Americans are already smoking less, drinking less, eating healthier diets and living longer than they were in past decades -- but the improving picture of U.S. health and fitness does not include everyone. Poor people are doing worse than ever.
Wracked by the worsening scourges of violence, drugs, AIDS and teen-age pregnancy, the nation's underclass is actually faring worse than their counterparts did several decades ago, according to some public health experts.
"The country is really broken into two countries," said Dr. Scott Zeger, senior associate dean of the Johns Hopkins School of Hygiene and Public Health. "We're more strongly polarized. There's improved health in the upper class and middle class, and decaying health in the inner city."
In a speech yesterday in San Diego, President Bush called on all Americans to stay healthier by exercising more, drinking less, eating right and avoiding drugs and risky sexual behavior.
People who can afford comfortable housing and health care already have taken his advice and adopted some of the lifestyles that are crucial to good health, said Dr. Zeger, a professor of biostatistics.
"We smoke less, we drink less and indulge in behaviors that affect our health less," he said. "The best indication of that is that we've had about a 50 percent decline in heart disease [deaths] in this country over the last 15 years. That's coming largely from decreased smoking and an improved diet."
Indeed, the national Centers for Disease Control has charted a dramatic downturn in smoking. Today, approximately 29 percent of Americans smoke, down from 30 percent in 1985 and 40 percent in 1964, the year of the surgeon general's landmark warning against smoking.
Although cancer rates continue to increase, Dr. Zeger said that the decline in smoking should translate into fewer cancer deaths in years to come. Lung cancer is still the leading cancer killer, far eclipsing cancers of the breast, prostate and colon. But most of today's victims were people who began smoking in past decades.
Americans also are behaving better on the road. Last year, the CDC reported that people are wearing seat belts more often and driving drunk less often. But at home, people are just as lazy as ever. Only 13 states reported improvements in exercise habits.
Dr. Louis Zen, a professor of exercise science at the University of Michigan, said the majority of Americans are approximately 20 percent overweight -- a state of affairs that has held steady over the last two or three decades.
But a recent survey of high school students found some disturbing trends.
Federal health officials recommend that youths in grades nine through 12 get at least 20 minutes of hard exercise at least three times a week. But the CDC found that only 37 percent of high school students reached that level -- down from 62 percent in 1984.
There are few positive trends to find in the inner city, Dr. Zeger said.
"I think the crack epidemic and the increased violence in the inner city reflects our being less healthy than we were even 20 years ago," he said.
One bellwether of a society's health is infant mortality, since the rate at which babies die reflects a variety of converging factors including nutrition, drug use and access to health care.
Overall, infant mortality has declined in recent decades. "But blacks have had very little change in the Reagan and Bush years," Dr. Zeger said.
The United States continues to have higher infant mortality rates than most other industrialized nations -- a trend that experts attribute to abnormally high death rates among babies born to poor women.
Sexual promiscuity and the failure to use condoms have not only fueled the AIDS epidemic but also have brought high rates of syphilis to the inner city. Last year, the nation's syphilis rate reached its highest point in more than four decades.