June 2008
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The Way We Will Be 50 Years From Today
"Fifty Years from Now: Today’s Baby Reaches Middle Age"
By Dr. Wanda Jones
Director of the Office on Women’s Health at the U.S. Department of Health and Human Services
This is an excerpt from the book The Way We Will Be 50 Years From Today © 2008 by Mike Wallace. This excerpt was modified for length and printed with permission from Thomas Nelson, Mike Wallace, and Dr. Wanda Jones.
Imagine the future headlines:
2058: Persons aged 50–70 more disabled than their parents
If today's trends in weight gain and obesity among children in the United States continue, in 50 years the adults they become will be marked by limitations in daily activities (mobility, household and personal care tasks) that today characterize many people over age 80. Arthritis, diabetes, heart disease, and cancers are the major health consequences of obesity; risk is increased when a person is even moderately overweight. The prevalence of these diseases historically has increased at midlife, but public health began sounding the alarm about diabetes increasing among children and young adults a decade ago. Our continued deafness to the calls for lifestyle changes bodes poorly.
2058: Workforce Opportunities for Persons 70 and Older
By 2058 the United States will experience a shift in workforce demographics.
The Census Bureau forecasts that the population of peak working-age adults, ages 25–44, will be smaller than it was during World War II. The echo boomers—children of the baby boomers—will be 45 and older and likely will be working into their 70s, partly because of the labor shortage, but also because they can. Those with the most options for changing jobs and recasting their careers will have escaped the perils of obesity. These workers won't stay at the same jobs; in fact, they may have several careers, with many more options available after age 60 than even we had imagined.
2058: Life expectancy declines after 30-year stagnation
A girl born today can expect to live nearly 81 years, a boy, almost 76. Life expectancy is calculated from death rates at various ages across the population. Populations that experience high infant, child, and young adult mortality rates generally have lower life expectancies. The scary feature of any prediction about the U.S. population 50 years hence is the rising prevalence of diabetes, driven by exponential increases since the 1960s in excess weight gain and obesity among young people. That factor alone could reduce life expectancy by 3–5 years if we fail to address this threat to health security.
Where did we go wrong? Our mothers told us to eat right, get enough sleep, go out and play, and to be careful, but we seem to have quit listening. By the end of the twentieth century, U.S. health data showed accelerating trends in overweight, obesity, and sedentary activity dating to the 1960s. Baby boomers (born between 1946 and 1964) have seized advances in technology that allow us to travel from our armchairs, eat from our cars, and "live large" in ways our parents never imagined. Our children and grandchildren have only amplified these trends, with the generations following us living and socializing electronically in ways we never imagined. Their world at midlife will be vastly changed from what we take for granted now.
Technology has given us many things, reducing the amount of physical effort we expend in daily activities. At the same time, for most Americans, food has never been more abundant and easier to obtain, and these two trends have contributed to our weight problem.
One of the criticisms of technology is that it isolates people from face-to-face social interaction. I believe the next 50 years will bring technologic touch—the neural impulses that allow us to feel, smell, and taste. This alone will change electronic shopping (some of us just have to feel the heft or softness or texture of something we might like to buy) and entertainment (the virtual getaway), but it will have far more significant implications for the delivery of health care and preventive medicine. Office visits may become a thing of the past, if a provider can conduct a complete history and physical over the internet.
New imaging devices—small, powerful, and relatively inexpensive—will assist with previously invasive or intrusive exams. Only rarely will a physical specimen (blood, urine, or tissue) need to be obtained, and that will be limited to advanced-care settings (successors to hospitals).
Genetic profiles at birth (perhaps before) will be routine. Gene therapy will be able to correct many defects that shorten life or reduce quality of life, and support structures will be in place to help families and individuals control modifiable risk factors (that may or may not interact with genetics to cause disease). Many organs and tissues will be manufactured, either from sophisticated materials or from a recipient's own cells, eliminating the risk of rejection.
