PRB

Early onset chronic disease, a growing caregiving gap, and climate change are among the major trends affecting the health and well-being of older Americans and their families, according to leading scholars from across the country.

Before a standing-room-only crowd at the 2025 meeting of the Population Association of America in Washington, D.C., experts identified seven key themes that are challenging policymakers, planners, and families as the U.S. population rapidly ages.

1. U.S. Life Expectancy Gains Have Stalled, Lagging Behind Other Higher-Income Countries 

The United States has experienced the earliest and greatest slowdown in life expectancy improvements among higher-income countries, reported Eileen Crimmins of the University of Southern California/University of California-Los Angeles Center on Biodemography and Population Health.

“We have horrible life expectancy—and it’s getting worse and worse,” she said, pointing to the diverging line for the United States in Figure 1. Though premature deaths from heart disease and stroke have declined, Americans today are unhealthy for a longer portion of their lives, coping with chronic diseases and conditions such as diabetes, hypertension, arthritis, cancer, and heart problems.

While we “have a long way to go” to improve the health of the U.S. population, Crimmins said, new research into biomarkers gathered through blood and other medical tests is offering clues into what speeds up or slows down the aging process, including stress levels, income, and social connections over a lifetime.

Figure 1: The United States Experienced the Earliest and Greatest Slowdown in Life Expectancy Improvements Among Higher-Income Countries

Trends in Life Expectancy Among 23 Higher-Income Countries, 1980-2024

Source: United Nations, World Population Prospects.

2. Americans Are Spending More of Their Later Years With Chronic Diseases Rooted in Their Early Lives

While advances in health care have succeeded in preventing many early deaths, older people are spending more time living with chronic diseases today than two decades ago, Crimmins’ forthcoming research shows. Americans spent more years after age 65 living with diabetes, cancer, heart disease, arthritis, and high blood pressure in 2018 than in 1998, she has found.

Scott Lynch of the Duke Center for Population Health and Aging agrees. Over the past century, complex chronic conditions like cardiovascular disease and cancer have replaced infectious diseases like pneumonia and tuberculosis as the leading causes of death, he noted. In addition to biomarker research, longitudinal studies that follow individuals over decades have contributed to a growing understanding that events and conditions in childhood and adolescence shape health and lifespans in adulthood and old age, he said.

Improving the health of children and young people has profound effects later in life, argued William Dow of the Center on the Economics and Demography of Aging at the University of California, Berkeley. He pointed to new research showing that people with Medicaid insurance in childhood have better health as adults. “By reducing disability and keeping people in the labor force, Medicaid is actually paying for itself,” Dow said.

3. The United States Faces a Caregiving Crisis As the Cadre of Traditional Caregivers Shrinks

Family members provide most of the care that enables older people to live safely in their own homes, said V. Joseph Hotz of the Center for Healthy Aging Behaviors and Longitudinal Investigations at the University of Chicago. Among care recipients ages 65 and older, 69% receive only informal home care from friends and relatives, whereas just 5% receive only formal paid home care  (Figure 2).

But a care gap is emerging as the baby boom generation ages. The traditional caregiver population (ages 45 to 64) is shrinking while the number of oldest-old Americans—those most likely to need care—is growing. By 2040, there are expected to be just three traditional caregivers per person ages 80 or older—down from a 6:1 ratio in 2025, according to Census Bureau projections.

But there is some good news, Hotz adds. While research finds that adult children feel less obliged to care for stepparents, new evidence suggests that an increasing share of adult children are stepping up when older parents are in need (for example, having trouble buying food). His own analysis shows that childless older people received as much help from their siblings, other relatives, and friends as their peers received from their adult children.

Figure 2: Most Older Americans Receive Only Unpaid Help From Family and Friends

Type of Care Received by Adults Ages 65+ and 85+

Source: Jonathan Gruber and Kathleen M. McGarry, “Long-term Care in the United States,” National Bureau of Economic Research, Working Paper 31881, November 2023, DOI 10.3386/w31881.

4. Older Adults’ Social Ties Are More Important to Health and Longevity Than Many Realize

Compared with their peers who have supportive families and robust social networks, socially isolated older people face a greater risk of early death, dementia, heart disease, diabetes, and a host of other conditions, explained Debra Umberson of the Center on Aging and Population Sciences at the University of Texas at Austin. “The evidence is increasingly convincing, overwhelmingly persuasive,” she said.

