Things to Remember
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We have tons of medical knowledge, but people are getting sicker younger: Life expectancy is actually going backward in wealthy countries, and we're seeing chronic diseases and cancers in people in their 30s and 40s at alarming rates. The problem isn't that doctors don't know what to do - it's that the system isn't working.
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Getting healthcare when you need it is broken: Whether you're waiting months for appointments and tests, can't afford your medications so you skip doses, or simply don't have access to specialists, the delays mean conditions get worse when they could have been caught early. All the healthy eating in the world won't help if you can't get that colonoscopy or scan when you actually need it.
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Ultra-processed foods are seriously harming us - and it's worse than you think: More than half of what we eat now is engineered food products (think anything with ingredients you wouldn't have in your kitchen). These aren't just making us gain weight - they're causing inflammation, messing with your gut, and increasing your risk of heart disease, diabetes, depression, and even early death. Your body literally processes them differently than real food.
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We're feeding this stuff to our kids systematically: School meals, including free school meals meant to help children, are 70-80% ultra-processed foods. We're setting up an entire generation with damaged metabolic health before they even reach their teenage years.
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Health advice has become so confusing that people are paralyzed: Everyone's arguing about keto vs. vegan, which supplements to take, and what exercise is "optimal" - while the basics are being ignored. People spend hours researching the perfect diet while still eating mostly processed food products. The fundamentals matter way more than the fine-tuning.
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The timing of rising early cancers matches when processed foods took over our diets: Starting in the 1980s, ultra-processed foods became the norm, and we're now seeing digestive cancers (colon, pancreatic, stomach) appearing in younger people at rates we've never seen before. Each generation seems to be getting sicker younger than the one before.
This article examines why so many people are dying prematurely despite having access to life-saving health information, and what's causing the widening gap between medical knowledge and how we actually live.
There's a peculiar kind of cognitive dissonance that happens when you work in medicine long enough. You see the research, you read the studies, you watch the science accumulate - and then you watch people get sicker anyway. Younger people. People who should have decades ahead of them.
Healthcare Access Barriers by System: What's Blocking Your Care
| Healthcare System | Primary Barrier | Typical Wait Times | Out-of-Pocket Impact | Key Consequence |
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| US Private Insurance Model | Financial cost | Days to weeks (if affordable) | High ($1,000s - $10,000s annually) | Delayed care due to cost calculations; skipped medications |
| UK/NHS Public Model | Wait times & capacity | 3+ weeks (GP); months (specialists) | Low to none | Disease progression during queue times; late diagnoses |
| Developing World Systems | Infrastructure absence | Unavailable or indefinite | Variable (often catastrophic) | No screening programs; no treatment pathways for many conditions |
| Hybrid/Mixed Systems | Combined cost + wait times | Weeks to months | Moderate to high | Inequitable access based on ability to pay for private care |
Ultra-Processed Foods: Health Impact by Body System
- Metabolic System
- Effects: Insulin resistance, type 2 diabetes risk, weight gain
- Evidence: Dose-response relationship confirmed in BMJ 2024 meta-analysis
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Threshold: Risk increases above 50% of daily calorie intake
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Cardiovascular System
- Effects: Increased heart disease risk, elevated blood pressure, arterial inflammation
- Evidence: Direct correlation with cardiovascular disease mortality
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Population Impact: Contributing factor to declining life expectancy in wealthy nations
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Gut & Immune Function
- Effects: Microbiome disruption, chronic low-grade inflammation, altered immune response
- Mechanism: Industrial additives and preservatives not found in traditional foods
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Long-term outcome: Accelerated cellular aging
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Mental Health
- Effects: Increased depression risk, mood dysregulation
- Evidence: Confirmed in Nature Reviews Endocrinology studies
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Note: Independent of calorie count - damage occurs at same calorie levels as whole foods
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Overall Mortality
- Finding: Higher all-cause mortality with increased UPF consumption
- Current consumption: >50% of diet in UK and US populations
- Trend: Rising percentage correlates with earlier chronic disease onset (30s-40s)
The gap isn't closing. It's widening.
I've been thinking about this a lot lately. Not just because of the patients I see, but because of something deeper - a systemic failure that we don't talk about enough. We have more medical knowledge than at any point in human history. We can sequence genomes, target cancers at the molecular level, replace failing organs. And yet, life expectancy in wealthy countries is going backward. Chronic diseases are appearing in people in their thirties and forties at rates we've never seen before.
The question isn't "do we know how to prevent this?" We do. The question is: why aren't we?
The Access Problem: When Knowledge Doesn't Reach You
Medical knowledge sitting in journals doesn't save lives. Access does.
I think about this every time someone tells me they've been waiting months for a scan. Or when they mention they can't afford their medications, so they're taking them every other day. Or when they finally get through to a specialist - six, eight, twelve months after symptoms started - and by then, things have progressed.
