ing a challenge to the sustainability of systems designed to support older persons. If the trend toward increased longevity continues without a parallel extension in working life, the stress on these systems could be even greater.
As discussed elsewhere in this volume, labor force participation, investment and saving behavior, and provision of health services are complex phenomena that are interrelated at both the individual and societal levels (Quinn and Burkhauser, 1994; Smith, 1999). For example, incentives provided by government and employers play important roles in determining labor force participation. Reducing the implicit tax on continuing work beyond the normal age of retirement and reducing the costs of hiring (and possibly retraining) older workers have the potential to encourage longer working lives (see Chapter 3). Yet in designing such incentives, policy makers need to know how long they can reasonably expect people to keep working. Just how physically and mentally capable are older people? What is the trajectory of health and function as people age? Can their productivity be maintained and enhanced at older ages, and at what cost? Does the type of productivity and engagement change with age? How can health care services be provided in such a manner as to maintain optimal health and function? Most basically, policy makers must make difficult decisions about the allocation of limited resources to preserving and improving health. How is good health achieved at a reasonable cost? Should more resources be directed toward behavioral change and other health promotion and disease prevention programs, including health enhancement in early life, or should more be dedicated to the treatment of patients with advanced diseases? How much should be invested in the development of new health care technologies, service delivery enhancements, and professional training?
A focus on national-level health status and its temporal trajectory is critical for several reasons. Health status is one of the most important indicators of well-being, and it predicts a large proportion of societal expenditures on health and social services for the elderly. Health status is also reciprocally affected by social and political policies and programs. Further, health status is malleable through high-quality health promotion and disease prevention programs, as well as effective medical services. National programs and policies that may appear to be devoted to health and health services for older persons often have important implications for and complex interactions with other economic sectors. Table 6-1 provides examples.
This chapter is devoted to the centrality of health status and change in informing health, social, and economic policy formulation. We first outline the key issues to be addressed by research on the health status of the elderly. We then present a conceptual model of the determinants of health