The World is Getting Healthier in Worrisome Ways, Says Thomas Bollyky in New Book

Last updated October 1, 2018

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September 28, 2018—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 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.

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, a senior fellow and director of the Global Health Program at the Council on Foreign Relations.

“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.

To interview Bollyky, please contact Andrew Palladino at apalladino@cfr.org or at 212.434.9541.

View the book page at cfr.org/book/plagues-paradox-progress.

Praise for Plagues and the Paradox of Progress

“Bollyky’s book can help to save many lives.”—Michael R. Bloomberg, Founder of Bloomberg LP and Bloomberg Philanthropies, World Health Organization Global Ambassador for Noncommunicable Diseases, and three-term mayor of 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, Founder and President of Heartfile and Former Federal Minister for Pakistan

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, M.D., Ph.D., Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and author of Prescription for the Future.

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More on:

Health Policy and Initiatives

Infectious Diseases

Public Health Threats and Pandemics

Noncommunicable Diseases

Immigration and Migration

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