Sickness and Death in the Twenty-First Century: A Transformation toward Health?

Abstract

Two visions of the future emerge from this review of the past, and the two seem at first glance to be at odds. According to one, both aggregate and age-specific morbidity rates will increase when the death rate declines. The death rate has declined during the past century, and further decline can be forecast. Therefore, the future would seem to promise more sickness. According to the other, the amount of sickness and the timing of death are influenced from four directions: genetic traits and propensities, exogenous hazards, endogenized hazards or insult accumulation, and age. During the last century, certain kinds of exogenous insults, usually infectious dis-eases, have been avoided or have had diminished effects on the health of some age groups, especially infants and children. Fewer ill-health episodes mean a slower rate of insult accumulation and arrival at advanced ages with better health histories. From this perspective, the future should promise less sickness.

Most of the next century must become a story of continued increase in the need for health care.^l