Inflammation, depression, hypervigilance, alcohol consumption, and the disadvantages of lower levels of education all play a role in poorer outcomes among older adults, Umberson said. Social isolation is a modifiable risk factor; the challenge is “identifying who is most at risk, why, and what can be done.”

Research suggests that “isolation begins to increase as early as adolescence and continues steadily through the life course,” she reported. Black Americans, people living in poverty, and sexual and gender minority populations tend to experience higher levels of isolation than other groups. Experiencing the death of a family member, extreme weather events (like Hurricane Katrina, which dispersed community members), pandemics (as we saw with COVID-19), incarceration, and deportation can also disrupt families and communities.

5. Medicare Advantage Plans Could Lead to Cost Savings and More Home-Based Services, But May Shift More Caregiving to Families

In 2024, more than half of Americans ages 65 and older (54%) were enrolled in the Medicare Advantage program, up from just 19% in 2007. The dramatic change from a fee-for-service model to a privately run managed care model has vast implication for aging Americans, said Dan Polsky of the Johns Hopkins’ Economics of Alzheimer’s Disease and Services (HEADS) Center. Medicare Advantage plans may offer efficiency and flexibility that can lower recipients’ costs and increase access to home-based care, which most Americans say they prefer, according to Polsky. But new findings by Lauren Nicholas suggest that unpaid family caregivers may be providing more end-of-life home care for people with dementia, essentially moving costs from the formal system of payment to unpaid family members, he reported.

At the same time, traditional Medicare is not without innovations: A new program is exploring ways to meet the health care needs of both people with dementia and their caregivers, Polsky noted.

In the pipeline are new disease-modifying pharmaceutical treatments for dementia, but they require an early diagnosis, which only a fraction of people receive. Should these treatments scale, it could cost the Medicare program tens of billion dollars a year, presenting an additional challenge to the already-strained Medicare budget. Implementing new early diagnosis techniques and providing cost-effective new treatments will present complicated hurdles for the health-care delivery system, Polsky suggested.

6. Americans Caring for Relatives With Dementia See Increasing Demands on Their Time and Constraints on Their Employment

The more than 5 million family members and friends who provide unpaid care for older adults with dementia have high—and increasing—demands on their time, reported Jennifer Wolff of the HEADS Center, based on her team’s research using nationally representative data.

On average, the time that family caregivers spent helping older adults with dementia grew by almost 50% between 2011 and 2022, going from 21 hours per week to 31 hours (Figure 3). By contrast, time spent assisting older adults without dementia fell during the same period.

Wolff and team show that more than half (52%) of dementia caregivers lived with the person they were caring for in 2022, up from 39% in 2011. And the share able to hold jobs—outside their caregiving work—dropped from 43% to 35% during the same period.

Noting that the number of individuals affected by dementia is projected to triple in the next 30 years, Wolff underscored the importance of monitoring unpaid caregivers and developing interventions to support them. Some strategies could include providing direct financial assistance and tax relief, supporting flexible work arrangements and paid family leave, and using digital tools and remote monitoring technologies to help caregivers manage care more efficiently and connect with support networks.

Figure 3: Family Caregivers Are Spending 50% More Time Caring for Older Adults With Dementia

Average Weekly Family Caregiving Hours, by the Dementia Status of Older Adults (65+), 2011 and 2022

Source: Jennifer L. Wolff, Jennifer C. Cornman, and Vicki A. Freedman, “The Number of Family Caregivers Helping Older US Adults Increased From 18 Million to 24 Million, 2011–22,” Health Affairs 44, no. 2 (2025): 189-95.

7. Extreme Weather Events and Warmer Temperatures Pose Unique Challenges for Older People

More devastating fires, storms, and hurricanes, along with greater climate variability are the “new normal,” said Elizabeth Frankenberg of the Carolina Population Center at the University of North Carolina at Chapel Hill.

People who experience these events not only face an increased risk of death and disease but also lost livelihoods, diminished assets, and poor quality of life for months, years, and even decades to come, she noted.

Older people can be uniquely vulnerable due to reduced physical mobility, cognitive decline, diminished temperature regulation, and changes in economic resources, access to safety net programs, and the availability of social and family networks. Further, their ability to cope with change may be influenced by anxiety around uncertainty, a deep attachment to where they live, and difficulty making life-changing decisions.

