A longer life for all? A better life? Can medicine keep one step ahead of disease? And can we afford it? n

ECONOMISTS predict that the 21st century will be an unmitigated disaster in health-care terms, because the young will have to support a huge ageing population. As usual, their claims are eyewash, because what they see as a catastrophe for society is, for most of us, a blessing. We shall be alive, instead of 6ft under.

By the year 2050, 3 million of us will be over 85, compared with only 500,000 in 1981. "Death rates before middle age have come down by about a half in the last 30 years, which is huge," says Richard Peto, professor of medical statistics and epidemiology at Oxford University. "Overall the pattern of mortality is likely to get better rather than worse."

Death rates from cancer, heart disease and stroke are all falling, except in a few selected age groups. Smoking-related deaths among older women, for example, are still rising as the effects of their having taken up the weed during and immediately after the Second World War are felt. But overall the trend is downwards. Moreover, the incidence of certain other disorders, such as appendicitis and stomach ulcers, which are not killers but cause much misery, is also falling.

What no one can predict, however, is whether by living to a greater age, we will experience longer periods of dependency and infirmity at the end of our lives, or whether this period will remain much the same but simply occur later. Robert Maxwell, secretary of the King's Fund, an independent health-care think- tank, says: "Optimistically, greater longevity will mean that the problems of ultimate decline and death will just be postponed. But we cannot assume that. In the over-85 age group, the proportion of people still living in their own homes, while still high, declines sharply."

A pessimist might infer that the best health strategy for the future will be to avoid a miserable old age by dying relatively young, in which case there is little point in looking after one's health. Such reasoning is flawed. In fact, most of the current evidence suggests that, the healthier you are, the shorter will be the eventual period of dependancy with which your life will probably end.

In some respects, unfortunately, staying healthy may become harder, especially for the less affluent, since experts predict a widening of the health gap between rich and poor. "By and large," says Mr Maxwell, "the messages about smoking, diet and exercise are getting through to the better educated and more prosperous, who are, to some extent, less pressurised, and not to the poorer sections of society." In addition, Britons of all classes could face new outbreaks of infectious diseases, just as they have faced the challenge of Aids in the past 15 years. Some microbes are developing resistance to existing drugs, and global warming could allow insect vectors of disease to survive in places which were previously too cold for them.

"Nature will never allow a microbiological vacuum," says Alasdair Geddes, professor of infection at the University of Birmingham. "It is a natural trend for new diseases to appear and for old ones to re-emerge. Tuberculosis, for example, which everyone thought was disappearing, has re-surfaced. The organism responsible for it is becoming resistant to the currently available drugs. And if the world experiences global warming, as the scientists predict, we in this country could have to deal with tropical diseases, such as malaria."

In the US, doctors have recently come across cases of dengue fever, imported by infected mosquitoes arriving in the US from South East Asia through shipments of old car tyres. And global warming could also mean an increased death rate among the elderly during heat waves, while the depletion of the ozone layer could result in a rise in skin cancer and cataracts.

This is not to say that overall levels of health will decline: there will, after all, almost certainly be progress in medicine as well. But it would be complacent to assume that we will inevitably win the age-old war between man and microbe. A more realistic hope would be that the current cycle of battle and truce will continue.

New whizz-bang medical advances will continue to appear, of course, but it is not clear to what extent they will affect general health - or whether we will be able to afford them. As far as advances that probably will affect the average person are concerned, John Wickham, consultant urological surgeon at Guy's Hospital, London, thinks that minimally invasive therapy, or keyhole surgery, will become the norm in the next century. "We shall look back in horror at the idea that we used to open people up and put our hands inside them," he says. He predicts that, as this trend takes off, we shall move from having large hospitals with small car parks, to small hospitals with large car parks. Certainly, the rate at which hospital beds are closing in most large cities seems to bear this out.

Other developments could be more problematic. On the one hand, new genetic tests, both for adults and babies in the womb, could make certain diseases, such as thalassaemia and sickle cell disease, problems of the past, while adults who discover that they carry the genes for disorders such as familial breast and colon cancer will be able to take preventive measures to avoid developing life-threatening disease, including regular screening tests or even, in extreme cases, prophylactic surgery. On the other hand, such developments are likely to pose heavy ethical and personal dilemmas both for doctors and for patients - whose role in decision-making will surely increase.

Transplant surgery could become more common as scientists breed animals that are genetically compatible with man. Transplant surgeon Sir Roy Calne, from Addenbrooke's Hospital, Cambridge, has conjured up the idea of everyone having a "self-pig", a specially bred animal which will be his or her immunological twin in porcine clothing. If you need a heart or kidney transplant, it will provide you with one, without any of the usual problems of rejection.

