- Greater instability in less-developed nations
- Greater immigration pressures, and increased levels of fear (vs. optimism) in the populations of developed countries
- World population expected to nearly double once more within the next generation before leveling off near 10 billion
| Continued rapid increase in international travel, trade, mega-urbanization, small-scale warfare, displaced populations | - Environmental devastation across borders and regions, and globally
- Rapid spread of "new" infectious diseases
Examples: - AIDS
- Turning the pampas into fields of maize resulted in a rapid rise in the population of field mouse that is host for the Junin virus, which gave rise to Argentine hemorrhagic fever
- The Hanta virus showed up in areas in which humans had migrated into an area occupied by a virus-carrying mouse
| Aging U.S. population | - Growing burden on healthcare
- Relatively smaller working population to support it
- Boomers progress into middle age and toward retirement
- Their parents move toward frail elderly stage, end-stage illness, and death
| Chaotic change in family structure | - Social fragmentation
- Increase in women and children in poverty
| Fragmentation of U.S. population by ethnic group, class, language and culture | - Increase in fear
- Rise of radical social movements of fragmentation and blame
- Decrease in wide civic awareness and responsibility
| Shifting economy | - Spread of "McJobs"
- Decrease in health coverage (job-based in U.S.) and in stability of provider relationships
| Continuing concern about cost and access | The percentage of the economy dedicated to healthcare will likely be forced down, whether by a rational plan or chaotically | Reasons:- Historically high levels of cost
- Growing class gaps
- Growing instability of present structure, as people lose jobs and health insurance
- Unwillingness by business, Washington, or states to continue to fund limitless growth
| Decline in the effectiveness of antibiotics (multi-drug-resistant pathogens) | Huge need for research into substitutes, vaccines, other public health measures - at a time when funding can be expected to become scarcer
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| Proliferation in clinically useful knowledge | - Doctors and other medical professionals increasingly depend on medical review writers and other experts, who are often several years behind in recommending changes in practice
- Explosion and integration of "expert systems" and other silicon "doc extenders"
Clinically useful knowledge is estimated to have doubled twice since 1986
| | Shift in public awareness of the true vectors of health and disease | Increased public awareness of the behavioral vectors of much of helath and disease
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| Turbulence within the industry, dissatisfaction within the medical profession | - Rapid reduction in inpatient acute care
- Rapid consolidation and integration
- Drop in doctor's income especially specialists
- Rapid spread of capitated models
- Movement of power from doctors and providers to insurance entities
- failure of nationwide reform
Data points- Patient bed days per thousand drop from nationwide peak of 1130 in early 1980s to
less than 200 in some jurisdictions now, expected to bottom out at that level nationwide
- Hospitals operating by 2000 expected to be about one third of those operating in 1980
- AMA survey shows that 92 percent of MDs under 40 would not choose the profession again.
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