly methodological, and partly epistemological. Experts assembled here need to bear in mind the topic’s complexity when considering how to measure the impacts on public health of such factors and interpret research findings. The implications of efforts to extend life and improve its quality are far-reaching: they shape the actions of individuals, communities, and decision makers at local, national, and international levels.
Measuring the Health Impact of Lifestyles: Scientific Challenges
Presenter: Dr. Julie Gerberding
The IOM offers a unique setting for scientists to discuss dispassionately efforts by the Centers for Disease Control and Prevention (CDC) to quantify and interpret lifestyle contributions to preventable death. CDC can benefit by listening to, and learning from, experts who have come together to explore the topic, discuss controversial and emerging scientific issues, and move the field forward.
The workshop aims to address the methodology of a recent CDC study of the causes of preventable death, as well as the broader issues it raises (Mokdad et al. 2004). Appearing in the Journal of the American Medical Association (JAMA), the CDC study updated another study published a decade ago (McGinnis and Foege 1993). That earlier study broke new ground by estimating the contribution of several modifiable lifestyle factors—including tobacco use, alcohol use, and poor diet and physical inactivity—to death. The study set the stage for years of research, analysis, and public health policy. Yet while attempting to refine the earlier study’s estimates, the 2004 study created controversy over its methodology. CDC also discovered, after publication, a computer-related computational error that slightly overestimated the contribution of diet and physical activity as causes of preventable death. CDC submitted an erratum to the same journal correcting the computation, and launched a review of its internal mechanisms of peer review. The corrected figure is 365,000 deaths, instead of 400,000, from poor diet and physical inactivity (Mokdad et al. 2005).