Global Health Then and Now
The world has become healthier over the past few centuries, but new challenges are on the horizon.
Since early 2020, COVID-19 has dominated international headlines. But even amid this global pandemic, it's worth taking stock of just how far the world’s health-care systems have come in two centuries.
In 1800, for example, global life expectancy was estimated to be just twenty-nine years. Today, global life expectancy is nearly seventy-three years. That means that in just two short centuries, the average length of our lives has more than doubled, thanks to great strides in areas such as medical research, sanitation, and vaccines.
These gains reflect the world’s increased commitment to global health. New organizations and funding focused on global health have steadily grown. Hundreds of different governmental and nongovernmental organizations (NGOs), international organizations, governments, funds, and initiatives—such as the Gates Foundation, Doctors Without Borders, and the World Health Organization—now work on these issues. For example, Gavi, a vaccines-focused public-private partnership, has helped vaccinate over 822 million children since it was founded in 2000.
Some infectious diseases no longer pose major threats.
For thousands of years, smallpox ravaged parts of the globe, killing about one-third of those who caught it. But better science led to a new vaccine, which, combined with funding and political will, resulted in the official eradication of the disease in 1980. As recently as 1967, two million people died from smallpox annually; now, no one does.
Polio has almost been eradicated too, although not entirely. Just 30 years ago, polio was common in 125 countries. Today, it’s endemic to just two: Afghanistan and Pakistan. Polio persists in large part because of the difficulty in delivering vaccines to these countries, either for geographic reasons—many people live in rural areas or move around frequently—or for political reasons, such as local mistrust of Western NGOs.
Despite a century of progress, infectious diseases remain a threat. And global health gains haven’t been uniform.
Important progress has been made in preventing and treating HIV/AIDS. Deaths from HIV/AIDS have been nearly halved in just ten years. New HIV infections have also fallen, and as of June 2020, about twenty-six million people with HIV were accessing antiretroviral therapy—up significantly from just eight million in 2010. But nearly forty million people still live with HIV/AIDS, the majority of them in Africa, despite a large coordinated effort to counter this epidemic.
Nor are these gains permanent.
Maternal and infant deaths have declined extraordinarily since 2000, when child mortality and maternal health became priorities for the Millennium Development Goals. Since then, governments, NGOs, and private partners have invested in more programs, such as sex education, nutrition, and pre- and postnatal care, that help mothers and babies stay healthy. More families also have access to better clinics and trained health professionals. But in the United States, maternal mortality is rising—the only industrialized country where that is the case—with pregnancy-related death rates highest among Black women.
While a century of progress can’t be discounted, the world continues to face health challenges.
In fact, a major health crisis is upon us—the deadly, infectious disease COVID-19, which spread across the world at light speed.
Meanwhile, the world is combating the rise of noncommunicable diseases (NCDs). Heart disease is now the biggest killer in the United States—it causes one in every four deaths. This statistic mirrors a global trend. In 2000, just four out of the top ten causes of death worldwide were NCDs; by 2019, that number had grown to seven out of ten. Worldwide, nearly three-quarters of all deaths now result from NCDs.
In the United States, these illnesses disproportionately affect people of color. For instance, Black and Hispanic/Latinx Americans face higher rates than white Americans of high blood pressure, obesity, and diabetes—dangerous conditions, which can also make COVID-19 even more threatening. About 90 percent of Americans hospitalized with coronavirus in March 2020 had one of these or similar preexisting conditions.
But new kinds of diseases bring new challenges—not only to people affected by them but also to the web of organizations and governments dedicated to tackling global health problems. For example, most people ultimately die due to an NCD, but most global health funding doesn’t target NCDs. Because NCDs are a relatively new challenge that are often correlated with lifestyle factors—including rising income—and require longer-term care and treatment, funding hasn’t caught up with the need. Moreover, infectious diseases are often a more attractive intervention area for donors: a specific, quantifiable problem that can be targeted in a more straightforward fashion, such as with a vaccine or mosquito nets.
The questions surrounding how best to treat NCDs and how to tackle other emerging health challenges are emblematic of a shift occurring in the global health field: the idea that health is about more than just doctor visits and vaccinations. In fact, a range of issues—including poverty, gender equality, systemic racism, and climate change—affect a person’s health and their vulnerability to NCDs. Advances in these related areas mean progress in global health too.