Amidst all the talk about the aging of the baby boomers and the costs that this imposes on social security and health care, there is less discussion of the actual health of older Americans. To bring to light the data being compiled by federal agencies on the health and well-being of the elderly, COSSA sponsored a Congressional Briefing on Capitol Hill on April 27 entitled, Living Longer, Staying Well: Promoting Good Health for Older Americans.
COSSA invited three distinguished scientists to discuss the trends outlined in the report, Older Americans 2000: Key Indicators of Well-Being (which can be viewed at www.agingstats.gov), by the Federal Interagency Forum on Aging-Related Statistics (see Update, September 25, 2000), and their own research on the health of the elderly.
The central plank of American public health policy is living longer and staying well, remarked Mark D. Hayward, Director of the Population Institute and Professor of Sociology and Demography at the Pennsylvania State University. Some groups, however, have a harder time living longer and staying well than others. Hayward spoke on "Truncated Lives and Worse Health: The Plight of African Americans and the Economically Disadvantaged."
Demographers, Hayward explained, gauge population health in several basic ways, including measuring mortality (life expectancy), morbidity (incidence of disease), and healthy life expectancy (the number of years lived without a major health problem). Using data from various sources, such as the Census, the National Health Interview Survey, the Health and Retirement Survey, and death certificates, Hayward examined the differences among various indicators between racial and ethnic groups.
One question Hayward addressed was whether groups with higher life expectancies also enjoy more years of good health, or whether they spend their extended years struggling with disability. Hayward found that on average African Americans experience both a truncated life and more years spent with a chronic disabling condition compared to white and Asian Americans, and that longer life is associated with more years in good health for Asian Americans.
Hayward also focused on chronic disease in different populations. He found that, by middle age, blacks are more likely to be afflicted than whites by hypertension, diabetes, and stroke.
But what is behind these disparities between race and ethnic groups? "The basic public health silver bullets of smoking, exercise, alcohol consumption, and BMI [body mass index] are not responsible," declared Hayward. "Instead it is education. It is income. It is wealth. It is the kind of jobs that blacks and whites work in." In short, Hayward's research found that race disparity in health is largely rooted in the fundamental social conditions that mark disease (especially education levels) rather than behavioral differences.
Living longer and staying well, of course, is also affected by policy. Toni P. Miles, Professor in the Department of Family Practice at the University of Texas Health Science Center in San Antonio, Texas, spoke on "Chronic Disease and the Policies That Bind."
"What does it take to stay well?" Miles asked. "It takes some behaviors on your part, but it also takes consistent access to a care provider." However, there are instabilities in the health care system, Miles observed, that undermine our ability to look after the growing elderly population, many of whom live with chronic disease.
"Without [my eye glasses] . . . well, you wouldn't want me driving. . . But with these things, I can make a contribution to society, contribute to the tax base, and stay off the welfare rolls." Access to health care enables people to be responsible for themselves, Miles asserted. But in Texas last year, 500,000 people were left without care because their Medicare HMO went out of business.
Payment policies can similarly leave people in need of care. If you are "Medicare only," or without supplemental health insurance, you may be denied access, Miles continued. "It's not an issue of the providers being greedy, for the most part . . . It's a matter of keeping [their] office afloat."
Another problem surrounds medical schools, Miles observed. Medical schools, the only places we have that produce doctors, are having to divorce themselves from the hospitals where they do their training because of financing issues, she said.
Unfortunately, Miles commented, there is very little data on the consequences of these realities. For instance, having to change providers every year or two diminishes the quality of care for people with chronic disease, but we lack data on the experience of changing providers.
Another area where we lack data is in clinical trials, Miles observed. Many groups are excluded from these trials, for a variety of reasons. For instance, pharmaceutical companies try to recruit samples of people who have only the disease of interest, but many older people have more than one disease and are hence excluded from the trial. So elderly people with chronic diseases, some of whom will take the medication when it comes to market, are inadequately represented in these trials, Miles suggested.
The findings of the first two speakers suggested a connection between health and wealth. In the final presentation, Frank P. Stafford, Director of the Institute for Social Research at the University of Michigan, spoke on "Building Wealth Over the Life Course: Who Does, Who Doesn't, and Why?"
In today's economy, Stafford remarked, the rate of savings is low; however, overall wealth is growing. The factors in this growth, he posited, include the occupational migration of women into new industries and jobs and the growth of information technology.
This increase in wealth, though, is not equally distributed - since the early to mid-1980s, average wealth in the U.S. has grown, but median wealth has grown only modestly. One reason is that the rising tide in the value of equities did not lift all ships - African Americans are far less likely to hold equities (or even a bank account), and therefore were left out of the prosperity, Stafford observed.
The effects of these disparities become crucial during retirement years, he said, when public pensions like Social Security are critical. "Some people are just not going to be able to organize their lives to have adequate resources when they retire," Stafford said.
However, he pointed out, some have argued that public pensions have contributed to the demise of private saving, particularly among poor people. Stafford suggested this view is erroneous, pointing to Sweden, which does not have this lack of retirement wealth in the bottom quartile of its population.
There is wide dispersion in wealth holding even across families at similar points in the life course, Stafford concluded. Many factors contribute to this dispersion. The social science challenge, he said, is to improve our understanding of the fundamentals. "From this understanding others may then be able to shape policy, sustaining a blend of public and private pensions. The ideal policy will provide incentives for saving and at the same time provide sufficient resources to avert poverty among all older American families."
A transcript of the proceedings will be available in early July. Please email cossa@cossa.org to request a copy.