The second trend to watch for is the very real possibility that the health status of more than eighty million aging adults will decline unless we do some things very differently. This notion of the danger of declining health status is substantiated by the fact that there are a number of high-profile, well-respected experts who are in general agreement that this will indeed be the case.
For example, one of the nation’s preeminent health promotion research- ers—Dr. Dee Edington, former director of the University of Michigan’s Health Management Research Center—highlights the stark reality that, as people get older, they generally move from relatively good health to compromised health to poor health. In other words, as individuals age in this country, they systematically and predictably migrate from low-risk to moderate-risk to high-risk status. And although this idea of health status migration is interesting in and of itself, consider for a moment the
health status the measurement of the health of an individual or population as subjectively assessed by the individual or by more objective measures, including life expectancy and presence of disease conditions TREND2: THEHEALTHSTATUS OFAGINGADULTSWILLDECLINESTEADILY 323
implications of having eighty million baby boomers all getting old at the same time and the vast majority of them being in poor health (Edington, 2013).
Believe it or not, as the boomers age, the Centers for Disease Control and Prevention (2013b) estimate the following will happen:
• One-quarter of all Americans will have heart disease.
• One in twelve Americans will have asthma.
• One in fourteen Americans will have diabetes.
• One in seven Americans will develop Alzheimer’s.
• Approximately one in five Americans will have arthritis, already the country’s leading cause of disability.
Almost implausibly, Kotlikoff’s bold prediction of an elderly population languishing in understaffed, substandard nursing homes begins to make sense.
But could this really happen? Could eighty million people—all of whom are getting old at the same time—potentially put such a strain on our society (and specifically our health care system) to bring us to our knees? Truth be told, this is already occurring. Consider for a moment just a few of the statistics that indicate our population is indeed migrating from low-risk to moderate-risk to high-risk health status.
For example, at the time of this writing, there are over eighteen million people in the United States who have been medically diagnosed with type 2 diabetes. Add to that another seven million US citizens who are presently undiagnosed and that brings the total to twenty-five million people with type 2 diabetes in the United States. The real concern, however, is the fact that some eighty million Americans are considered to be prediabetic and, if left unaddressed, these people will most assuredly progress to type 2 diabetes. This means that of our nation’s approximately 313 million citizens, more than 100 million are wrestling with type 2 diabetes. If left unchecked, type 2 diabetes will manifest itself in terms of heart disease, vascular problems, blindness, and amputations (Hoffman, Salerno, &
Moss, 2012).
As can be plainly seen, the potential catastrophic human, economic, and social consequences of an aging population only further solidifies the need for placing a greater emphasis on health promotion and better preventive practices in this country. With a greater emphasis being placed on devel- oping and delivering comprehensive health promotion interventions will also come a renewed interest in better understanding and mastering the various well-documented theoretically-based behavior change models such
as Prochaska’s transtheoretical model as well as Bandura’s social cognitive theory, which were described in chapter 2.
Trend 3: Adults Won’t Be the Only Ones Who Are Losing Their Health Status
Although it’s one thing to witness the US adult population losing their health status, it’s quite another to imagine the health status of children being severely compromised. Unfortunately, this is indeed the case at the time of this writing.
For example, consider observations from former US Surgeon General Richard Carmona (2004):
Over the past 20 years, the rates of overweight doubled in children and tripled in adolescents. Today nearly two out of every three American adults and 15 percent of American kids are overweight or obese. That’s more than 9 million children—one in every seven kids—who are at increased risk of weight-related chronic diseases. These facts are astounding, but they are just the beginning of a chain reaction of dangerous health problems—many of which were once associated only with adults.
Today pediatricians are diagnosing an increasing number of children with Type 2 diabetes—which used to be known as adult-onset diabetes.
Research indicates that one-third of all children born in 2000 will develop Type 2 diabetes during their lifetime. Tragically, people with Type 2 diabetes are at increased risk of developing heart disease, stroke, kidney disease, and blindness. These complications are likely to appear much earlier in life for those who develop Type 2 diabetes in childhood or adolescence. Because of the increasing rates of obesity, unhealthy eating habits, and physical inactivity, we may see thefirst generation that will be less healthy and have a shorter life expectancy than their parents.
Fortunately, there is still time to address these serious and rapidly multiplying adolescent health issues—and the answers in large part revolve around promoting better preventive practices. Consider thefindings of the Department of Health and Human Services’Diabetes Prevention Program in which clinical trials showed that people with prediabetes can delay and even prevent type 2 diabetes by losing just 5% to 7% of their body weight through moderate changes in diet and exercise. These lifestyle changes worked for people of every ethnic or racial group who participated in the
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study. The changes—such as walking for thirty minutes a day five days a week—are simple and prove that small steps can indeed bring big rewards (National Institute of Diabetes and Digestive and Kidney Diseases, 2008).
Although children in this country comprise a smaller percentage of the population, they are 100% of our future. Better health promotion practices will ensure that today’s children reach their full potential—and to be successful as a country we will need our children to learn and carry good health into their adult years. This will become a significant priority as we move into the future. Chapter 10 gave several examples of where health promotion is happening to affect the health of children of all ages.