To effectively plan for, mitigate, and adapt to severe weather events and temperature changes, demographers should team up with engineers to better understand the level of vulnerability in specific risky locations, Frankenberg said. For example, older people with lower incomes and limited mobility may need emergency support in places with rising sea levels or that are prone to wildfires.

How Future Research Can Address Unanswered Questions About Population Aging

The experts noted several promising areas for future research that can improve the health and well-being of older adults, including:

• Advanced data collection: Expand the use of wearables, MRIs, sound files, and other innovative data collection methods to better understand social interactions and biological processes.
• Macro-level demographic analysis: Better integrate micro-level research on households and individuals with population-level questions and policy implications.
• Biological mechanisms of aging: Focus on understanding physiological dysregulation, molecular and cellular changes, and other factors that determine fast versus slow aging trajectories.
• Early-life interventions: Evaluate social and economic interventions earlier in the life course to prevent later health problems.
• Real-world care delivery for people with dementia: Study how new diagnostic technologies and treatments can be effectively integrated into primary care systems.
• Measurement harmonization: Develop better methods to harmonize measures of dementia across different surveys and data sources.
• Root causes of isolation: Better understand why people become isolated, focusing on people, place, climate, and social disruption factors.
• Caregiving workforce: Better quantify and understand the economic value of unpaid family caregiving as the care-to-support ratio declines.
• Medicare Advantage impacts: Study how the shift to private Medicare plans affects care quality and costs, especially for vulnerable populations.

The researchers emphasized that many of these priorities require sustained investment in longitudinal data collection and interdisciplinary collaboration across aging research centers.

The scholars featured above lead many of the 15 research centers on the demography and economics of aging and Alzheimer’s disease and Alzheimer’s related dementias supported by the National Institute on Aging (NIA) of the National Institutes of Health for the past 30 years.

A coordinating center based at the University of Michigan supports the dissemination of findings from the centers in partnership with PRB.

As the large Baby Boom generation enters advanced ages, more family members and other unpaid helpers are stepping in as caregivers. In just over a decade, the number of family caregivers regularly assisting older adults with daily activities at home grew by 32%, increasing from 18.2 million to 24.1 million between 2011 and 2022.¹

While the caregiving cadre has grown, who’s getting care has also changed. Older Americans receiving family care are younger, better educated, and less likely to have dementia than they were in 2011, report Jennifer L. Wolff of Johns Hopkins University, independent consultant Jennifer C. Cornman, and Vicki A. Freedman of the University of Michigan.

The increase in family caregiving partly reflects the rising share of older adults with multiple chronic conditions, such as heart disease, hypertension, stroke, and cancer. And while the share of older adults with dementia has declined, unpaid caregivers average twice as many hours each week caring for people with dementia than without dementia (about 31 hours versus 14), Wolff and team found (see Figure 1).

In addition, a new study estimates that the number of new dementia cases will double over the next 40 years as the population ages—setting the stage for more demands on dementia caregivers and more changes to the caregiving landscape.

“Understanding the changing composition and experiences of family caregiving has never been more important, but it is challenging to assess,” the researchers write. “[It] requires consistent measurement for well-characterized, generalizable samples of people who receive and provide help.”

The nationally representative National Study of Caregiving and the National Health and Aging Trends Study offer important insights. The two studies provide a snapshot of the family caregivers that help Americans ages 65+ who live in the community (i.e., at home or with a relative) or in a residential care setting other than a skilled nursing facility, such as an assisted or independent living facility, a personal care home, or a continuing care retirement community.

Family caregivers include relatives and unpaid helpers, like neighbors and friends, who assist with personal care tasks like bathing and dressing; mobility tasks like getting out of bed and getting around the house; and household activities such as laundry, food preparation, shopping, and managing money.

Dementia Caregivers See Increasing Demands on Their Time, Employment Woes

On average, the time that family caregivers spent helping older adults with dementia increased by almost 50% over the decade, rising from 21.4 hours per week in 2011 to 31.0 hours in 2022. By contrast, time spent assisting older adults without dementia fell from 15.3 hours a week in 2011 to 13.9 hours in 2022 (Figure 1).

Figure 1: Family Caregivers Are Spending 50% More Time Caring for Older Adults With Dementia

Average Weekly Family Caregiving Hours, by the Dementia Status of Older Adults (65+), 2011 and 2022

Source: Jennifer L. Wolff, Jennifer C. Cornman, and Vicki A. Freedman, “The Number of Family Caregivers Helping Older US Adults Increased From 18 Million to 24 Million, 2011–22,” Health Affairs 44, no. 2 (2025): 189-95.