The barriers look different depending on where you are. In the United States, it's often cost. Can you pay? Do you have insurance? Is this covered? People delay care because they're calculating whether they can afford it. They wait until symptoms become unbearable, by which time early intervention is off the table.
In the UK and similar systems, cost isn't the barrier - wait times are. You can see a GP eventually, but "eventually" might be three weeks. Specialist referrals can take months. Diagnostic tests sit in queues. The care is free, but the clock keeps ticking.
In much of the developing world, there's simply no infrastructure. No screening programs. No accessible specialists. No treatment pathways at all for many conditions.
And here's what strikes me: someone could be doing everything "right" - eating well, exercising, managing stress - but if they need actual medical intervention and can't access it in time, all that prevention means nothing. I've seen people who were meticulous about their health, who took every supplement, who tracked every metric, still end up in dire situations because the system failed them when they needed it most.
There's a strange irony in our current moment. We're drowning in wellness advice, biohacking protocols, longevity optimization strategies - while basic healthcare access crumbles for most people. We can tell you the optimal dose of creatine but can't get you a timely colonoscopy.
The Ultra-Processed Problem: We're Poisoning Ourselves Systematically
Let me say something that should be uncontroversial but somehow still isn't: ultra-processed foods are destroying public health.
Not just making us fat. That's the visible part. The metabolic damage runs deeper - gut microbiome disruption, chronic low-grade inflammation, altered immune function, early cellular aging. Ultra-processed food (UPF) - basically anything that contains ingredients you wouldn't find in a home kitchen, engineered for shelf stability and hyper-palatability - makes up over 50% of the diet in the UK and US now.
Think about that number. More than half of what people eat isn't really food in the traditional sense. It's industrial products designed to be addictive.
And the research keeps piling up. A 2024 meta-analysis in the BMJ linked high UPF consumption to increased risk of cardiovascular disease, type 2 diabetes, depression, and all-cause mortality. Not just correlation - dose-response relationships. The more UPF you eat, the worse your outcomes. Another study from Nature Reviews Endocrinology showed that for the same caloric intake, UPF leads to greater weight gain than whole foods. Your body processes them differently. They bypass normal satiety signals. They're metabolically expensive in ways we're only beginning to understand.
And here's the kicker: we're feeding this stuff to children systemically. School meals in the UK are about 70-80% ultra-processed. Free school meals - meant to ensure children don't go hungry - are largely nutritional disasters. We're creating a generation whose baseline metabolic health is compromised before they hit puberty.
I don't think this is an accident. I think it's what happens when food policy is shaped by food industry lobbying rather than public health evidence. When the primary consideration is cost and shelf-life rather than long-term health outcomes.
And then we wonder why we're seeing early-onset cancers spike. Particularly digestive cancers - colorectal, pancreatic, gastric - appearing in people in their thirties and forties at rates that would have been unthinkable forty years ago. There's something called the birth cohort effect in epidemiology: each successive generation seems to have higher cancer rates at younger ages than the generation before. Some of this is better detection, sure. But not all of it. Something environmental is happening.
The timing lines up eerily well with the proliferation of ultra-processed foods in Western diets starting in the 1980s. I'm not saying it's the only factor - there are others, plastics and microplastics among them - but UPF is likely a major driver.
The Simplicity Buried Under Complexity
Here's what frustrates me: we've made health seem impossibly complicated. Keto or vegan? Intermittent fasting or six small meals? Dairy or dairy-free? Omega-3 or omega-6? Seed oils or olive oil? High-intensity interval training or zone 2 cardio?
People are paralyzed by contradictory advice. They spend hours researching optimal supplementation protocols while their diet is 60% ultra-processed.
If I could simplify the dietary advice down to one actionable thing, it would be this: reduce ultra-processed food consumption as much as you can. That's it. Not eliminate - because that's often unrealistic - but reduce.
Cook more. Eat ingredients you recognize. If something has fifteen ingredients and half of them sound like lab chemicals, maybe skip it. This isn't about perfection. It's about direction.
The evidence is clear enough now that this should be public health priority number one. But it's not, because food industry lobbying is powerful, and governments are reluctant to regulate what people eat. We've somehow decided that informing people about risks is sufficient, even when the entire food environment is engineered to override rational choice.
Imagine if we approached cigarettes this way. Just inform people smoking is bad, but keep cigarettes cheap, advertise them heavily, and make them available in schools. We wouldn't accept that. But we accept it with ultra-processed foods.
The Weight of Where You Live
One thing I've learned over years of practice: health is profoundly local. Where you live shapes your health outcomes as much as your genetics or personal choices - maybe more.
If you live somewhere with walkable neighborhoods, access to fresh food, clean air, safe parks, reliable healthcare infrastructure, and strong social networks, your baseline health prospects are fundamentally different from someone in a food desert with no public transport, high pollution, unsafe streets, and overwhelmed clinics.
This is the part that individual optimization misses. You can't biohack your way out of a toxic environment. You can't supplement away the effects of living in a place where healthcare is inaccessible or chronically underfunded.
