Agenda - 03-09-1999 - III-B - Laserfiche WebLink

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• • control of infectious diseases through immunization, and other population- based, public health activ- ities." Despite the marked reductions in overall mortality, disparities remain among certain sub - populations in the United States (e.g., persons of low socioeconomic status, African Americans). We recently conducted a review of major trends that are likely to affect public health in the coming decades. The trends identified were those that were already in progress and likely to have significant im- pacts in the coming decades rather than those that may be more speculative in nature. To identify these trends, we conducted key informant interviews with six experts in public health who represented a range of perspectives including academia; medicine and health care; and local, state, and federal governmen- tal public health. Findings from these structured in- terviews were summarized and subsequently re- viewed by nine other public health experts. This review was designed to validate major trends and to assist in prioritizing the initial list of 88 "implica- tions" that were identified in the first phase of the review process. A literature review also was con- ducted to help validate and clarify the implications of major trends. In this article, we summarize seven "macro- level" trends, ranging from sociodemographic changes to policy and social trends. For each, we provide evi- dence of the trend and a discussion of its expected impact on the public health system. The implica- tions of each trend also are summarized for public health research, practice, and education (see Appen- dix). Trend Aging of the population. Evidence The elderly, defined as persons aged 65 years and older, are the most rapidly growing segment of the U.S. population. Among the elderly, the proportion of persons aged 85 years and older is growing most rapidly. In 1960, 9.2 percent of the population was aged 65 years and older. This compares with 12.5 percent (31.2 million) in 1990.28 From 2010 to 2030, the survivors of the "baby boom" cohort will enter the elderly age groups. During this period, the popu- lation aged 65 years and older is projected to in- crease from 39.7 million in 2010 to 69.8 million in Future Trends Affecting Public Health 51 2030.28 The 65 year and older age group is expected to comprise over 20 percent of the nation's popula- tion by 2030.28 Impact The greater proportion of elderly persons will place increasing demands on the public health and health care systems. About 80 percent of the elderly visit a doctor eight times a year or more because of illness, and the elderly consume twice as much med- ication as all other age groups combined .29 Older adults are more likely to suffer from multiple chronic diseases and therefore require more complex treat- ment regimens and drug treatments .13 New methods are needed to prevent and control a variety of chronic diseases that afflict the elderly. This group of diseases includes heart disease, stroke, cancers, ar- thritis, osteoporosis, and Alzheimer's disease.30 In addition to impacts in the elderly subgroup, the old- est of the baby boom cohort are now turning 50, which will impact a variety of preventive services. Trend Changing patterns in the U.S. racial /ethnic compo- sition. Evidence The racial /ethnic composition of the United States is projected to change substantially in the coming decades. The non - Hispanic Caucasian population is projected to grow slowly from 191 million in 1992 to 208 million in 2029, then slowly decline to 202 mil- lion in 2050 (53 percent of the total population) .28 The African American population is projected to double from 32 million in 1992 to 62 million in 2050.28 The Hispanic population is anticipated to triple in size from 24 million in 1992 to 81 million in 2050.28 The Asian and Pacific Islander group is ex- pected to continue as the most rapidly growing ra- cial /ethnic group on a percentage basis — rising from 9 million in 1992 to 41 million in 2050.28 Each of these major racial/ethnic groups is younger than the non - Hispanic Caucasian population. For example, 76.5 percent of African Americans are under 45 years of age, compared with 65.8 percent of non - Hispanic Caucasians. Urban areas are likely to grow dispro- portionately more diverse compared with other met- ropolitan and rural areas of the United States.91 91