Giant Strides in World Health, but It Could Be So Much Better

Am I the only person that see the direct correlation between human health and longevity and the acceleration of our environmental decay and destruction of our planet?

"Increased life expectancy in every country in the world"--except not in the US, where it has been increasing for the last three years, for the first time in a century, notwithstanding the highest health care expenditures in the world, by far.

And yet... - as Bill Gardner demonstrated in a previous edition of Carroll and Frakt's blog, "The Incidental Economist," we in the US are sliding backwards, with 20,280 more death in children and adolescents aged 0 to 19 each year than if our health were as good as comparable OECD countries. - Injury fatality rates for those aged 15-24 in the US is INCREASING (related significantly to gun violence). - And life expectancy for the middle aged in the US is DECREASING (related to drugs, alcohol, suicide, and overall "despair"). In addition to helping the world, we in the wealthiest country in the West need to address the root cause – poverty - here at home.

There is no one “third world.” You need a map.

I think the epidemic of homelessness and substance abuse in America contributes to our overestimating the problems in poorer nations. We feel out of control so therefore it must be worse in a poor country. Thank you for the good news.

How admirable how the US is addressing the medical needs of so many outside our borders on the interest of common global good. What of the needs of our citizens? The unchecked monopolistic drug industry that is enriched beyond comprehension presumably addressing the ills of our country while manipulating the dark world of drugs that are ravaging this country? I throw up every time a politician opens their mouth proposing just how the system needs to be overhauled and the industry managed. Right up there with reducing taxes on the middle class. Never happen! But for now let's all be proud of our dedicated humanitarians sending home postcards from across the globe.

I appreciate that the writers first noted the effect of politics, the need for good governance. These countries do have the human capital needed to prosper, but are usually controlled by an oligarchic set of one kind or another. I wish I had answers for how to break that control and keep it from re-forming. I'd be very grateful for a separate article on potential effectiveness of extensive and well-funded civil society efforts. While recognizing that that in itself is sticking one's nose into other people's business, I wonder if the effect might be significantly greater than even these excellent ideas for health initiatives. The point made about girls education was great.

Developing countries are not the only ones who could use stronger anti-smoking campaigns. I was struck while in Spain in 2017 by how very much smoking there was everywhere I went. Although the UN has been dismissed and denigrated by Trump & his ilk in recent years, world health is another important reason that international organization and our participation in them is so important. Great strides have been made, but there is certainly more work to do.

Generally speaking, if Americans ever found out just how bad they have it in relation to developing nations, they would be outraged. By all accounts we should be leading the world in almost every standard in terms of quality of life and healthcare, but we definitely don't. It's Americans that are getting poorer and poorer every year. It's Americans whose life expectancy is getting shorter and shorter. And our healthcare system? The biggest joke of all. The same procedures, with the same medications, often performed by doctors trained in the US, in hospitals with US certifications are ten percent the cost of the US.....and those doctors and hospitals I'm speaking of are private, and for-profit.

Of course we should applaud great news of better health worldwide. But for every solution there is a new problem. The unintended consequence of more people living longer or not dying in childhood is...more people. And we have too many humans already.

Great photo!

Everyone in both low-income and high-income countries would benefit from expanding financing for development of new medications away from monopoly pricing by patent holders.

I recently read a book that covered many of these points. It was very informative and exceptionally well-researched. The book is: Factfulness: Ten Reasons We're Wrong About the World--and Why Things Are Better Than You Think, by Anna Rosling Ronnlund, Hans Rosling, and Ola Rosling. Many of the comments from fellow Commenters are covered in there as well such as lack of media coverage of good news, drivers of lower birth rates globally, etc. The book also makes the point that while things are better globally, things are not perfect so we must continue to improve. It's a great read.

It is heartening to learn that many poor nations have established good public health systems. This only makes it much more difficult to understand why the public health system in the USA is less than adequate, in fact it is unacceptable. Part of the failure is due to the 'modern parental mentality' against immunization, antibiotics (which have been abused in the past), however throwing the baby out with the bath water is not the solution. We don't want 'government control', however left to our own judgement, we have allowed children's diseases to return. In those situations we are not better than the banana republics who have not had the opportunity to control communicable diseases among children. We, in many areas, (education, public health, cyber tech, etc. etc.) are not any longer the country to set examples, let alone lead.

Yes, it would be “so much better” if the United States could figure out how to make it’s people healthier by eliminating the largely avoidable plagues of heart disease and diabetes. Instead, we’re setting an example for other countries to adopt our rich society’s diseases.

This is where groups like IAVI.org are essential. By bridging the gaps between all the beneficial yet limited potentials across orgs, labs, pharmas, and delivery systems on the ground in 3rd world countries, they find all the potentials out there and make them realities for those who need these treatments most. It's those kinds of groups, doing these kinds of thankless tasks, that make all these near-results into actual ones.

Giant strides could be so much better, if only the charitable groups could view birth control with equal importance

The thought of taking care of the worlds heath problems on paper is an amazing act of humanity. Unfortunately the real world makes that act,a feat of mismanagement and thievery, at the highest level. Take Ebola 11,300 deaths from 2014-2016 The cost in 2014 to fight it 2.4 billion. So for a natural disease that for hundreds of years has reared its ugly head. The total cost is about 600,000. dollars per victim. This is classic charity where in the willingness to give is amazing, butt the reality of only 5% going to the victims is the problem. If we use this base to combat an unnatural epidemic like Opioid with deaths at about 40,000 in U.S.2017. The U.S. should be asking for 24.4 billion dollars. Would love to crush this epidemic also but that would mean about 200 dollars per worker in america. Not realist, so my point is, that the problem is not in the willingness to give. It is the way the funds are handled. You see while we are wiping our tears of compassion the thief is grabbing our wallet. John 12: 4 Then saith one of his disciples, Judas Iscariot, Simon's son, which should betray him, 5 Why was not this ointment sold for three hundred pence, and given to the poor? 6 This he said, not that he cared for the poor; but because he was a thief, and had the bag, and bare what was put therein. All this has been going on for a long time, We need to put a stop to the thief and handle these things in earnest!!