People caring for older adults with dementia have high—and increasing—demands on their time. More than half (51.7%) of dementia caregivers lived with the person they were caring for in 2022, up from 39.4% in 2011, Wolff and team report. And the share able to hold jobs—outside their caregiving work—dropped from 42.5% to 34.6% during the same period.

Among caregivers with formal jobs, the share who reported challenges with their employment—including working fewer hours or being less productive—increased over the decade, regardless of whether they cared for someone for dementia.

“Challenges are exacerbated when caregivers are in poor health themselves; have a lack of choice in assuming the caregiving role; and, for the substantial proportion of family caregivers who are employed, work in low-wage jobs with limited flexibility,” the researchers note.

Care Recipients Are Mainly Older Women, but the Share of Men Receiving Care Is Growing

Which older Americans get family care? As in the past, they tend to be female, non-Hispanic white women who are married or widowed. But growing numbers of family care recipients are male and have some college education. More are also separated and divorced compared to 2011, reflecting national trends.

Adult Children Continue to Care for Their Parents

Who’s providing care? Family caregivers continue to be largely female and married, and most report being in good health. In 2022, adult children still made up the largest share of family caregivers for older adults, at 40.7%, but this represents a significant decline since 2011 (Figure 2).

Figure 2: The Share of Adult Children Caring for Older Relatives Has Declined

Relationship of Family Caregivers to Adults Ages 65 and Older Receiving Care, 2011 and 2022

Source: Jennifer L. Wolff, Jennifer C. Cornman, and Vicki A. Freedman, “The Number of Family Caregivers Helping Older US Adults Increased From 18 Million to 24 Million, 2011–22,” Health Affairs 44, no. 2 (2025): 189-95.

In 2022, adult children accounted for about half (49.1%) of family caregivers for older adults with dementia, compared with 38.4% of caregivers for those without dementia. Just 17.7% of family caregivers for older adults with dementia were spouses, compared with 24.5% of family caregivers for people without dementia.

A sizeable share of family caregivers (17.0%) had children under age 18 at home in 2022, and 6% to 13% viewed their care responsibilities for older adults as a source of financial, physical, or emotional difficulty.

Despite these challenges, the researchers report a decline in the use of support groups (4.1% to 2.5%) and respite services (12.9% to 9.3%) between 2011 and 2022.

Trends and Policy Implications

Many caregivers face extraordinary demands and should be the focus of support services, Wolff and colleagues say. They single out those caring for older adults with dementia or nearing the end of life, as well as caregivers “from racial and ethnic minority groups who are more likely to assist people who have extensive care needs in circumstances that involve scare economic resources.”

Family care needs are likely to rise as the number of U.S. adults ages 85 and older is  projected to triple by 2050. The researchers note that the number of family caregivers rose even as the long-term use of skilled nursing facilities among older Americans dropped and community living increased. The challenges these caregivers continue to face is “sobering,” they write, including competing time demands from work and child care while spending an average of 17 hours per week on care. In addition, about 1 in 8 family caregivers report financial, physical, or emotional difficulties related to their caregiving roles, percentages that were largely unchanged over the 11 years examined.

Policies and programs to help reduce the financial, physical, and emotional burden of caregiving exist, but do not represent a coherent strategy, the researchers say. “Local, state, and federal policies are a patchwork that is uneven in availability and largely symbolic in magnitude,” they argue. Addressing the needs of family caregivers will require a “cohesive framework in support of the care economy.”

New data released today by PRB and the Appalachian Regional Commission shows that rates of labor force participation, educational attainment, income, and poverty continue to improve in Appalachia.

The 14th annual update of The Appalachian Region: A Data Overview from the 2018-2022 American Community Survey draws from the latest American Community Survey and comparable 2022 Census Population Estimates. Known as “The Chartbook,” the report contains more than 300,000 data points comparing Appalachia’s regional, subregional, state, and county economic status with the rest of the nation.

Key improvements in the region’s economic indicators are as follows.

Increased income and lower poverty rates

• Poverty rates declined in every Appalachian subregion, state, and type of county (urban and rural). The region’s overall poverty rate (14.3 percent) decreased two percentage points between 2013-2017 and 2018-2022.
• Median family income increased 9.3 percent between 2013-2017 and 2018-2022, which was on par with national median income growth.
• All income measures increased for every subregion, state, and type of county (urban and rural)—even after adjusting for inflation.

