Dementia — that is, irreversible and usually progressive destruction of the brain in old age, the causes of which have yet to be identified - is arguably the most significant single problem currently facing the health services. Ten per cent of the population aged 65 years and over (more than 700,000 people) are affected by the condition (s) and of these about half exhibit symptoms of a severe degree.
In the richer nations of Europe and North America the gaining of control over the common infectious illnesses was a long, gradual process. It was initiated by improvements in the diet available to the mass of the people, coupled with public health measures like the provision of clean water supplies and adequate sanitation. Subsequently the attack was driven home by advances in both curative and preventive medicine. Amongst the most significant of these were the development of effective and safe immunising techniques.
More people of working age who are in hospital or disabled in the community suffer from schizophrenic illness than any other potentially handicapping condition. In the UK approaching 150,000 people are affected at any one time. The annual cost of their health and social care alone is some £200 million.
Over the past few years serious efforts have been made in Britain and elsewhere to achieve a more rational distribution of health care resources. It has often been assumed that an optimum supply of health care facilities could be achieved by the measurement of objective health care needs, and that, then, these resources could be fairly allocated to those requiring them. Unfortunately, well intentioned as these attempts have been, the reality is that the problem is much more complex.
On each day in 1976 in England and Wales approximately forty-one people died and thousands more were either severely or slightly injured as a result of accidents. Such occurrences generate substantial social and economic costs which are borne not only by accident victims themselves but also by their relatives and the community as a whole. A growing appreciation of the extent of these burdens and of the potential for preventing a significant proportion of accidental injuries and fatalities has in recent years drawn much public and professional attention to the problem.
In 1978 the cost of the National Health Service in the United Kingdom will rise, to an estimated record level of £8,000 million. Even when adjusted for the falling value of the pound this means that the NHS costs three times as much as when it was first established. However, public spending in other sectors like education has risen to a similar degree and in the past decade the outlay in the NHS has remained constant at about 10 per cent of all public expenditure, less debt interest.
Most of the 600,000 babies born in England and Wales each year are healthy and have before them the prospect of active lives spanning seventy years or more. A proportion of these infants, however, possess impairments, present at or arising during or immediately after delivery which may lead to severe temporary or permanent handicaps. The most frequently occurring of these impairments, involving physical and/or mental disability, are the subject of this paper.
In the financial year 1976-77 over £220 million was spent on health care research in the United Kingdom. Taking account of recent expenditure growth and making an allowance for less readily identifiable contributions it may be estimated that total health care research spending is currently approaching the £300 million mark. In real terms this is an almost twofold increase on the £80 million (£172 million at 1976 prices) recorded at the beginning of the decade.
This paper analyses the occurrence and causes of reduced mental ability and its handicapping consequences with the objective of highlighting those areas where there is most opportunity for either preventing its incidence or alleviating the distress it generates.