Global Health Then and Now
The world has become steadily healthier over the past one hundred years, but new challenges are on the horizon.
Between 1918 and 1919, an influenza pandemic swept the world. It infected one-third of the world’s population and killed between fifty million and one hundred million people—about five to ten times as many people as died in World War I. In the United States alone, the flu killed at least 675,000 and made U.S. life expectancy fall by twelve years.
Global health has made enormous progress in the past one hundred years, thanks to better science and more funding.
The flu is just one example. The short story is that the current scientific understanding, resources, and technology—from new vaccines to better health facilities—can better tackle more diseases affecting an even greater number of people.
But many of these gains are the result of global health becoming an international priority. The focus on global health—now overtly linked to national security, economic prosperity, and climate change—has become a trend in international development. 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 vaccinated 690 million children in less than twenty years since its founding.
The number of deaths from infectious diseases has shrunk significantly.
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—in just one year; now, no one does.
Polio has almost been eradicated too, although not entirely. Just thirty years ago, polio was common in 125 countries. Today, it’s endemic to just three: Afghanistan, Nigeria, and Pakistan. Polio persists in large part because of the difficulty in delivering vaccines to these countries, either for geographical 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 lingering 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 in 2017, about twenty-one million people with HIV had access to antiretroviral therapy—up significantly from just eight million in 2010. But nearly forty million people still live with HIV/AIDS, the vast majority of them in Africa, despite the largest coordinated effort to counter an epidemic in modern times.
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 after years of declining, maternal mortality is rising in the United States—the only industrialized country where that is the case—particularly among black women.
While a century of progress can’t be discounted, the next challenge is around the corner.
What the next health challenge will be or when it will hit cannot be predicted. A new flu pandemic could emerge. As could another outbreak like Ebola or Zika. And with increased resistance to antibiotics, new diseases might be difficult to fight even with the science and technology currently available.
One new challenge, however, is already here—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 1990, just three out of the top seven causes of death worldwide were NCDs; by 2015, that number had grown to six out of seven. Worldwide, 73 percent of all deaths now result from NCDs.
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, and climate change—affect a person’s health. Advances in these related areas mean progress in global health too.