The next big thing: Public health's biggest concerns

Experts worry about the future impact of the nation's obesity epidemic. But what other scary possibilities -- exotic infections, systemic gaps or the altogether unknown -- keep them up at night?

By Stephanie Stapleton, AMNews staff. May 17, 2004.

When it comes to the future, public health experts have a lot to worry about. Obesity and chronic disease, already high-ranking causes of death and disability, threaten to increase at exponential rates.

But what other scary possibilities keep them up at night?

There's the gnawing reality that everything old could be new again. Diseases once thought conquered have the potential to find new footing if complacency takes over.

Societal changes also might give rise to new or stronger infections -- a chance that leads to questions about the health system's ability to respond. Meanwhile, there is the recognition that biological attacks once unimaginable are no longer so.

Those in the know agree that contemplating these kinds of threats and challenges could be useful. Still, crystal ball gazing has its limits.

"If you would have asked someone in the 1970s what big problem was going to happen, I don't think anyone would have predicted AIDS," said Peter Beilenson, MD, MPH, Baltimore's health commissioner. So with all of today's unknowns, prevention and planning are more important than ever. "As long as we have a decent public health infrastructure and are fairly flexible, hopefully, we'll be able to deal with [whatever comes]."

High on almost everyone's list of concerns is obesity -- a current epidemic that literally looms even larger in the future.

Results of the 1999-2000 National Health and Nutrition Survey indicate that an estimated 64% of Americans are now overweight or obese. And despite national health objectives to reverse the obesity trend, research shows that the problem is worsening.