Unexpected Challenges, Including AIDS, Remain : ‘Cause for Optimism’ on U.S. Health Reported

In a midterm assessment of the federal government’s decade-long strategy for improving the nation’s health by 1990, the Department of Health and Human Services on Sunday reported “a cause for optimism” in such areas as high blood pressure and its related conditions, smoking, alcohol abuse, automobile injuries, childhood immunization and occupational health.

But considerable challenges remain in “new and unanticipated” diseases, such as AIDS, and in other chronic health care problems that continue “as blemishes on the nation’s health profile,” the report said. They include other infectious diseases--such as hepatitis B, influenza and whooping cough--infant mortality, teen-age pregnancy, cocaine abuse, obesity and inadequate physical fitness, the department said.

“We can be extremely pleased at high levels of public awareness about life style factors and their contribution to health,” Health and Human Services Secretary Otis R. Bowen said in a written statement. “Already we have begun to see results from reduction in smoking, per capita alcohol consumption and use of automobile seat belts. Yet we must face up to problems in improving pregnancy outcomes, dealing with the seemingly intractable problem of teen-age pregnancy and controlling sexually transmitted diseases.”

29 Goals Met

Of the 226 national health objectives set in 1980 by federal officials, 29 have already been accomplished, 78 should be achieved by 1990 if present trends continue, 60 appear unlikely to be met, eight “are moving in the opposite direction from the 1990 target” and the rest lack sufficient data to measure, the department said.

“The general picture is one of a nation doing the business of preventing disease and promoting health for its citizens more effectively in this decade than it did in the last, despite selected causes for concern . . .” the report said.

It said that, by 1985, death rates had decreased 25% for infants and 17% for Americans in all other age groups. The 1990 target death rate decreases are 35% for infants, 20% for children and young adults and 25% for adults ages 25 to 64.

The report said that, between 1972 and 1984, the death rate from heart disease fell 33.9% and that, since 1980, the rate has fallen 9%. In the same 12-year-period, the death rate from stroke dropped 47.8% and, since 1980, the rate has fallen 17%.

‘Public Awareness’

“Achievements in control of high blood pressure, including a remarkable level of public awareness, have contributed to this positive change,” the report said.

The decline in adult smokers to about 30% of the population “suggests the 25% target by 1990 is likely to be reached,” the department said. “Teen-age girls are the only population group 2003332979increased in this decade.”

The department said the death rate from automobile accidents between 1978 and 1983 fell from almost 24 per 100,000 population to 19 per 100,000, “a decline ascribed largely to seat belt use, reduced drunken driving and improved roadway safety.” The 1990 target is 18 per 100,000.

The report said that the sexually transmitted disease problem “has been expanding at an alarming rate, both in its scope and in its complexity.” AIDS, or acquired immune deficiency syndrome, “has emerged as a major sexually transmitted disease, which was unknown in 1979, and has appropriately been placed at the top of the public health agenda,” the report said. AIDS cripples the immune system, leaving the individual powerless against otherwise rare “opportunistic” infections and cancers.

Minority Infant Mortality

Although infant mortality rates have fallen for all groups in the nation, the goal of fewer than 12 infant deaths per 1,000 live births for minority and low-income women probably will not be reached, the department said.

“Further reduction of black infant mortality rates will require a concentrated national, state and local effort, with high priority given to reaching black women of childbearing age with information, (and) better access to prenatal care . . .” the report said.

Although drug use among the nation’s youth has declined in this decade, “a disturbing increase in the use of cocaine--up 13% in one year from 1984 to 1985--poses a particular national challenge,” the department said.

The report also found:

--In 1985, 85% of the nation’s children were immunized against preventable infectious diseases and the 1990 target of 90% “appears well within reach.”

--Workplace-related accidental deaths fell in 1984 below the 1990 target of 3,750 per year.

--More than 25% of adult Americans continue to be overweight, “posing health risks such as heart disease, cancer and diabetes,” and only 10% to 20% of adult Americans engage in the kind of regular exercise “most likely to ensure cardiovascular fitness.”

--Hepatitis B, pertussis (whooping cough), influenza and tetanus “continue to defy public health efforts to reduce their spread.”