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As we move into the 21st century, much has been written about what the new millennium will bring. Forecasters have made detailed projections about world demographics and what the population will look like in terms of disease, activity levels, and health in the next quarter of a century. Dramatic changes are expected in the field of medicine that will impact the manner in which diseases are diagnosed and treated. There are large initiatives already in place in the United States, aimed at prevention and wellness, which project into the next decade. Information technology, an area where health care companies are beginning to invest heavily, will revolutionize how we communicate and utilize information.

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This chapter will examine forecasts made for the next 20 years or so to create a picture of health care in the future and relate it to the practice of cardiopulmonary physical therapy. Many questions come to mind when one thinks so far into the future. What will the profile of a physical therapist look like in the year 2030? In what environments will therapy be practiced? How will physical therapists use new information technologies? There is no doubt that those just entering the field of cardiopulmonary physical therapy will witness a wide variety of change in the next 20 years. This chapter will attempt to prepare both the new and experienced therapist to meet the challenges of tomorrow's health care environment.

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Let us begin by looking at the world at large, to examine the changes anticipated in the growth of the population. Most demographers agree that the population of the world will continue to grow from its present 6.6 billion people to approximately 9.4 billion in 2050. The incredible fact is that 212,036 people are being added to the world's population each day!1 United Nations forecasting predicts global population to peak at 11 billion in the year 2200. The total population in industrial countries is expected to decline, whereas 60% of the increases will take place in Asia, China, India, and Africa. Countries with the highest growth rate will feel the greatest impact on their public health system. Unfortunately, most of the world's population growth is projected to occur in the most distressed regions, where destruction of land, lack of food, and water will have a major impact on the health of the inhabitants.25

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Aging Demographics in the United States

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Age composition of the United States will change dramatically as we move further into the 21st century. By the end of the 1990s, one in every four persons was aged 50 years or older. The United States Bureau of the Census projects a moderate increase in the elderly population until 2010, then a rapid increase for the next 20 years to 2030, and then a return to a moderate increase in the years 2030 to 2050.6 This is based on population momentum, more commonly referred to ...

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