Higher educational attainment and labor force participation

• The share of individuals ages 25 and older who held Bachelor’s degrees increased by three percentage points, with more than one in four Appalachian adults reaching or surpassing this level of educational attainment in 2022.
• Between 2013-2017 and 2018-2022, labor force participation increased in every Appalachian subregion and type of county (urban and rural).

Increased population growth in south

• Southern Appalachia’s population increased 11.8 percent between 2010 and 2022, which surpassed the nation’s population growth average by more than four percentage points.

Increase in broadband access

• The share of Appalachian households with at least one computer device rose 8.6 percentage points between 2013-2017 and 2018-2022, while the share with broadband internet access increased by 12.2 percentage points. Both increases surpassed the national average, with federal and state programs designed to narrow persistent gaps in digital resources likely contributing to improvements.

“We celebrate the progress Appalachia has made, including declined poverty rates and increased broadband access. However, we know that there is still much work to be done for our entire region to reach economic parity with the rest of the country,” said ARC Federal Co-Chair Gayle Manchin. “ARC will continue to prioritize the quality of life of Appalachia’s 26 million residents, and remains committed to continued collaboration across federal, state, and local levels to ensure our people have a bright future.”

Despite positive trends, several data points revealed vulnerabilities that emphasize the inequities in Appalachia compared to the rest of the nation:

Overall population decline

• Nearly 60 percent (252) of the region’s 423 counties saw a population decline between mid-2010 and mid-2022. Rural counties were especially susceptible—77 of the 107 rural Appalachian counties lost residents.

Poverty rates for children and families and specific counties

• Though regional poverty rates have declined overall, rates have stayed the same or increased in 76 Appalachian counties. Poverty rates are highest for Appalachians under 18 (19.2 percent) and ages 18-24 (22.1 percent).
• Though the percentage of Appalachian households receiving payments from the federal Supplemental Nutrition Assistance Program (SNAP) decreased slightly more than the national average, participation was still higher (over 13 percent) compared to all U.S. households (over 11 percent). Participation of Central Appalachian households reached more than 20 percent.
• For households with children under the age of 18, Appalachia’s SNAP participation rate (21 percent) is nearly three percentage points higher than all U.S. households.

Disability and poverty in older adults

• Appalachia’s population trends older than the nation as a whole, with individuals ages 65 and older reaching at least 19.5 percent in 292 Appalachian counties.
• Additionally, the percentage of Appalachians ages 65 and older with a disability is more than three percentage points higher than the national rate. This was also the only age group for which poverty rates increased slightly.

Despite gains in access, digital divides persist

• Even with higher-than-average increases, Appalachian households still lagged nearly four percentage points behind U.S. rates for broadband subscriptions and device ownership. In 73 Appalachian counties, households were at least 13.3 percentage points below the U.S. average for broadband subscriptions. This gap in high-speed internet connectivity impacts residents’ access to remote work, online learning, telehealth, and more.

“The data in this year’s Chartbook highlight strides being made in the Appalachian Region, with noteworthy improvements across economic, educational, and health-related measures,” said Sara Srygley, a senior research analyst at PRB. “Yet, these data also emphasize considerable variation throughout the region—particularly the persistent challenges facing rural communities.”

The data show that Appalachia’s rural areas continue to be more vulnerable than its urban areas. Appalachia’s 107 rural counties are also more uniquely challenged, compared to 841 similarly designated rural counties across the rest of the U.S. Though rural Appalachians did have higher health insurance coverage than the rest of rural America, rural Appalachian counties continue to lag behind on educational attainment, labor force participation, broadband access, household income and population growth.

The Appalachian Region: A Data Overview from the 2018-2022 American Community Survey was written by PRB and the Appalachian Regional Commission.

In addition to the written report, ARC offers companion web pages on Appalachia’s population, employment, education, income and poverty, computer and broadband access, and rural Appalachian counties compared to the rest of rural America’s counties. For more information, visit www.arc.gov/chartbook.

About the Appalachian Regional Commission

The Appalachian Regional Commission is an economic development entity of the federal government and 13 state governments focusing on 423 counties across the Appalachian Region. ARC’s mission is to innovate, partner, and invest to build community capacity and strengthen economic growth in Appalachia to help the region achieve socioeconomic parity with the nation.

