jason lee / reuters Against medical advice: a miner smoking in Heilongjiang Province, China, October 2015.

Health Without Wealth

The Worrying Paradox of Modern Medical Miracles

For the first time in recorded history, bacteria, viruses, and other infectious agents do not cause the majority of deaths or disabilities in any region of the world. Since 2003, the number of people who die each year from HIV/AIDS has fallen by more than 40 percent. Deaths from malaria, tuberculosis, and diarrheal diseases have fallen by more than 25 percent each. In 1950, there were nearly 100 countries, including almost every one in sub-Saharan Africa, South Asia, and Southeast Asia, where at least one out of five children died before his or her fifth birthday, most of them from infectious diseases. Today, there are none. The average life expectancy in developing countries has risen to 70.

But the news is not all good. In the past, gains in longevity went hand in hand with broader improvements in health-care systems, governance, and infrastructure. That meant the byproducts of better health—a growing young work force, less deadly cities, and a shift in countries’ health-care needs to the problems of older people—were sources of wider prosperity and inclusion. Today, improvements in health are driven more by targeted medical interventions and international aid than by general development. Without that development, the changes that now accompany declines in infectious diseases are potential sources of instability: rising youth unemployment, overcrowded and underbuilt cities, surging rates of premature chronic diseases, and more migration.

Many developing countries are not investing enough to ensure that children who survive past adolescence get a good education, solid job opportunities, and high-quality health care as adults. Many rich countries, meanwhile, are embracing policies on trade, immigration, and climate change that make those tasks even harder.

There is a paradox in humanity’s progress against infectious diseases: the world has been getting healthier in ways that should make us worry. The recent hard-won gains threaten to bring a host of new and destabilizing problems. Whether the dramatic improvements in global health turn out to be a blessing or a curse depends on what the world does

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