44 THt FIVE-YEAR OUTLOOK 



ured by the Consumer Price Index (CPl), rose about 120 

 percent compared with 95 percent for the overall CPI. 

 Although such other factors as labor costs need to be 

 considered, one of the major mechanisms for slowing the 

 escalating costs of the health care system may lie with 

 health research advances. For example, new cost-efficient 

 technologies can reduce the need for labor-intensive serv- 

 ices and can suggest more appropriate ways to use outpa- 

 tient ambulatory facilities, although, as discussed below, 

 other technologies may raise health care costs. Advances 

 in medical research may also reduce the use of costly 

 surgical procedures and suggest less expensive forms of 

 medical care. Furthermore, research into preventive ap- 

 proaches for some diseases could greatly reduce the need 

 for costly primary health care services (NRC-2). Thus, 

 although advances in biomedical research and develop- 

 ment cannot control escalating health costs by them- 

 selves, they do present an opportunity for mitigating the 

 problem in the coming years. 



This section considers a range of high-priority health 

 needs and opportunities requiring consideration during 

 the next 5 years. They are (1) increasing emphasis on the 

 prevention of disease; (2) dealing with a shifting age 

 distribution in the American population; 13) dealing with 

 such addictive behaviors as alcoholism, drug abuse, and 

 cigarette smoking; (4) fostering the development and as- 

 sessment of health care technologies; and ( 5 ) development 

 of better and more cost-effective health care delivery 

 systems. Some constraints on accomplishing these goals 

 are considered at the end of the discussion. 



FURTHERING THE PREVENTION OF ILLNESS 



The contributions of basic biomedical research to the 

 prevention and containment of many illnesses have been 

 substantial. For example, while cardiovascular diseases 

 remain the number one killer in this country, the rate of 

 death from those illnesses has fallen by more than 30 

 percent since 1950. A variety of factors have played a part 

 in the rapid advance against heart disease, including more 

 effective drugs and procedures for repairing the heart and 

 diseased blood vessels. One major factor in the declining 

 mortality rate from cardiovascular disorders appears to be 

 an increase in the use of preventive measures. Adult 

 Americans are increasingly heeding warnings about the 

 adverse effects of certain personal habits, such as ciga- 

 rette smoking and high consumption of animal fats, al- 

 though there is evidence that the smoking rate in adoles- 

 cents is increasing. Americans are becoming more aware 

 of the dangers from high blood pressure. Additionally, 

 new and improved methods for treating hypertension, 

 including new drugs that are more effective and have 

 fewer side effects, are now being applied widely (NRC-2; 

 NRC-14). 



Cancer, the most feared of the life-threatening diseases, 

 remains a major cause of death and debilitation in this 



country. Approximately one person in four now living in 

 the United States will develop some form of cancer in his 

 or her lifetime, and one in six will die from this broad 

 class of diseases if present incidence and mortality rates 

 remain the same. However, some 30-40 percent of all 

 serious cancers are now being treated successfully, and 

 there is reason to believe that that rate will continue to 

 improve. In addition to treatment advances, there have 

 been some marked advances in developing strategies for 

 minimizing the risk of developing cancer Known risk 

 factors for cancer include a variety of environmental fac- 

 tors, such as tobacco smoke, radiation, and viruses, as 

 well as such other factors as attitudinal variables, genetic 

 predisposition, congenital defects, and aging (NRC-2). 



Although great progress has been made in both the 

 treatment and the prevention of illness, remaining high 

 incidence and mortality rates indicate that additional 

 progress is still badly needed. It is widely agreed that 

 further progress in the treatment of disease will come 

 primarily from additional basic biomedical research 

 efforts into the causes and detailed courses of specific 

 disorders (NRC-2; NRC-14; HEALTH). Those research 

 efforts will have to continue if methods of treating illness 

 are to be substantially improved in the coming years. 



Major opportunities also appear to lie in illness preven- 

 tion — although, of course, not all illness can be pre- 

 vented — and a variety of suggestions for maximizing the 

 probability of achieving those potential advances appears 

 in the Source Volumes (NRC-2: SSRC-2; NS; HEALTH). 

 Two related strategies meriting attention and action in the 

 next 5 years are: (1) improving the research base linking 

 behavior patterns and lifestyles with cancer, coronary, and 

 other diseases; and (2) increasing efforts to motivate the 

 public to adopt healthier lifestyles and behaviors. 



IMPROVING THE RESEARCH BASE LINKING BEHAVIOR 

 PATTERNS AND LIFESTYLES WITH CANCER, CORONARY, 

 AND OTHER DISEASES 



Many medical problems, including some of the most 

 common in modem society, such as heart disease and 

 cancer, appear to be influenced by social and behavioral 

 factors. The processes linking behavior patterns to physi- 

 cal illness may be grouped into three broad categories: (1) 

 direct psychophysiological effects, which involve 

 changes in tissue function via physiological responses to 

 such psychological and social inputs as stress; (2) habits 

 and lifestyles that are damaging to health, such as ciga- 

 rette smoking, excessive consumption of alcohol, and 

 poor dietary patterns; and (3) reactions to illness and the 

 sick role, which may lead to a delay in seeking medical 

 care or a failure to comply with treatment and rehabilita- 

 tion regimens (SSRC-2). 



These categories include a broad range of factors gener- 

 ally acknowledged to be important in health and illness. 

 However, convincing evidence about the specific causal 