The limiting factor is not technology but cost. Mr Maxwell points out: "The things that doctors and surgeons would like to do will continue to grow faster than our capacity to pay for them. We will see many more dilemmas like the recent case of child B, in which a health authority refused to pay for a child's leukaemia treatment. New modern technologies often make great differences to countries' health care systems. They do not necessarily greatly affect health itself."

n

n

n

n

n

n

n

n

Have you tried new the Independent Digital Edition apps?
Arts and Entertainment

ebooksNow available in paperback
Arts and Entertainment

ebooks
Arts and Entertainment
Anthony Hopkins in Westworld

TV
Arts and Entertainment

TV
Arts and Entertainment
Rock and role: Jamie Bell's character Benjamin Grimm is transformed into 'Thing' in the film adaptation of Marvel Comics' 'Fantastic Four'
film review
Arts and Entertainment
Katie Hopkins veered between sycophancy and insult in her new chat show
TV review
Arts and Entertainment

books
Arts and Entertainment
In his role as Hamlet, Benedict Cumberbatch will have to learn, and repeat night after night, around 1,480 lines

Theatre
Arts and Entertainment
Belgian sexologist Goedele Liekens with pupils at Hollins Technology College in Accrington
TV review
Arts and Entertainment

music
Arts and Entertainment
Judges Paul Hollywood and Mary Berry

TV
Arts and Entertainment

TV
Arts and Entertainment
The rapper Drake

music
Arts and Entertainment
The gaffer: Prince Philip and the future Queen in 1947
TV review
Arts and Entertainment
Style icons: The Beatles on set in Austria
film
Arts and Entertainment
By Seuss! ‘What Pet Shall I Get?’ hits the bookshops this week
Books
Arts and Entertainment
The mushroom cloud over Hiroshima after Enola Gray and her crew dropped the bomb
TV review
Arts and Entertainment
Elliott outside his stationery store that houses a Post Office
TV review
Arts and Entertainment
Rebecca Ferguson, Tom Cruise in Mission Impossible Rogue Nation

Film review Tom Cruise, 50, is still like a puppy in this relentless action soap opera

Arts and Entertainment
Rachel McAdams in True Detective season 2

TV review
Arts and Entertainment
Off the wall: the cast of ‘Life in Squares’

TV
Arts and Entertainment

Books And it is whizzpopping!

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
SPONSORED FEATURES

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    The Silk Roads that trace civilisation: Long before the West rose to power, Asian pathways were connecting peoples and places

    The Silk Roads that trace civilisation

    Long before the West rose to power, Asian pathways were connecting peoples and places
    House of Lords: Outcry as donors, fixers and MPs caught up in expenses scandal are ennobled

    The honours that shame Britain

    Outcry as donors, fixers and MPs caught up in expenses scandal are ennobled
    When it comes to street harassment, we need to talk about race

    'When it comes to street harassment, we need to talk about race'

    Why are black men living the stereotypes and why are we letting them get away with it?
    International Tap Festival: Forget Fred Astaire and Ginger Rogers - this dancing is improvised, spontaneous and rhythmic

    International Tap Festival comes to the UK

    Forget Fred Astaire and Ginger Rogers - this dancing is improvised, spontaneous and rhythmic
    War with Isis: Is Turkey's buffer zone in Syria a matter of self-defence – or just anti-Kurd?

    Turkey's buffer zone in Syria: self-defence – or just anti-Kurd?

    Ankara accused of exacerbating racial division by allowing Turkmen minority to cross the border
    Doris Lessing: Acclaimed novelist was kept under MI5 observation for 18 years, newly released papers show

    'A subversive brothel keeper and Communist'

    Acclaimed novelist Doris Lessing was kept under MI5 observation for 18 years, newly released papers show
    Big Blue Live: BBC's Springwatch offshoot swaps back gardens for California's Monterey Bay

    BBC heads to the Californian coast

    The Big Blue Live crew is preparing for the first of three episodes on Sunday night, filming from boats, planes and an aquarium studio
    Austin Bidwell: The Victorian fraudster who shook the Bank of England with the most daring forgery the world had known

    Victorian fraudster who shook the Bank of England

    Conman Austin Bidwell. was a heartless cad who carried out the most daring forgery the world had known
    Car hacking scandal: Security designed to stop thieves hot-wiring almost every modern motor has been cracked

    Car hacking scandal

    Security designed to stop thieves hot-wiring almost every modern motor has been cracked
    10 best placemats

    Take your seat: 10 best placemats

    Protect your table and dine in style with a bold new accessory
    Ashes 2015: Alastair Cook not the only one to be caught in The Oval mindwarp

    Cook not the only one to be caught in The Oval mindwarp

    Aussie skipper Michael Clarke was lured into believing that what we witnessed at Edgbaston and Trent Bridge would continue in London, says Kevin Garside
    Can Rafael Benitez get the best out of Gareth Bale at Real Madrid?

    Can Benitez get the best out of Bale?

    Back at the club he watched as a boy, the pressure is on Benitez to find a winning blend from Real's multiple talents. As La Liga begins, Pete Jenson asks if it will be enough to stop Barcelona
    Athletics World Championships 2015: Beijing witnesses new stage in the Jessica Ennis-Hill and Katarina Johnson-Thompson heptathlon rivalry

    Beijing witnesses new stage in the Jess and Kat rivalry

    The last time the two British heptathletes competed, Ennis-Hill was on the way to Olympic gold and Johnson-Thompson was just a promising teenager. But a lot has happened in the following three years
    Jeremy Corbyn: Joining a shrewd operator desperate for power as he visits the North East

    Jeremy Corbyn interview: A shrewd operator desperate for power

    His radical anti-austerity agenda has caught the imagination of the left and politically disaffected and set a staid Labour leadership election alight
    Isis executes Palmyra antiquities chief: Defender of ancient city's past was killed for protecting its future

    Isis executes Palmyra antiquities chief

    Robert Fisk on the defender of the ancient city's past who was killed for protecting its future