(April 2002) The West Bank and Gaza are unique entities in today’s world. Parts of the two areas consist of a series of autonomous, Palestinian-governed regions. The West Bank, approximately the size of Delaware, is bordered by Israel to the west and Jordan to the east. Gaza (also called the Gaza Strip) is approximately twice the size of Washington, DC, and shares a border with Israel to the north and east and Egypt to the south.

Political History

Britain ruled the area it called Palestine after World War I under a mandate from the League of Nations. Following Britain’s withdrawal in 1948, war broke out between Palestine’s Arab majority and Jewish minority for control of the territory, the former eventually supported by troops from surrounding Arab states. Jewish forces won, and the State of Israel was created from 77 percent of Palestine. Jordan and Egypt took control of the remaining 23 percent. Jordan annexed the area under its control and called it the West Bank; Egypt maintained control over what became known as Gaza but never annexed it. Israel seized both areas during the 1967 Arab-Israeli war, and later annexed East Jerusalem while keeping the bulk of the West Bank and Gaza under occupation. Israel also drew international criticism by erecting more than 180 Jewish settlements in the areas.

As part of the peace process between Israel and the Palestine Liberation Organization (PLO), the two sides signed a series of agreements beginning in 1993 that provided for a limited withdrawal of Israeli forces from parts of the West Bank and Gaza and the establishment of an autonomous, PLO-run government in areas inhabited by Palestinians. The Palestinian Authority (PA) began functioning in 1994.

The two sides deferred negotiations over “final status issues” to a later date. Among these issues were whether the Palestinian-governed regions of the West Bank and Gaza would become an independent state and what its borders would be. The result is that the autonomous Palestinian areas remain locked in an unviable, semi-statal condition. Following the staged Israeli withdrawal, the PA exercises full civil and security control over 80 percent of Gaza. The remainder contains Jewish settlements and is still under Israeli control.

The situation in the West Bank is much more complicated. The Israeli-Palestinian agreements created three zones: Area A consists of territory under the full civil and security control of the PA; Area B is territory under the PA’s civil and partial security control, but Israeli forces exercise predominant control; and Area C remains under full Israeli control and contains the Israeli settlements. By 2000, 17 percent of the West Bank was classified as Area A, 29 percent as Area B, and 59 percent as Area C. Much of the area where the PA exercises some type of control does not form a contiguous territory, however. Gaza is separated from the West Bank, while in the West Bank, Areas A and B are themselves divided among 227 separate areas (199 of which are smaller than 2 square kilometers) that are separated from one another by Israeli-controlled Area C. All but 40,000 West Bank Palestinians live in Areas A and B.

A Young and Growing Population

The population of the West Bank and Gaza is almost completely Palestinian Arab. The bulk of these are Sunni Muslims: 92 percent of West Bankers and 99 percent of Gazans, with the rest Christians. In addition to the Palestinian population, approximately 214,000 Jewish settlers live in the West Bank and Gaza, according to the Foundation for Middle East Peace in Washington, DC [Data are from 2002.]

* Palestinian population only.
Source: US Census Bureau.

The population of the West Bank and Gaza boasts several notable features. The population growth rate is among the highest in the world: 3.4 percent in the West Bank and 4.0 percent in Gaza, according to US Census Bureau estimates. A full 45 percent of the West Bank population are children under 15 years of age, compared with 50 percent in Gaza. Palestinian-controlled Gaza is also one of the most densely populated places on earth with some 4,091 people per square kilometer. Regionally, the Palestinians exhibit high levels of literacy. Among those 15 years and older, the rate is 92 percent for males and 80 percent for females, according to the Palestinian Central Bureau of Statistics. About 825,000 Gazans (78 percent of total) and their descendants are registered refugees from the 1948 war as are 583,000 West Bankers (30 percent of total). Not all refugees reside in refugee camps: 55 percent of Gaza refugees live in 8 refugee camps while only 27 percent of West Bank refugees live in 19 camps.

Life expectancy at birth is relatively high compared with Arab countries. But the territory faces several significant health concerns relating to underdevelopment, the legacy of occupation, and ongoing political turbulence and violence. The Palestinian uprising since October 2000 itself includes a major health problem. Between October 2000 and late February 2002, more than 1,000 Palestinians were killed and over 17,000 injured in clashes with Israelis. Israeli forces have reentered parts of Areas A and B, prevented movement among many Palestinian areas, and laid siege to Palestinian towns. The escalation in tensions between the two sides has resulted in reduced access to health and medical facilities for some Palestinians.

