Competing Risks: Investing in Sickness Rather Than Health.
Introduction Fighting disease is deeply ingrained in American medical culture. The steadfast support for medical research fewer than one in ten Americans would cut research to reduce the deficit underpins a national belief that curing cancer and other major diseases today will mean longer, healthier lives tomorrow. During the last half century, faith in the diseasespecific research model has rewarded the U.S. with significant returns on investment in life expectancy and better health. But, there are troubling signs that targeting diseases in isolation may be outliving its usefulness. Prevalence of major chronic conditions high blood pressure, heart disease, diabetes, cancer, and stroke is increasing. This trend is fueled by a combination of higher rates of obesity and gains in life expectancy, which in turn will be driven by innovations in medical technology that allow people to live longer with chronic conditions. As a result, disability rates also are increasing, suggesting the average length of a healthy life span defined as length of life lived without disability may decrease in the future. For example, the authors estimate that life expectancy for 65 year olds will grow by about a year between 2010 and 2030 to 20.1 years, but expected years of life with a disability for 65 yearolds during the same time will rise even more, from 7.4 years to 8.6 years. Likewise, disability rates have increased for younger Americans, especially 30to 49 year olds, which could have adverse consequences for public financing of disability insurance, Medicare, and Medicaid. And though attacking diseases individually has extended life for younger and middle aged people, competing risks from other illnesses make such progress more difficult for older people.
American journal of preventive medicine