tendency for underprivileged populations to drop out of school, suggest that future generations may fare less well than their predecessors in this regard. Difficult-to-treat infectious diseases continue to emerge and could have a significant impact, especially later in life. What is more, the increasing political and economic pressures on entitlement programs that provide financial security and health care for older persons and the poor may have significant effects on their access to health care.

On the other hand, things could get much better. Continued advances in biomedicine, especially a cure for cancer or Alzheimer’s disease, could have remarkable effects, as would basic advances that slow the process of aging, which remains the major risk factor for disability. Of course, the committee is not interested in disability for its own sake but rather for its effect on the need for personal care services and its impact on the capacity of individuals to work. This latter consideration includes both those in the traditional “working age” category as well as those over 64 who may wish or need to work. In the next chapter the committee presents forecasts it commissioned of the size of the future workforce, including individuals up to age 74, based on several possible trajectories of disability change.

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