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Plagues and the Paradox of Progress
Why the World Is Getting Healthier in Worrisome Ways
Global health expert Thomas J. Bollyky explores the paradox in our fight against infectious disease: the world is getting healthier in ways that should make us worry.
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There is a paradox in global health: the extraordinary progress being made in overcoming the bacteria, viruses, and parasites that were pervasive in poor societies is causing new sources of instability and impoverishment that threaten to undo all the good that has occurred.
“For the first time in recorded history, parasites, viruses, bacteria, and other infectious diseases are not the leading cause of death and disability in any region of the world,” writes CFR Senior Fellow for Global Health, Economics, and Development and Director of the Global Health Program Thomas J. Bollyky in a new book, Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways. But the news is not all good.
The recent dramatic declines in plagues and parasites have not been accompanied by the same advances in infrastructure, job opportunities, and governance that have attended health improvements in the past. That means the byproducts of better health—a growing young work force, less-deadly cities, and a shift in countries' health needs to adults—have become potential risks instead of the drivers of prosperity and inclusion that they should be. For improved health to lead to broader progress, it must be embedded in a larger development strategy, including investment in quality health-care and education systems, making cities more livable, and family planning and reproductive health care.
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Today, “the recent gains in infectious disease control in many lower-income nations have been more dependent on international aid and effective medical technologies,” notes Bollyky.
“The growth of many poor world cities is far outpacing their infrastructure, leaving nearly a billion people living in slums. Lack of sufficient jobs for young adults is breeding instability and spurring desperate attempts at migration,” he adds.
While fewer people are dying from plagues and parasites today, “heart disease, cancers, diabetes, and other noncommunicable diseases are increasing rapidly in most developing countries. In 1990, these noncommunicable diseases caused about a quarter of the death and disability in poor nations. By 2040, that number is expected to jump to as high as 80 percent in some of these countries,” he writes.
Bollyky urges policymakers and foreign aid agencies to “make existing aid and health programs less focused on donor-directed inputs—specific disease-reduction targets, years of primary schooling, and ‘dollar a day’ poverty—and more concerned with local outcomes such as learning, capable economies and governments, and better health, especially among the poor and disenfranchised.”
“Global health priorities must also include the noncommunicable diseases and associated health risks that now cause the largest proportion of premature death and disability in lower-income nations,” he writes.
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A Council on Foreign Relations Book
Educators: Access Teaching Notes for Plagues and the Paradox of Progress.
Also explore Bollyky's interactive reports, The Changing Demographics of Global Health, The Future of Global Health Is Urban Health, and Democracy Matters in Global Health.
In the News
The Paradox of Declining Infectious DiseasesLiving Lab Radio
Un Mundo Más Saludable Debe PreocuparnosEfecto Naím
Toward Linking Clinical and Population Health Interventions in Low-Income CountriesAmerican Journal of Public Health
Farewell to the God of the PlagueLancet Infectious Diseases
How Much Should We Be Worried?Lancet
Plagues, Urban Inequality and Restricted BooksBBC
Africa’s Warp-Speed Health Revolution Has an Old ThreatFinancial Times
Plagues and the Paradox of Progress ReviewNature
Fareed Zakaria on Global Health and Noncommunicable DiseasesCNN
Heart Disease Used To Be an Ailment of the Rich. But It’s Now Striking the World’s Poor.Vox
A thought-provoking book that should be required reading for anyone working in public health or public policy arenasLibrary Journal