The Paradox of Declining Infectious Diseases

Mar 3, 2019

Increasing life expectancies comes at a price, says Thomas Bollyky.
Credit Miguel Oros / unsplash

Life expectancies have increased around the globe in recent decades. That is, in large part, due to the decline in infectious diseases. But, for some of the world's poorest countries, that progress has come with a price - widespread unemployment and skyrocketing chronic health problems.

That's the argument Thomas Bollyky, Director of the Global Health Program at the Council on Foreign Relations, makes in his new book Plagues and the Paradox of Progress: Why the World Is Getting Healthier in Worrisome Ways.

As recently as 1950, according to Bollyky, there were nearly 100 countries - including most of sub-Saharan Africa, South Asia, and Southeast Asia - where one out of five children died before their fifth birthday. Today, there are none.

"The good news is very good," said Thomas Bollyky, Director of the Global Health Program at the Council on Foreign Relations. "For the first time in recorded human history, viruses, bacteria, and other infectious diseases do not cause the majority of death and disability in any region of the world."

In the U.S., the drop in infectious disease-related deaths happened before the advent of antibiotics and was  primarily the result of public health and hygeine initiatives, like water and wastewater systems. Those infrastructure investments meant that longer lifespans were accompanied by socioeconomic improvements.

But in countries where the decline has happened more recently, the primary driver has been vaccines and antibiotics. While lifesaving, those medications don't change the underlying conditions that lead to infectious disease. They don't increase capacity for dealing with emerging outbreaks, like Ebola. And they leave poor nations with a conundrum: a rapidly growing young adult population, and no jobs for them.

"The by-product of saving many children's lives is that you're going to have more adults," explained Bollyky. "We need to invest in better global health programs - in a larger strategy - that recognizes that when you save the lives of children you will have more adults and you need to have job opportunities and health systems and education systems that can support what those adults will need to thrive and prosper."

Bollyky says that hasn't been happening in many places, and the results are becoming clear.

"Each year for the next ten years, sub-Saharan Africa will add 11 million people to the work force and, currently, the region of sub-Saharan Africa is producing about 1 to 2 million jobs per year," Bollyky said. "There's a significant shortfall."

The World Bank and the Gates Foundation are both investing in these issues, but Bollyky says that, ultimately, these kinds of investments are the responsibility of governments.

"Nobody can build a quality health system for you. Nobody can run and improve the quality of your schools. That really can only be done by those governments, but there are things we can do to try to support them in this process."

Bollyky says he's "not pessimistic" about prospects moving forward, but cautions we are at an inflection point.

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