And this is where public health policy matters. Because these aren't individual failures. They're systemic failures.
When I see someone in their forties with preventable diabetes, often the story isn't "they made bad choices." The story is: they live in a neighborhood where fresh vegetables are expensive and hard to find, fast food is everywhere, their job is sedentary and stressful, they can't afford a gym membership, they have no safe place to walk, their healthcare access is limited, and they're constantly exposed to food advertising designed to hijack their reward system.
In that context, "just eat better and exercise more" is almost offensively inadequate advice.
What Would Actually Help
The solutions aren't mysterious. We know what works. Other countries have figured this out - at least partially.
Japan has the highest life expectancy in the world. Why? Several factors, but key ones include: a diet low in ultra-processed foods, built environment that encourages walking and cycling, strong social cohesion, universal healthcare access, and cultural norms around portion control and meal composition. These aren't just individual choices - they're societal structures.
Singapore has similarly high life expectancy despite being a dense urban city-state. How? Heavy investment in public health infrastructure, strict food standards, excellent healthcare access, urban planning that integrates green spaces and walkability, and policies that make healthy choices easier and cheaper than unhealthy ones.
Mediterranean countries with strong adherence to traditional diets (before they got Americanized) consistently show better health outcomes than similar-income countries with different dietary patterns. Not because they're more disciplined - because their food environment still somewhat reflects traditional patterns.
The pattern is clear: environments matter. Policies matter. Systems matter.
So what would actually help?
Regulate ultra-processed foods like we regulate tobacco. Warning labels. Advertising restrictions, especially to children. Taxation. Make them harder to access and more expensive than whole foods. This isn't about banning anything - it's about making the healthy choice the easy choice.
Invest in healthcare infrastructure. Universal access means nothing if wait times are prohibitive. Fund systems adequately. Train more specialists. Reduce administrative burden so clinicians can actually see patients.
Redesign food environments. Subsidize fresh produce. Make it easier and cheaper to buy real food than processed food. Create incentives for grocery stores in food deserts. Revise school meal programs with actual nutrition standards.
Build cities for humans, not cars. Walkable neighborhoods, bike infrastructure, accessible green spaces, public transport that works. The Dutch figured this out decades ago. Their health outcomes reflect it.
Address social determinants. Poverty, housing instability, job insecurity, social isolation - these are health issues. You can't be healthy if you're chronically stressed, underhoused, and disconnected.
These aren't radical ideas. They're common sense applied at scale.
The Paradox We're Living In
Here's what keeps me up at night: we're living in a medical golden age and a public health crisis simultaneously.
We can cure hepatitis C with a pill. We can edit genes. We can grow organs in labs. And yet, a 40-year-old today in the US or UK is statistically less healthy than a 40-year-old thirty years ago. More likely to have diabetes, cardiovascular disease, autoimmune conditions, mental health disorders, early-onset cancers.
The gap between what we know and how we live has never been wider.
And I think part of the problem is we've medicalized health to the point where we've forgotten it's also social, environmental, and political. We talk about health as if it's purely personal responsibility - eat right, exercise, take your supplements, optimize your sleep, manage your stress. And yes, those things matter. But they matter within a context.
If the context is broken - if your environment is toxic, your food system is corrupted, your healthcare system is inaccessible, your built environment discourages movement, and your economic system creates chronic stress - then personal responsibility only gets you so far.
We need both. Individual agency and systemic change. But right now, we've placed almost all the burden on individuals while largely ignoring the systems.
What You Can Do (And What We All Need)
For individuals reading this: yes, your choices matter. Reduce ultra-processed foods as much as you can. Move your body regularly. Sleep adequately. Build strong relationships. Access preventive healthcare when you can.
But don't let anyone tell you that your health is entirely your responsibility. It's not. You exist within systems that either support health or undermine it. And right now, many of those systems are undermining it.
For societies - for all of us collectively: we need to demand better. We need food policies that prioritize health over industry profits. We need healthcare systems that are actually accessible. We need environments that make healthy living possible, not heroic.
The science is clear. The solutions are known. What's missing is political will.
And I think the reason we lack political will is because we've been convinced this is all about individual choice. That if you're sick, it's because you made bad decisions. This narrative is convenient for industries selling us products that make us sick and for governments reluctant to regulate those industries.
But it's a lie. A profitable lie, but a lie nonetheless.
Most people want to be healthy. They're not failing because they lack information or discipline. They're failing because the entire system is stacked against them.
And until we're willing to acknowledge that - until we're willing to actually change the systems rather than just lecturing individuals - we're going to keep seeing the gap widen. More chronic disease, younger onset, declining life expectancy.
We know how to do better. We've just chosen not to. The question is: how long will we keep choosing badly before we decide the cost is too high?
I honestly don't know the answer. But I know this: every year we wait, more people die too soon. And that's preventable. Not at the individual level only. At the systemic level.
Maybe that's worth paying attention to.
