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Respiratory disease in England and Wales.

There has been concern in recent years about the low priority given to respiratory medicine in the allocation of resources, particularly in relation to staffing'2 and to research.3 It was therefore considered appropriate to assess the burden of respiratory disease in the community and the implications for the health services. This report is a synthesis of the currently available information on respiratory disease, and is focused on England and Wales; in some cases, however (notably with the General Household and the Health and Lifestyle Surveys), it has been impossible to separate the England and Wales data from those for Scotland. Throughout the paper the burden of respiratory disease has been related to all diseases combined rather than to specific disease groups. In 1975, in a discussion on biomedical research priorities, Black and Pole published a report on the health burden imposed by 54 different disease categories.4 Although not primarily concerned with respiratory disease, they ranked it as second in importance to mental illness and mental handicap. Over the last 15 years several important changes have occurred. There has been a steady decline in the proportion of adults who smoke; in 1974 51% of men and 41% of women over 16 years of age were regular smokers, but by 1984 the proportions had dropped to 36% and 32%.5 There has been a continuing shift in the age distribution of the population such that the population aged 75 years or more increased by 24% from 1971 to 1981, but that below the age of 15 fell by 13%.6 The incidence of some diseases (notably tuberculosis) has continued to fall whereas there have been reports