Smoking will be almost unheard of, but other addictions will evolve and require attention (such is the nature of humans, but these biochemical pathways will be better understood and amenable to various treatments as well). All but a few types of breast and prostate cancers will be curable. Several cancers (stomach, pancreas) and autoimmune diseases (multiple sclerosis, myasthenia gravis) will have a vaccine to prevent them. The blood-brain barrier will fall, and mental and physical health will be fully integrated and encompassed in all health disciplines. Alzheimer's will be preventable and treatable (although not yet curable).
Health will be thought of as a global investment, not a national or corporate venture. Technology will perfect and secure the electronic health record, and any indicated interventions (preventive, diagnostic, and curative) will be automatically prompted, recorded, and monitored by the electronic health record. Each individual will have direct access to his or her own records via a pocket-sized device, which will record physiologic and other data about the wearer's activities, diet, emotional state, and other components to aid in risk assessment. That device may also deliver treatment and provide ongoing monitoring for some physical and mental illnesses. Implantable and patchlike devices will be commonplace for those with chronic conditions; they will deliver medicine or directly modify biochemical pathways by influencing defective enzymatic or other processes.
Furthermore, we will better understand how physiology changes over the lifespan, and how it differs between the sexes and among populations (as well as at the individual level). This will result in even more efficient and effective preventive, medical, and mental health services.
Because no one lives forever, society will be better equipped to deal humanely with end-of-life issues. Health-care professionals will have tools for assessing futility of treatment and better ways of easing pain of terminal illnesses. Family support will allow loved ones to stay engaged (even from a distance) at this final transition. Far-improved systems of home- and community-based care will allow the aged and disabled to stay in their homes as long as they choose, rather than being forced into long-term care or other dependent living.
Broad alliances between employers, education systems (all types and ages), faith groups, and communities will help identify families and youths at risk, providing wraparound services to support literacy and skills development. Direct intervention will reduce diabetes, reduce family and community violence, improve mental health, and reduce underemployment.
Extended life spans will create new opportunities in education, workforce, and leisure. Technologic advances will allow almost anyone who wants to work to do so, with options for working from home, assistive technologies, and knowledge-based employment that is less physically demanding. Education may be interrupted by a period of service between high school and college, allowing young people to explore fields for which they have aptitude but no previous exposure. And periods of work may be interrupted by periods of education, particularly allowing mid-life and older workers to learn new skills for second or third careers. Lifelong learning will be a national mantra.
I can't even address who pays. With tremendous pressures by baby boomer retirements and increasing consequences of being overweight or obese among Medicaid populations, it's not clear that Medicare and Medicaid or even private insurance as we know it now can survive without significant changes. Reframing health as wellness first—instead of medical care—will open new opportunities by applying a range of technologies to assess individuals, families, and communities for optimal lifestyle strategies, and provide the necessary support to achieve them.
Massive change over the next 50 years will happen, and we must drive it, unless we are willing to accept the increased disability and reduced life expectancy consequences of the poor choices being made today.
I hope to be among the several million centenarians 50 years from now, by doing all I can to control the risks I know I have. The choices I make every day about my diet, my activity, my safety, and so many others will stack the odds for me. I'm excited about even having the possibility of being here in 2058! Besides, by then I'm confident I can put my feet up and read the stack of books I have no time for now. Even if technology allows us to literally "absorb" knowledge in 50 years, nothing beats the satisfaction of turning the last page in a good book.
About Dr. Wanda Jones
Dr. Wanda Jones is the director of the Office on Women’s Health at the U.S. Department of Health and Human Services, where she oversees ten areas of women’s health, including HIV/AIDS, cardiovascular disease, violence against women, diabetes and obesity, lupus, breastfeeding, and mental health. She was previously at the Centers for Disease Control, where she was active in policy issues related to HIV laboratory testing, women and AIDS, HIV vaccine development, and healthcare workers.
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Content last updated June 2, 2008.
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