One would think that since we Americans spend more money per capita on health care than any other nation on the planet, that we would enjoy the best health. Well, in many categories we’re not even in the top 10. Pregnancy related deaths put us somewhere above India but below most industrialized nations. A recent report by the National Research Council found that those of us still under 50 are more likely to suffer from chronic diseases and die prematurely than similar aged citizens of 16 other countries.

What are the principal causes of these premature deaths and chronic diseases? Well, according to these folks at the the National Research Council, the list includes car accidents, gun violence, obesity, diabetes and drug overdoses.

For the next few paragraphs, please excuse the rants of a middle aged doctor,who nevertheless still believes that we can make our health system and our lives better.

Car accidents are often caused by inattention (read texting, tweeting and so forth) overtired drivers and drivers under the influence of alcohol. Cars are much safer than years past, and need to be made even safer. But ultimately guys, we need to be more responsible drivers. Doctors should be making patients aware of this.

Gun violence is a major cause of premature death. Reasonable gun control, curbing our appetite for violent games and movies and a political will to do something about this needless violence are a start. Doctors need to be part of this solution by encouraging gun safety with patients who are gun owners, advocating for research about improving gun safety and what roles violent games and movies play.

The next two causes, obesity and diabetes are related. Obesity is the primary preventable cause of diabetes and guess what, a staggering 70% of us are either obese or overweight. The number of diabetics has increased tremendously. No easy fix here: Diet and exercise are the answer, but getting healthy, non junk food into school cafeterias, changing our eating and exercise habits and encouraging the food industry to support healthy perhaps less profitable alternatives to junk food will take time and effort.

Drugs both legal and illegal are readily available in this country. One reason the Mexican drug cartels are doing so well is that their biggest market-America- is right next door and more and more customers are willing to pay for their drugs. Alcohol, without a doubt the greatest contributor to drug deaths is and should be legal, but we need to recognize that alcohol and other drug addiction are  diseases, not simply caused by a weak personality. We need to realize that mental health issues are often intertwined with drug addiction. If we spent a fraction of the money we spend on our wars in Iraq and Afghanistan on drug addiction, we might make some real progress. And yes, doctors share the blame: A huge and ever increasing portion of drug deaths are from accidental overdoses of prescribed narcotics for chronic pain. We doctors need to rethink our strategy of simply throwing narcotics at chronic pain patients, rather than exploring other non pharmaceutical alternatives.

We certainly don’t get a bang for our buck in terms of health care spending. And we need to streamline our health care system, cool down the lawyers and ultimately work not for the government, nor in fear of the lawyers but for our customers-our patients. At the same time, each and every one of us, as health care consumers,  must take responsibility for his or her health.