Some economic indicators actually declined during the early years of the peace process and have recently worsened. During 1992-1996, real per capita gross domestic product for Palestinians declined by over 36 percent, because of the combined effects of falling aggregate incomes and high population growth, according to Palestinian Chambers of Commerce, Industry, and Agriculture. The poverty rate in September 2000 stood at 21 percent. During the first three months of the uprising that began in October 2000, the situation worsened as the Palestinian economy contracted by 50 percent and unemployment rose to 40 percent. The Jordan Investment Trust estimates that the economy suffered a total of US$6.8 billion in losses during the first 12 months of the uprising.

Pollution is an environmental and health risk. Of particular concern is groundwater pollution by organic and inorganic contaminants that seep into the aquifers, especially in Gaza. These include untreated sewage (only 38 percent of households are connected to sewage systems), garbage and industrial waste, and fertilizers from agricultural runoff. The West Bank and Gaza also face problems from dumps, including Israeli dumps over which Palestinians have no control.

Michael R. Fischbach is an associate professor of history at Randolph-Macon College in Ashland, Virginia, where he specializes in modern Middle Eastern history.

References

• Palestine Economic Research Institute (MAS), Economic Monitor 5 (June 1999).
• Jordan Investment Trust, Weekly Review & Analysis 1, no. 19 (November 11, 2001).
• US Census Bureau, International Data Base, accessed online at www.census.gov/ipc/www/idbnew.html, through March 20, 2002.
• Palestinian Central Bureau of Statistics (PCBS), accessed online at www.pcbs.org, on April 16, 2002.
• Palestinian Chambers of Commerce, Industry and Agriculture, accessed online at www.pal-chambers.com, on April 16, 2002.

Children and youth with special health care needs (CYSHCN) who receive family-centered care generally have better health outcomes, research shows. When health care providers engage and prioritize the needs of the family, CYSHCN enjoy better overall health; better access to coordinated, ongoing, comprehensive health care within a medical home; fewer emergency department visits; and fewer unmet health needs.

Yet in the United States, CYSHCN families from disadvantaged groups face barriers to receiving high-quality family-centered care, according to a new analysis of national survey data by Paul Morgan, now at the University at Albany, SUNY, and colleagues at Penn State University and SRI International.¹

The researchers assessed family-centered care by measuring the extent to which doctors or other health providers:

• Spent enough time with the child.
• Listened carefully.
• Showed sensitivity to the family’s values and customs.
• Provided the family with specific information they need concerning the child.
• Helped the family feel like a partner in the child’s care.

Data were from the 2016–2019 National Survey of Children’s Health (NSCH), which uses a five-question screener to identify CYSHCN.

The study focused on the quality of care received by CYSHCN families in visits to health professionals in the previous year and controlled for potentially confounding factors including children’s general health status and the severity of their impairments.

Socioeconomic Background Is Tied to the Quality of Family-Centered Care

Morgan and colleagues found that some CYSHCN families report greater barriers to receiving high-quality family-centered health care, including:

• Families without consistent health insurance coverage.
• Poor and lower-income families.
• Single-parent families.
• Families who usually receive care in a clinic or health center, emergency room, or other setting outside a doctor’s office.
• Families of children with autism spectrum disorders, anxiety, or depression.

By contrast, families of CYSHCN with asthma—the most commonly reported special health care need—were significantly more likely to receive family-centered care than families of CYSHCN without asthma.

The results did not show consistent racial/ethnic disparities across all the measures of family-centered care—a finding that surprised the researchers. However, families of Black and Hispanic CYSHCN reported that providers spent relatively less time with their children compared with families of white CYSHCN. Families of Hispanic CYSHCN also said that providers showed less sensitivity to their family’s culture and customs.

A Targeted Approach Could Help Improve Care

Evidence from the study suggests that socioeconomic factors, rather than race or ethnicity, are central drivers of disparities in family-centered care among CYSHCN in the United States. To address these disparities, policies and systems of care serving these young people and their families can adopt comprehensive, coordinated approaches to increase provider-family engagement, cultural responsiveness, and shared decision-making, the authors noted.

