The Futures Foundation

Dr Baume, professor of community medicine at the University of New South Wales, was responding to an article in The Futurist by health futurist Clem Bezold, which looked at changes now taking place in the world of health care. While supportive of the central theme of the story, which tracks the shift in health care systems around the world away from costly medical procedures towards the promotion of preventive measures, Peter Baume noted that the author had said nothing in the article about dying.

"If things carry on as they are, we are only going to be permitted to die from the nastiest illnesses which medical scientists have not yet mastered," he told Future News. "It is not a prospect of unalloyed joy."

The Futurist warmed to the theme in its next issue, with an article by editor Cynthia Wagner which explores the challenges of Living Beyond 100.

"Centenarians are the fastest-growing age group in the world, and their numbers are predicted to increase 16-fold by the middle of the twenty-first century," she wrote. The story was inspired by a recent book about Jeanne Calment, who broke all human longevity records when she died in 1997 at the age of 122. It also features an athlete of 103, a new graduate aged 103, and the world's oldest competitive ballroom dancer, aged 102.

Acknowledging the trend, the United Nations Population Division has reshaped its demographic categories: "elderly" now means 85 and older, instead of 65 and older.

"In 1998, around 135,000 persons in the world are estimated to be aged 100 or over," the Population Division reported. "The number of centenarians is projected to increase 16-fold by 2050 to reach 2.2 million persons."

Revolutions in pharmaceuticals and biotechnologies seem to promise a cornucopia of medical miracles, but with pharmaceutical sales booming (up 85% in five years in the US) at prices of two to ten times the treatments they replace, life and health are being linked more closely than ever with affluence and power.

Meanwhile, back in the other world, the picture shifts from glossy technicolour to stark black-and-white. The time-bomb of overpopulation in under-developed countries, identified as one of the world's top issues by the global Millennium Project, contrasts with the demographics of dwindling populations in developed countries, where future youth will carry a heavy burden. Reports of the impact of AIDS in African countries foreshadow a future of unsupported victims and unparented children. Would it be easier to resolve our dilemmas about the allocation of scarce resources if we were to extend the field of inquiry? To make ethical choices on a global basis?

There are certainly plenty of opportunities to reframe the discourse, when we recognise the broader social and political implications of health. Foundation member Trudi Lang in Perth draws our attention to an item in the Los Angeles Times (19/5/99) on the grim diagnosis facing the Russian population of 147 million people -- a population that "has become so remarkably unhealthy that its decrepitude could affect the country's role in the world for decades to come".

Harvard University demographer Nicholas Eberstadt reports that Russia's crisis in public health "is historically unprecedented: no industrialised country has ever before suffered such a severe and prolonged deterioration during peacetime."

Every year, 700,000 more Russians die than are born Eberstadt suggests that the root cause-of-death statistics show Russia has experienced striking increases in two categories: first, cardiovascular diseases, such as heart attacks and strokes; and second, deadly injuries, including accidents, suicides and homicides. Bad diet, lack of exercise and heavy smoking all contribute to this epidemic. But above all, Eberstadt says, is alcohol abuse. Not only does it contribute to high rates of heart disease, but it is also a key factor underlying the car crashes, industrial accidents, murders and suicides that make deadly injuries so prevalent in Russia.

From another end of this cat's-cradle of competing tensions comes a report from Lester Brown and colleagues which argues that global population growth --whatever its profile -- may be the most critical issue of today.

Their article in The Futurist lists 16 major ways in which it affects human prospects, including impacts on food and agriculture; environment and resources; and economic and quality-of-life impacts.

How many more levels of magnitude do we need to engage in understanding the real meaning of a wholistic approach to health? Does the shift to recognising our ultimate interdependence begin when we recognise the influence of our own culture and experience on the way we interpret our world?