Finn 



relationship between risk factors and heart disease, can- 

 cer, and other major causes of illness is lacking. There- 

 fore, research efforts need to progress beyond their cur- 

 rent point of simply identifying correlations between 

 psychosocial factors and physical illness toward the iden- 

 tification of those causal relationships. Accordingly, an 

 important priority for scientific research will be to inte- 

 grate behavioral and biomedical knowledge in a manner 

 that identifies the factors underlying the interplay between 

 behavior, pathological processes, and bodily dysfunction 

 to provide a base from which truly effective treatment and 

 prevention techniques might be developed (SSRC-2). 



MOTIVATING THE PUBLIC TO ADOPT HEALTHIER 

 LIFESTYLES AND BEHAVIOR PATTERNS 



Although the evidence is not yet complete, there are 

 ample indications that lifestyles and behavior patterns are 

 critical elements in sustaining high levels of individual 

 health (NRC-2; SSRC-2; HEALTH). A related problem 

 for the health care enterprise then is: How can individuals 

 be better motivated to adopt healthier lifestyles and 

 behaviors? 



Various approaches have been used in the past, most of 

 which have taken the tactic of modifying or treating al- 

 ready established patterns of behavior Some of them are 

 (1) using social pressures and media campaigns to educate 

 groups of people; (2) using individual treatment ap- 

 proaches, such as behavior therapy and hypnosis, that can 

 condition individuals to change their deleterious life- 

 styles; and (3) using public health approaches aimed at 

 labeling of dangerous products and warning the public in 

 other ways of potential health hazards. Although these 

 approaches have been moderately successful, a different 

 kind of approach, one that attempts to dissuade people 

 from adopting those deleterious behavior patterns in the 

 first place, could also be productive. Development of 

 those techniques, which might serve preventive rather 

 than simply treatment functions, requires a shift in re- 

 search focus toward acquiring a better understanding of 

 the factors encouraging health-impairing habits, and not 

 just a focus on techniques to modify them once they have 

 been acquired (SSRC-2). 



DEALING WITH A SHIFTING AGE 

 DISTRIBUTION 



There have been major changes in the demographic profile 

 of the U . S . population over the past decades . The changes 

 have stemmed both from a sharp increase in birth rates 

 after 1947. with a sharper decline after 1957, and from 

 increased lifespans for older Americans. Of particular 

 importance to the health field are the changes in age and 

 sex characteristics of the population. The number of per- 

 sons aged 65 and above, for example, is now projected to 

 increase by nearly 50 percent before the end of the 20th 



tioiuil Area Problems, Opportunities, and Constraints 45 



century. Marked differences in male and female mortality 

 rates will also create different lifestyles and health needs 

 for men and women. For example, under present condi- 

 tions, a newborn American female can expect to live 9 

 years longer than a newborn male (NRC-1; NRC-2). 



Continued changes in the age/sex profiles of the popula- 

 tion will require both individual and societal flexibility in 

 anticipating national health care needs. On the one hand, 

 more people will be unwilling to retire at relatively early 

 ages, since their capabilities for productive work are 

 likely to remain high longer into their lifetimes. On the 

 other hand, more people will have to be concerned with 

 supporting and caring for an elderly parent, and the num- 

 ber of people in nursing homes and intermediary care 

 facilities will increase. There also will be increased pres- 

 sure on the working population to provide for the needs of 

 the elderly (NRC-1). These changes will demand both 

 individual and societal adjustments. 



Changes in the age and sex profiles of the population 

 have, similarly, placed new demands on science and tech- 

 nology to increase knowledge about the aging process and 

 about health needs and health care appropriate for that 

 population. Additional research emphasis on problems of 

 aging people will be needed during the next 5 years to 

 enable the United States both to deal with and to take full 

 advantage of the potential in its aging population. Science 

 and technology can affect problems associated with an 

 aging population in many ways, two of which are dis- 

 cussed below. One is by increasing the functional capaci- 

 ties of the elderly, and the other is by assessing and 

 redesigning health services to meet the needs of the aged 

 more effectivelv. 



INCREASING THE FUNCTIONAL CAPACITY OF THE 

 ELDERLY 



People reaching the age of 65 today are more educated, 

 healthy, and economically secure than ever before, and 

 their capacity for intellectual and physical performance 

 continues to rise. However, in the face of the projected 

 demographic changes noted above, the potential for even 

 further development and expansion of the quality and 

 productiveness of their lives needs to be further explored. 

 That is partly due to a relative lack of knowledge about the 

 true functional capabilities of that population, about their 

 health care needs, and about the form of appropriate 

 health services suited to sustaining longer, healthier, and 

 more productive lives. Two kinds of factors will require 

 particular attention if the functional capacity of the aged is 

 to be increased. One set of factors is related to the de- 

 bilitating effects of both disease and its treatment. For 

 example, although some marked progress has been made 

 in treating such disorders as arthritis, the senile demen- 

 tias, diabetes, and atherosclerosis and other cardiovascu- 

 lar disorders, there is still a long way to go before the 

 debilitating effects of those and other diseases are con- 