All the more important in the context of more frequent severe weather events, especially those which effect the world's most vulnerable. U.S. teaching hospitals, nursing and public health programs, could help mitigate the effects through community-based collaborative research and teaching, especially in those countries considered most at risk from these events. It's wonderful that teams of U.S. doctors and nurses volunteer their time treating folks in developing countries. But more long-term institutional collaboration may be a way to help countries further prepare for the effects of climate change.

How is it possible to speak of maternal health initiatives and transitioning from extreme poverty to first world conditions without a single mention of access to birth control and US foreign aid policies that oppose family planning initiatives. Melinda Gates would not have nice things to say about this article....

Nice story now just like with the drive against slavery, or the fight for women's votes or the fight for equal rights in the 1960s there should be a nation movement against our de facto criminal health care system that is putting us closer to a third world country than an industrial one. We are at or near the bottom of major quality of life indices re our peer countries at 1/3 to 2/3 more expensive with up to 50 million people (pre ACA) with no insurance.

The other published comment so far on the miss on climate change helps make my point, and it shows a recurring NYT reporting tic: you frame the usually end-of-the-year "things are actually getting better" theme inappropriately. The points about overlooked, unexpected good news are, of course, welcome. Yes, it's good to know that public health investments can pay off. Contrarian news has its own value. And, yes, a lead has to catch the readers' attention. But while not incorrect, "In so many domains, life is improving across the world," is misleading and, fundamentally, gets the implied math wrong. There is no common denominator to net out the gains and losses and conclude: "Hey, surprisingly, we're actually better off!" What we're losing on climate change, and the uncharted challenges that's taking us to for which we're psychologically unprepared, is a huge negative that could overwhelm the good news. There are the tipping points possibilities that using up the buffers provided by natural capital, not counted in the linear mindset, can change things for the worse without warning. Then there's the human bias to the whole recurring theme that, somehow, the sixth extinction doesn't count. Losing critters and plants apparently doesn't matter even though our fates are interlinked. We continue to use up nonrenewable resources at rates vastly larger than we should. So, please, tell us the good news, and these public health areas do deserve more attention. But, watch the framing!

In addition to wellness, there should be an emphasis on birth control as African needs to reduce its population to be in harmony with its natural resources.

It would also be much better if we could eliminate the ignorance on the part of people who refuse to vaccinate their children and themselves. Washington state is suffering from a measles epidemic caused by anti-vaccine people, and mostly a problem in this country. Since Louis Pasteur, medical science's greatest achievement has been the discovery how to protect millions of people against disease with a simple vaccination.

It seems that this article—through no fault of the authors, obviously—overlooks a larger conversation about the role of news coverage in creating these incomplete perceptions. It’s unreasonable to expect newspapers and other media give equal weight to positive developments and still succeed financially, but it does seem that developing countries are disproportionately hurt by the equation of “newsworthy” with “disastrous.” Crises should clearly be reported, but a more consistently well-rounded picture could serve as a partial antidote to this problem.

Public Health Infrastructure by it's very nature makes a community much more resilient to the predictable effects of climate change. Water and sewage systems are the backbone of good public health infrastructure. Public Health Personnel are equally important and provide the brains, leadership and community education. Housing and land use policies and laws are also critical for a comprehensive public health vision. Long ago the early Progressive Movement in the United States recognized the importance of all these strategies to improve the health and well being of our citizens. Let us not forget these strategies are time tested and represent the foundation of what makes our country a true global leader.

Somehow it is refreshing and heartening to imagine governments and health care systems working together for the benefit of the populace. Maybe someday we will see that more clearly again in the USA.

No discussion of larger societal /global issues like climate change, massive inequities between rich and poor, risk of nuclear war, for profit health systems like in the US? Any interim improvements will be dwarfed by the negative effects of these.

Frakt and Carroll note that "while public health has phenomenal returns on investment in the United States, America puts relatively few dollars into it." Yes, and that is because for-profit insurance companies have no interest in investing in public health because most subscribers only stay with the same insurance company a few years. So there is no incentive to invest. By contrast, Britain, which operates a system of socialized medicine that covers every citizen from cradle to grave, has a great incentive to reduce or eliminate disease. That's why Britain invests heavily in public health, and one reason why their infant mortality figures are so much lover than America's. Yes, world health- and America's health- could be so much better. If only Times writers admitted that for-profit health insurers were damaging our public health.

Interesting that Cuba has the same life expectancy as the US while spending a fraction of what we spend on health care. I could guess why (can’t afford to overeat) but don’t really know.

This excellent article completely misses what is arguably the most important threat to the health of children and adults in developing and developed nations—climate change. If we fail to hold the warming of the planet to less than 2.0 degrees C, ideally 1.5 degrees, we will have unleashed a public health catastrophe that will play out over the decades and centuries to come. But if we succeed—by rapidly and fully embracing the clean energy revolution—we will create cleaner air and water, better health, and more sustainable wealth for all, which will be especially beneficial for the world’s poorest and most vulnerable people.