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Introduction
and Rationale
 America’s
increasingly multicultural and aging population creates both
tremendous public health challenges and
rich opportunities. The U.S. Census Bureau documents the increasing diversity in
the United States, and projects that by the year 2030 60% of
the U.S.
population will self-identify as White, non-Hispanic and 40%
will self-identify as members of other diverse racial, ethnic,
and linguistic
groups.
The diverse
Hispanic and Asian groups are currently growing at rates much
higher than the total population. The growth rate
for these groups between 2000 and 2003 was 13% and 12.5%, respectively,
compared to 3.3% growth for the total population (U.S. Census
Bureau, 2004). The so-called minorities are in the majority
in Hawaii,
New Mexico, California and the District of Columbia, however,
many states are demonstrating rapid increase of diverse groups.
For
example, according to the U.S. Census Bureau,1 since
2000, there was a:
- 24% increase
in the Black population in Idaho
- 9% increase
of American Indians and Alaska Natives in Nevada
- 21% increase
of Asians in South Dakota
- 15% increase
of Native Hawaiians and other Pacific Islanders in Oklahoma
- 19% increase
of Hispanics in Georgia
The proportion
of older persons to the rest of the population is expected to
increase in
the coming decades. This increase
will
be due to declining birth rates and advances in life expectancy
in the second half of the 20th century. For example, the
over 65 group is expected to increase to 71 million (nearly 20%)
in 2030,
up from 35 million (12%) in 2000. There is an increased risk
for and incidence of disability for this group.2
According to
the Centers for Disease Control and Prevention (CDC), approximately
80% of persons over 65 have at least
one chronic condition and half have more than one such
condition (CDC, 2003).
Other factors, such as medical advances that have increased
survival rates for conditions previously often lethal,
have increased the
total numbers of persons living with disabilities, estimated
at 35 million to 53 million people in 1997, depending on
the
definition
of disability (Fujiura, 2001).
Although
public health achievements have led to a significant decrease
in mortality
due to
infectious disease and other acute illnesses, the new challenge
in this “epidemiologic
transition”3 is chronic diseases
such as cardiovascular diseases and cancer.
References
1
Press
release, 2003 at http://www.census.gov/Press-Release/www/2003/cb03-144.html.
2 (Waldrop & Stern,
2003).
3 See p.
2, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5206a2.htm.
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