ABSTRACT
Prologue: Americans are growing older, in part as a consequence of dramatic advances in the treatment of acute and chronic illness. Paradoxically, these achievements are making the task of providing health care to every citizen more formidable.Not only does death occur later in life, but the causes of death have shifted dramatically over the course of the twentieth century. While impressive gains have been made in postponing deaths from heart disease, cancer, and stroke, as Christine Cassel and her colleagues point out in this paper, far less progress is evident in preventing, postponing, and treating the nonfatal diseases of old age. Much more emphasis should be placed on controlling disability and chronic disease and providing effective long-term care. Cassel, a member of the Institute of Medicine, National Academy of Sciences, and her colleagues have sought to develop more effective approaches to forecasting future health care needs by combining what they characterize as medical demography with biological factors. Cassel holds a medical degree from the University of Massachusetts. She trained in internal medicine at the University of California, San Francisco, and has completed fellowships in bioethics and geriatrics. Cassel chairs the Section of General internal Medicine at the University of Chicago and is director of the Center for Health Policy at the university’s Harris School of Public Policy Studies. During 1991–1992, she was a Henry J. Kaiser Family Foundation Fellow at the Center for Advanced Study in the Behavioral Sciences in Stanford, California. Mark Rudberg trained in medicine at the Medical College of Wisconsin and holds a master’s degree in public health from Boston University. Jay OLshansky has a doctorate in sociology from the University of Chicago and is a scientist at Argonne National Laboratories. He is on the faculty of medicine at the University of Chicago.
