Canadian Medical Association Journal 1996; 155: 1723-1724
[en bref]
© 1996 Charlotte Gray
The book has topped bestseller lists since it first appeared. One financial institution bought several hundred copies, and it has been a must-read for Ottawa's mandarins. Why? Because it looks into the future and, moreover, gives us hope. The authors promise to provide information that will help readers profit from the coming demographic shift.
Foot, an economist and demographer at the University of Toronto, is a popular speaker and consultant. Stoffman, an award-winning journalist, first met him while preparing a magazine profile.
Futurology has always been a beguiling science, and often is as accurate as tea-leaf reading. The people who specialize in it rely on different methods, from focus groups and public-opinion surveys to analysis of newspapers. Those methods may produce valuable insights, but the use of demographics provides something we can all understand.
Consider lipstick. In retrospect, it all seems blindingly obvious why demand for bright lipsticks started shrinking around 1993 just as sales of skin-care products started to rise. With the aging of the baby-boom generation, the cosmetics market was changing. The number of customers in their 30s and 40s who were starting to count their wrinkles was growing, and many were prepared to spend large amounts on anti-aging creams. At the same time, the number of women in their teens and 20s who wanted war paint was shrinking. You don't need an advanced degree to understand this, yet when the change happened it took cosmetics companies off guard. Will the same thing happen with health care?
Foot and Stoffman devote an entire chapter to the topic. It's provocative stuff, but as they point out demographics only explains two-thirds of everything -- the remaining one-third may be the decisive factor in shaping events because counting bodies will never predict the arrival of a wonder drug, the breakup of the country or the emergence of a new left-wing messiah. Still, the authors' observations might offer food for thought to all provincial planners hell-bent on cost-cutting.
Most of the predictions seem credible, and the policy analysts I ran them by largely agreed with them. But there are cavils. Aging baby boomers are much healthier than their parents, so will probably require fewer health care services in their 50s and 60s than their heavier-smoking and heavier-drinking predecessors. And hospitals are being closed not only to save money but also because we no longer think hospitals are the right place to deliver a lot of medical care. As well, for the next several years the political ramifications of an expanded private health care system may be too great for any government to swallow. Adjustments aren't going to be made until the I-want-my-service-now brigade shouts louder than the don't-touch-medicare lobby. This will likely happen when the majority of baby boomers is older than 50.
In most chapters Foot and Stoffman simply make their predictions and then move on to the next area. However, in the chapter entitled "The health care crunch" they agonize about the privatization issue. They ask why both Canadians and foreigners shouldn't be allowed to buy any health service they want in Canada, thereby giving highly trained physicians an incentive to stay and generate export wealth for the economy while taking pressure off the public system and reducing delays. They point out that the distinction between essential and nonessential in the Canada Health Act is becoming increasingly arbitrary as medical science advances. Why not simply allow all medical services to be purchased privately by those willing to spend the money?
However, they do warn that care must be taken by acknowledging medicare's significance in our national life. "Canadians value medicare not just because they need it, but because it brings them together as a national community."
The duo see the health care field as fertile territory for canny investors. "Canadians' bodies are beginning to wear out just as governments are putting a lid on health care expenditures. The confluence of these two events creates an opening that private industry is sure to exploit."
There will be growing demand for all the services that hospitals used to provide and that the families of sick people who will now be caring for them cannot supply. These include follow-up treatments and physiotherapy as well as meals on wheels and laundry and house-cleaning services. Companies that offer a full-service package of nursing care, meals and home help are going to do well.
The most promising investment is probably drug-company stocks. Consider the afflictions affecting elderly people. AIDS won't be on the list but prostate problems will be: after age 60, 10% of men experience serious urinary problems because of enlarged prostate glands. Drugs and medical devices that help these patients will find a huge market.
According to Boom, Bust & Echo, the real winners are the companies that are already producing pills, patches and creams that supply estrogen. The debate about whether to take estrogen is interesting because it highlights a conflict between two values near and dear to the heart of the baby-boom generation.
On the one hand is the high status given to things natural, and isn't menopause a natural part of every woman's life? Proponents of this view, such as Germaine Greer, argue that it is wrong to turn a normal life event into a condition that requires long-term drug therapy.
On the other hand, there is the urge to feel and look good that has made so many plastic surgeons and cosmetics companies smile. Proponents of hormone replacement therapy (HRT) argue that it provides long-term health benefits by lowering the risk of heart disease and osteoporosis. "With the front end of the baby boom entering its menopause years, this debate will be with us for many years to come." And so will the demand for HRT products.
Foot and Stoffman offer other nuggets of insight. Older, affluent customers like smaller specialty shops, and this could mean trouble for places like Wal-Mart and the Price Club because an aging market won't want cheap stuff in bulk -- they'll be looking for service and quality.
Predictions about the future are both fun and dangerous. What doctor, gazing into the crystal ball 25 years ago, would have predicted the arrival of AIDS, or the looming large-scale use of artificial hearts? The predictions Foot and Stoffman make about health care are interesting because they anticipate how the attitudes of an aging population are going to change as people's own health care needs become more pressing.
The lesson, I suppose, is that we all want to survive as a national community, but more immediately we all want just to survive.