Functional Area Problems. Opportunities, and Con.straints 43 



The United States has entered an era of greatly en- 

 hanced capabilities for exploring and making use of the 

 potential of space. But, as in so many other areas, the 

 United States no longer enjoys undisputed dominance. 

 Other industrialized countries have developed their own 

 impressive, if still limited, capabilities. Many less de- 

 veloped countries now understand both the potential ad- 

 vantages and the potential threats of sophisticated space 



systems. The development of U.S. space policy through 

 the 1980s and beyond will have to recognize increasingly 

 the concerns of other countries , the common as well as the 

 divergent interests among countries, the political and 

 financial advantages to be gained from carefully selected 

 cooperative ventures, and the potentially stimulating 

 effects of international competition in civil applications. 



D. Health 



Since the beginning of this century, great progress has 

 been made in improving the health status, quality of life, 

 and life expectancy of people in the United States and 

 throughout the world. Figure 2 shows changes in life 

 expectancy in the United States since 1900. That progress 

 has come about through advances in sanitation conditions 

 and nutritional practices, through the control of such 

 infectious diseases as smallpox, and through the early 

 diagnosis of disease and other improvements in the health 

 care delivery system. Moreover there are numerous in- 

 dications of further advances yet to come. The new re- 



100 



FIGURE 2. Survival of the Amencan Population. 



The curve for 1900 depicts the percentage of all people bom before 

 1900 who in that year would have been 10. 20. 30, 40 years old, etc. . and 

 who, in fact, were alive in 1900. The curve for 1980 is constructed 

 similarly. The "ideal" curve is a hypothetical extrapolation, with trauma 

 (externally generated injury) the dominant cause of death in early life. 

 Since 1900, life expectancy has increased significantly at all ages. 

 Because of the remarkable increase in survival during early and middle 

 years, the survival curve of Americans today need be improved relatively 

 little to approximate the "ideal." 



Source: James F. Fnes, M.D. "Aging, Natural Death, and the Compres- 

 sion of Morbidity." New England Journal of Medicine. Vol. 303( 1980), 

 p. 131. 



combinant DNA technologies, for instance, are expected 

 to aid the development of a wide variety of substances, 

 including new and more effective vaccines and drugs, and 

 perhaps will help in the control of genetic disorders. The 

 discovery of interferon and its effects on the human orga- 

 nism holds promise for improvements in the treatment of 

 viral infections and, maybe, cancer. Recent advances in 

 the neurosciences — such as the discoveries of additional 

 neurotransmitter substances and the naturally occurring 

 painkillers, the endorphins — have improved our under- 

 standing of the functioning of the brain and may result in 

 great progress in the treatment of mental disorders 

 (NRC-2; NRC-14; NRC-17; HEALTH; ASF/?-///). All of 

 these advances can be linked directly to biomedical sci- 

 ence and technology activities. 



Some needed health improvements, however, depend 

 heavily on lifestyle and on environmental changes, which 

 advances in biomedical science and technology cannot 

 effect alone. Such improvements will be facilitated by a 

 broadened approach, merging biomedical, behavioral, 

 and environmental considerations (NRC-2). There also 

 appears to be an increasing need for the U.S. biomedical 

 community to address diseases and conditions not typ- 

 ically considered problems for Americans. For example, 

 there are many tropical diseases to which American mili- 

 tary personnel are exposed that will require increasing 

 attention in order to counteract the severe toll those dis- 

 eases take on combat activities. Those diseases include 

 malaria, scrub typhus, hepatitis, diarrheal disease, and 

 arbovirus infections (NS). These diseases also pose se- 

 rious problems for people in the developing countries with 

 whom the United States will increasingly interact 

 (AAAS-7). In addition, the further development of un- 

 conventional weapons will present new classes of injury, 

 the treatment of which will require the development of 

 new technologies (NS). 



An overriding concern to Americans now and in the 

 years ahead is the escalating cost of the health delivery 

 system. Between 1967 and 1978, health costs, as meas- 



