Into the Future
As this volume has documented, the progress that occurred in biomedical science, health, and medicine between 1970 and 2020 was breathtaking. By the end of that period, billions of people around the world were living healthier and more fulfilling lives because of new knowledge, breakthrough therapies, and innovative polices. The National Academy of Medicine (NAM) contributed in substantive ways to many of these advances, and the principles on which it was based drove other innovations and breakthroughs.
Yet, any tally of achievements also reveals how much remains to be done. In each of the five domains surveyed in this book—biomedical science and technology, diseases and conditions, public health, U.S. health care, and global health—tremendous needs remain unmet, difficult problems remain unsolved, and profound questions remain unanswered. The issues of tomorrow are priorities of the NAM today, reflected by its current programs. The NAM will remain committed to responding to critical and pressing issues, advising the nation and the world on the future of health and health care, and leading and inspiring for the future—now and in the coming decades.
Following decades of grassroots work to illuminate both historical and current systems and structures causing continued impacts of racial and social injustice, the COVID-19 pandemic starkly demonstrated the disparities in health status and access to high-quality care that exist across populations. The barriers to health, well-being, and opportunity that some groups face are based on factors including socioeconomic status, gender, race and ethnicity, and geographic location. On a global scale, access to scientific advances remains unequal, with low- and lower-middle-income countries and populations reaping significantly less benefits. New technologies and procedures such as video doctor visits and text message reminders to take medications have the potential to increase health equity, but resources are needed for these approaches to reach everyone, including the most disadvantaged. Addressing the underlying causes of inequity requires understanding that Black, Indigenous, and people of color experience worse health outcomes, and that these disparities reflect and contribute to the impact of structural racism. The international community has a responsibility to acknowledge structural racism as a root cause of health inequity, and an extraordinary opportunity to advance health equity.
As globalization, urbanization, and interconnectedness increase, diseases will spread faster and farther. A growing population, increased demand for meat, a warming planet, and greater proximity to wildlife will result in more contact with animals and insects that can transmit pathogens to humans. More people are immunocompromised or suffering from chronic diseases, further raising disease susceptibility. Viruses and bacteria continually become more resistant to antibiotics and vaccines, and the possibility of biological warfare or accidental release of microbes from containment facilities remains ever present. Active surveillance, prompt response to disease outbreaks, and new ways of treating disease will all be required to stem future pandemics.
The Aging Global Population
As people live longer and fertility rates decline, older people represent an ever-growing proportion of the population. By 2050, 1 in 6 people worldwide is projected to be above 65 years of age, compared with fewer than 1 in 10 today. Increased longevity is one of the great achievements of science and health care, but an aging population also poses significant new challenges. More people will suffer from frailty, isolation, and age-related chronic and neurodegenerative diseases, requiring tremendous resources to care for them. Innovative technologies, therapies, and policies will be needed to enhance the quality of life for older people and to support economic stability.
The world will be much warmer by 2050, though the amount of warming will depend on future emissions of greenhouse gases. Storms and wildfires will intensify, glaciers will shrink, and the sea level will rise, resulting in loss of life and property, societal disruption, and political unrest. Shifting rainfall patterns and ocean acidification will deplete biodiversity and diminish food production, and mosquitoes, ticks, and other disease vectors will flourish. Widespread individual and collective efforts will be essential to prevent further warming, protect the health and well-being of those fleeing climate disasters, and to mitigate consequences that are already locked into the climate system.
Sequencing the human genome was one step in a centuries-long journey toward understanding how genes function within the human body. With increased understanding will come greater ability to correct genes that are over- or under-expressed, to silence or activate genes implicated in certain conditions, and even to alter genes to prevent or treat diseases. The future of health care may lie in personalized medicine, in which a patient’s unique genome and circumstances are examined to determine the most appropriate course of treatment. To deploy these future technologies safely, effectively, and equitably, many ethical issues must be addressed. How should society regulate genetic modifications that can be passed on to offspring? How can the benefits of personalized medicine be distributed equitably?
Chronic illnesses like diabetes, cardiovascular disease, and neurodegenerative conditions currently represent more than half the global burden of disease, and they will become more prevalent as climate changes, cities grow, and populations age. The worldwide scope of these conditions has become clear, with prominent risk factors including tobacco use, harmful consumption of alcohol, unhealthy diets, physical inactivity, air pollution, injuries, and systemic drivers of inequality and poverty. Rising rates of obesity worldwide have become particularly worrisome, since this condition is linked to many life-threatening and costly diseases. Better treatments for these diseases could come from stem cell therapy, gene editing, new types of medications, or surgically implanted devices, but systemic improvements will require the creation of health-promoting environments. Like chronic illness, mental illnesses are recurrent and are rarely cured, but are able to be treated and managed. Recognition of mental health as a part of overall health is growing, while ongoing stigma against seeking help continues to be combated. The isolation, stress, anxiety, and depression associated with the COVID-19 pandemic may become a “second pandemic” as the infectious disease itself retreats, and will make mental health support more necessary than ever as we move toward returning to a new normal.
The 21st century poses many social challenges, but few are as pressing as violence, misinformation, and the mistrust of scientific information. Conflict, crime, extremism, racial violence, and sexual- and gender-based violence continue to mar the lives of untold millions. The spread of false information has produced destructive actions and mistaken beliefs, especially as people increasingly rely on the internet and social media for news and health information. Contemporary political battles over issues ranging from climate change to genetically modified foods have undermined trust in scientific methodology, institutions, concepts, and facts. The public and private sectors will need to work together with a new determination to control violence and halt the spread of misinformation, and the scientific community must become more transparent and accessible to rebuild the public’s confidence.
The challenges ahead are daunting, but the achievements of the half-century from 1970 to 2020 offer hope and promise.
Science, medicine, and public health have conquered formidable challenges before. They have lifted billions of people out of poverty, expanded knowledge and technology in ways that were once thought impossible, and lengthened the human lifespan while improving health and well-being. The application of science and reliance on evidence—the principles on which the National Academy of Medicine is based—will continue to serve as beacons of progress, lighting the way toward a brighter future.