Strategies for reduction of morbidity

The future health of our increasingly senior populations depend upon the interrelationship between two critical points: the onset time of the first major disease, infirmity, or disability and the time of death. Reduction of morbidity requires compressing the average period between these points and reducing the average level of morbidity during this period. The goal of compression of morbidity currently is being achieved in some areas. Life expectancy increases in the United States above age 65 y have plateaued, with further increases becoming ever more difficult. Some major chronic diseases, such as atherosclerosis and lung cancer, now occur later in life. Work disability prevalence has begun to decline. Intergenerational comparisons demonstrate improved health at specific ages. Randomized-controlled trials of primary prevention have failed to decrease total mortality in risk subjects while markedly decreasing the morbidity experienced by the same subjects. Compression has been documented for higher socioeconomic class subpopulations. These observations have major implications for health policy and mandate initiatives directed at prevention of disability and infirmity.