University Times

Accessing health care in this country is like wrestling with an octopus, the head of AARP said.

That’s today. Tomorrow may be even worse, because the United States is not prepared for the upcoming flood of aging Americans.

“In 2011, the first members of the 76 million baby-boomer generation will turn 65,” said William Novelli, executive director and CEO of AARP, the 35 million- member group devoted to people age 50 and over. “This will mark the beginning of one of the most profound changes in American history. It will exert enormous pressure on our social structures — indeed, some of those pressures won’t wait until 2011. We already feel various pressures on America’s health care system, which is a mess.”

Novelli painted a somber picture of the status quo before offering some recommendations for change in his Porter Prize lecture, “2011: A New Vision for a Healthy America,” April 7 at Pitt’s Graduate School of Public Health (GSPH). The 20-year-old Porter Prize, which annually recognizes exemplary performance in the field of health promotion, has been administered by GSPH since 1999.

On the positive side of coping with an aging population, Novelli said, “In 21st century America, more people are living longer and aging better than ever before,” as the result of advances in public health, medical science and health care delivery.

In 1900, life expectancy in the United States was less than 50 years; today it’s about 76 years for men and nearly 80 years for women. “People 50 today have half their adult lives ahead of them,” Novelli said. About 80 million people, or 27 percent of the American population, are over 50. In 20 years, 35 percent of the population will be over 50.

The impact of the long-term trend toward an aging society is affected by three major forces, Novelli said: genetic luck; life-long personal behavior, and access to health care.

“Genetic luck is just that: luck,” Novelli said. But personal behavior and health care access are variables that society can and should improve.

“At least one-third of older men and half of older women report that they do not get enough exercise,” he said. “One-third or more of the entire population in this country is obese, which undermines many of the health gains we’ve made in the last century. As the New England Journal of Medicine put it: Poor physical fitness is a greater predictor of death than all other risk factors including smoking, high blood pressure and heart disease.”

While obesity in older folks is bad enough, Novelli said, childhood obesity has reached epidemic proportions here. “We’ve become a fast-food nation. We’re super-sizing our children, and we’re also engineering physical activity out of their lives. More often than not, later-life health is predicated on earlier personal behavior decisions. Not to address the health needs of children is really developing a generation with growing health problems. As more people live longer, we see that connection more clearly.”

First, Novelli said, the United States as a society must face some harsh realities, including:

• A health care delivery system directed to acute care versus preventive care, that is, a health care system that pays bills, but doesn’t promote health behaviors or awareness;

• More than 40 million uninsured Americans;

• Not enough doctors or health care professionals studying geriatrics;

• Soaring health care costs, but diminishing quality of care;

• Costs for prescription drugs rising dramatically with no end in sight;

• Baby boomers not saving nearly enough to support their retirement years, combined with:

• Employers eliminating retirement health care plans, which makes the 55-64 age group at greater risk to become uninsured. “Our health care system offers the best health care in the world — for people who can afford it. We spend more than any other nation on health care and yet we’re the only industrialized country that has not yet figured out how to insure all its citizens.”

• Many more people struggling to raise their children and to take care of their parents at the same time. “The sandwich generation is being chewed on from both ends,” Novelli quipped.

While information about specific diseases is nearly limitless, there is virtually no information about maintaining good health in general, he said.

“We have a disease focus in our system,” Novelli pointed out. “Where are interventions when nothing’s wrong with you and you want to keep it that way?”

America must change substantially and do it quickly, he said. “There should be a national sense of urgency. We’re only eight years — or four U.S. Congressional election cycles — from 2011. To recall an ancient proverb: ‘Where there is no vision, people perish.’ That’s a 2,000-year-old soundbite with an important lesson for us today.”

Novelli’s vision of healthy aging includes:

• Re-thinking the role of health care in an aging society. “We need to provide coverage of more preventative services and especially prescription drug coverage and Medicare. Health care has to be affordable, voluntary, accessible to all and have built-in cost containment,” he said.

• Recognizing the need for children to get a healthy start and maintain life-long healthy habits. “We need to look not only at obesity, but violence, drug abuse, child abuse and lack of affordable health care. The source of these problems is often child poverty.”

• Encouraging and training more non-physician health care professionals, such as nurse practitioners.

“And we need to chuck conventional wisdom,” Novelli said. “We’ve abandoned doctors making house calls, but can’t some do it? By providing treatment in a patient’s home, some practitioners are finding that it’s more effective treatment, less costly and more personal, and it helps keep people out of nursing homes.”

Similarly, there could be more consultation with physicians on the phone and via e-mail to save time and money.

“Contrary to popular belief, not all old people struggle to meet the bills, or live in nursing homes or with their adult children. Age does not equal disability.”

He pointed out that 80 percent of Americans 65 or older have no limitations on their daily activities.

“Our system offers support to the other 20 percent, as we should. But we should be looking at the majority as capable of contributing to society, as those who want to volunteer their knowledge and experience and skills. In other words, we should strive for our aging society not only to be healthy, but to age with dignity and purpose.

“2011 is just the beginning,” Novelli said. “We can’t sustain the current levels of rising health costs. Change is inevitable, and we expect it. And yet we often seem surprised by how it plays out. So the question is whether we’re going to manage change or whether change is going to manage us.”

—Peter Hart