Lifestyle Choices to Blunt Health Strides, Study Finds

Medicine will get better and keep people alive longer in the next 10 years, but the behavior of Americans will worsen as they exercise less, put on more weight and fall victim to preventable chronic diseases, according to an authoritative forecast of national health released Wednesday.

Lifestyles go halfway toward determining an individual’s health, says a report funded by the Robert Wood Johnson Foundation. A stubborn 24% of the population smokes, alcohol abuse is persistent and the incidence of obesity is rising, according to the report.

The country’s bill for health spending will soar from $1.2 trillion in 1998 to $2.2 trillion by 2010, with much of the growth coming in costly treatments for the victims of chronic conditions, such as diabetes and hypertension, according to the study, prepared by the Institute for the Future, a nonprofit forecasting and research firm in Menlo Park, Calif.

Medical advances will keep millions of people alive to an advanced age but many will be plagued by chronic ailments. More health dollars should be spent in persuading people to eat right and exercise “so we can spend less money curing diseases we could prevent if we behaved better,” Wendy Everett, director of health programs for the institute, said at a news conference where the report was presented.

Vaccines and antibiotics have successfully attacked many infectious diseases so “the burden of disease” is shifting “to disorders with behavioral causes, such as illnesses related to smoking and alcohol abuse,” according to the report, titled “Health and Health Care 2010.”

The factors that determine whether an individual is healthy are heavily weighted toward personal habits, the report said: 50% for lifestyle, 20% for environment, 20% for genetics and 10% for access to medical care.

The report delivered a harsh message: Americans’ inability or unwillingness to take care of themselves can overshadow the advances science and technology offer in health care.

Progress during the decade will be impressive, with transplantation of animal tissues and organs into humans, new oral and nasal sprays for use as vaccines and miniature medical devices to reduce trauma and bleeding during surgery, the report predicted.

Artificial blood will be created. “Personalized” drugs will be designed, depending on an individual’s condition and health history. Doctors will be aware of each patient’s genetic makeup, enabling them to prescribe, not just penicillin, but “your personal version of penicillin,” Everett said.

The report puts special emphasis on the need for prevention and for healthy lifestyles because the U.S. population is aging rapidly. Baby boomers, the generation born from 1946 to 1964, are reaching the age when they are likely to begin developing health problems. Exercise and better nutrition advocated by the report can reduce the likelihood of boomers coming down with chronic ailments.

The current system of health care delivery is likely to persist without dramatic changes, the forecast said. Health maintenance organizations “will cement their position as the dominant form of health insurance product over the next decade,” the report said.

The number of Americans enrolled in HMOs will grow from 78 million in 1998 to 120 million by the year 2010, according to the forecast.

Only a “tiny percentage of the employed” will still have insurance programs offering an unfettered choice of doctors and hospitals, the study noted.

Patients will have the freedom to go outside the tightly controlled networks of HMO doctors and hospitals, but they will have to pay a higher price in the form of increased co-payments and deductibles.

The United States in 2010 will have a significant excess supply of doctors--there are 570,000 physicians today and “another 170,000 in the medical school pipeline,” the report said. There will be too many specialists.

Even if medical schools reduced their classes and the nation allows fewer foreign doctors to practice here, excess supply still will be a problem. “Medical training takes so long that any changes in either medical education or policy will not be felt for another decade,” the report said.

The surplus of doctors could have some positive results, however. Some specialists who cannot find work in private practice may become researchers and clinical investigators, who are in short supply now, the report noted.

The Robert Wood Johnson Foundation is the nation’s largest philanthropic research group devoted exclusively to health care.