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March
2004
Demography Is Destiny
Given a looming federal deficit and an increasingly aging and
obese population, it is pretty clear that we are heading into a
time when we will have to make smarter and tougher choices in public
and individual health.
Demography
is destiny, and America’s health chart in a few
years looks like this:
- The population
will include a very large group of old people, the majority
of whom are white and who have chronic or disabling
conditions, or both. They are being cared for by a younger
population that is largely non-white and foreign born, whose
taxes will pay
for the older generation's care.
- The larger
population will experience the prevention and care of disease
as more and more complex. Chronic diseases that have
a lifestyle component will reign, interspersed with threats
from emerging infectious agents requiring fast and effective
public
health responses and risk communication.
- Individuals
will increasingly be on their own to make health decisions,
and their ability to actually benefit from advances
in biomedical research will be contingent upon education, race,
ethnicity, income and age.
I look at this picture and become concerned that despite epic
advances in science and technology, biomedicine alone is not going
to be up to the task we demand of it.
These are not problems that can be solved by a new pill, gene
assay, implant or surgical technique. They are problems of putting
into practice what we already know about prevention and treatment,
increasing our scientific knowledge about health research application
and investing strategically in the application of this knowledge.
But our strategy now is not directed at solving those kinds of
problems.
Two things lead me to question the scientific rhetoric and public
belief that the nation's investment in health research will improve
health.
First is the substantial gap between what we know about health
and what we do with this knowledge. This gap is due in large part
to a) the logistics of transferring information b) the speed with
which discovery outpaces application and c) the lack of health
insurance for 43.6 million Americans.
Second is the powerful allure of hope over the boring bureaucratic
reputation of clinical and applied research. And as our financial
investments follow our cultural preferences, public funding for
health research shows every sign of continuing to be heavily concentrated
on basic research.
But I am optimistic about a future in which biomedical and biobehavioral
studies are linked in the mission to improve health care quality
and streamlined delivery. I plan to use this space in coming months
to talk about some of the things we must do.
As inventor
and industrialist Charles Kettering said, “We
should all be concerned about the future because we will have to
live the rest of our lives there.”
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