from Global Health Program

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.

Foreign policy analyses written by CFR fellows and published by the trade presses, academic presses, or the Council on Foreign Relations Press.

Plagues and parasites have played a central role in world affairs, shaping the evolution of the modern state, the growth of cities, and the disparate fortunes of national economies. This book tells that story, but it is not about the resurgence of pestilence. It is the story of its decline. For the first time in recorded history, viruses, bacteria, and other infectious diseases are not the leading cause of death or disability in any region of the world. People are living longer, and fewer mothers are giving birth to many children in the hopes that some might survive. And yet, the news is not all good. Recent reductions in infectious disease have not been accompanied by the same improvements in income, job opportunities, and governance that occurred with these changes in wealthier countries decades ago. There have also been unintended consequences. In this book, Council on Foreign Relations Director of the Global Health Program Thomas J. Bollyky explores the paradox in our fight against infectious disease: the world is getting healthier in ways that should make us worry.

Plagues and the Paradox of Progress interweaves a grand historical narrative about the rise and fall of infectious diseases in human societies with contemporary case studies of the consequences. Those case studies include: Ethiopia, one of the world’s fastest growing economies; Dhaka, among the most densely settled places on earth; China’s campaigns against infectious diseases under Chairman Mao; and the history of migration from pre-potato famine Ireland to the rickety boats crossing the Mediterranean sea to Europe today. Bollyky uses these and other cases studies to describe how historic health achievements are remaking a world that is both worrisome and full of opportunities. Whether the peril or promise of that progress prevails, Bollyky explains, depends on what we do next.

A Council on Foreign Relations Book

More on:

Public Health Threats and Pandemics

Infectious Diseases

Also explore Thomas Bollyky's interactive report, The Changing Demographics of Global Health.

More on:

Public Health Threats and Pandemics

Infectious Diseases

Reviews and Endorsements

Noncommunicable diseases are an urgent global crisis that has been largely overlooked, with deadly consequences. By calling attention to it—and prescribing solutions—Bollyky’s book can help to save many lives.

Michael R. Bloomberg, Founder, Bloomberg LP and Bloomberg Philanthropies; World Health Organization Global Ambassador for Noncommunicable Diseases; Three-Term Mayor, New York City

A remarkable piece of work, superbly researched, beautifully written, and sobering. It should be required reading not only for policymakers and philanthropists but for anyone seeking to understand the great progress that has been made in global health and the significant challenges that remain.

Sania Nishtar, MD, Founder and President, Heartfile; Former Federal Minister, Pakistan

This stimulating new book is a must-read for those who care about our collective future. A well-recognized leader in global health, Tom Bollyky is a powerful advocate at a critical time, but does not shy away from some unsettling truths. Interweaving history, science, economic/development policy, and international affairs, he reveals the promise and peril of how health advances are reshaping our world, and he soundly argues that a safer, healthier world demands that we address this paradox of unintended consequences. We should take heed!

Margaret A. Hamburg, MD, Foreign Secretary, National Academy of Medicine; Former Commissioner, Food and Drug Administration

Plagues and the Paradox of Progress is a readable history of the rise and fall—and worrisome threat—of infectious diseases, as well as the new health threat to developing countries: chronic illnesses. Bollyky provides deep insight into how health challenges will impact the development of lower-income countries. This is an excellent addition to the scholarship on global health.

Ezekiel J. Emanuel, MD, PhD, Chair of the Department of Medical Ethics and Health Policy, University of Pennsylvania; Author, Prescription for the Future

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