To help particularly vulnerable CYSHCN families, targeted actions should focus on care provided in emergency departments, community clinics/health centers, and other non-office settings, and on providers caring for children with autism spectrum disorders or internalizing disorders, the authors suggested.

This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from Penn State University was highlighted.

The current growth of the population ages 65 and older, driven by the large baby boom generation—those born between 1946 and 1964—is unprecedented in U.S. history.

This aging of the U.S. population has brought both challenges and opportunities to the economy, infrastructure, and institutions.

Demographic Shifts

The number of Americans ages 65 and older is projected to increase from 58 million in 2022 to 82 million by 2050 (a 47% increase), and the 65-and-older age group’s share of the total population is projected to rise from 17% to 23%.¹

The U.S population is older today than it has ever been. Between 1980 and 2022, the median age of the population increased from 30.0 to 38.9, but one-third (17) of states in the country had a median age above 40 in 2022, with Maine (44.8) and New Hampshire (43.3) at the top of the list.²

The older population is becoming more racially and ethnically diverse. Between 2022 and 2050 the share of the older population that identifies as non-Hispanic white is projected to drop from 75% to 60%.³

The rising diversity among older Americans can’t match the rapidly changing racial/ethnic composition of those under age 18, creating a diversity gap between generations. In 2022, fewer than half of children ages 0 to 17 (49%) were non-Hispanic white.⁴ But research shows that there is fluidity in how people identify with racial/ethnic categories: Mixed-race Americans (particularly mixed Hispanic and white) increasingly see themselves as part of the white majority.⁵

Positive Developments

Education levels are increasing. Among people ages 65 and older in 1965, only 5% had completed four years of college or more. By 2023, this share had risen to 33%.⁶

Older adults are working longer. By 2022, 24% of men and about 15% of women ages 65 and older were in the labor force. These levels are projected to rise further by 2032, to 25% for men and 17% for women.⁷

The poverty rate for Americans ages 65 and older has dropped sharply during the past 50 years, from nearly 30% in 1966 to 10% today.⁸ The Census Bureau’s Supplemental Poverty Measure, which accounts for non-cash benefits, tax credits, and medical expenses, shows that 14% of older Americans lived in poverty in 2022.⁹

More older adults can meet their daily care needs. Older adults are functioning better on their own, and a shrinking share are living in nursing homes and assisted living settings than a decade ago. Home modifications and assistive devices such as walkers have helped older Americans maintain their independence.¹⁰

Challenges

Gains in life expectancy recently stalled. U.S. life expectancy at birth declined by 2.4 years between 2019 and 2021.¹¹ The drop in life expectancy was driven largely by the COVID-19 pandemic, but deaths from drug overdoses, heart disease, chronic liver disease and cirrhosis, and suicide also played a role.¹² Life expectancy rebounded slightly in 2022, to 77.5 years, but not enough to offset the decline during the pandemic.

Obesity prevalence among older Americans has increased at an alarming rate. In a single generation—between 1988-1994 and 2015-2018—the share of U.S. adults ages 65 and older with obesity nearly doubled, increasing from 22% to 40%.¹³

Wide economic disparities are found across different population subgroups. Among adults ages 65 and older, 17% and 18% of those identifying as Latino and African American, respectively, lived in poverty in 2022—more than twice the rate of those who identified as non-Hispanic white (8%).¹⁴

More older adults are divorced compared with previous generations. The share of divorced women ages 65 and older increased from 3% in 1980 to 15% in 2023, and for men from 4% to 12% during the same period.¹⁵

More older women are living alone. Over one-fourth (27%) of women ages 65 to 74 lived alone in 2023. This share jumped to 39% among women ages 75 to 84, and to 50% among women ages 85 and older.¹⁶

Older Americans face a caregiving gap, especially those with lower incomes and dementia.¹⁷ Demand for elder care is expected to increase sharply with a rise in the number of Americans living with Alzheimer’s disease, which could more than double by 2050 to 13 million, from 6 million today.¹⁸

Social Security and Medicare expenditures will increase from a combined 9.1% of gross domestic product in 2023 to 11.5% by 2035 because of the large share of older adults.¹⁹

Federal budget cuts and tax increases may be inevitable as more members of the large baby boom cohort reach retirement age and become eligible for entitlement programs. Policymakers can invest resources today to reduce poverty and improve the economic outlook for workers. These investments can increase young workers’ future productive capacity and help offset the costs of an aging population.