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The poor get richer and healthier, finally October 25th, 2020 by

Recent papers on the Global Burden of Disease (GBD) study for 2019 show that before 2000, the economy of wealthy countries grew at a faster rate than poor ones. But things are changing. Since the turn of the millennium, poorer countries have become healthier and wealthier at a faster rate. Wealth was long been linked with lower birth rates. “The rich get richer and the poor get children,” wrote F Scott Fitzgerald in The Great Gatsby, a novel first published in 1925. Yet birth rates are declining in poor countries and people are living longer, healthier lives.

From 2000 to 2019, the poorest fifth of countries added an average of nine healthy years to the life of each person, while the wealthiest 20% of countries added just two years. Articles in the prestigious medical journal, The Lancet, attribute the change to increased investments by governments in women and children, in health, development and education, as part of efforts to meet the United Nation’s Millennium Goals.

Measuring health improvements in populations used to be an inexact science. Since the introduction of disability-adjusted life-years (DALY), or years lost to death or disability, it’s become easier to monitor changes. According to the study, DALYs declined worldwide from 1990-2010 by 2.3% per year. In other words, people got healthier. The annual decline increased to 4.0% from 2010 to 2019, thanks largely to reductions in incidence of major diseases that kill children, such as lower respiratory infections, diarrhea and meningitis by more than 60% between 1990 and 2019. New treatments also meant that the health impact of other infectious diseases declined. The number of people with HIV/AIDS peaked in 2004 and has fallen ever since.

Despite on-going news reports about health crises, global health has steadily improved over the past 30 years. When the DALY is statistically adjusted for age (as people live longer), some of the poorest countries see an average yearly decline of 2% in the rate of death and disability. Good news for the people of Ethiopia, Angola, Burundi, Malawi, Sudan, Myanmar, Laos and Bangladesh, for example, and a powerful reminder that lives are improving.

Population growth is slowing. The world’s population is estimated to peak in 2064 at 9.73 billion, and to decline to 8.79 billion by 2100. Girls and women are spending more years in school and contraception is easier to get.

As middle-income countries develop and urbanize, improving their well-being will depend less on combatting infectious disease, and more on adopting healthier diets, getting exercise, and reducing tobacco use. For countries that are still poor, continued improvements in health will demand “doubling down on policies and strategies that stimulate economic growth, expand access to primary and secondary schooling and improve the status of women (Lancet 2020; 396: 1135).”

It is fashionable in some circles to mock the efforts of formal development. But government and international investments in health and education are improving the lives of poor people in measurable ways.

Further reading

Abubakar, Ibrahim 2020 The future of migration, human populations, and global health in the Anthropocene. The Lancet 396: 1133-1134.

Murray, Christopher J. L. and collaborators 2020 Five insights from the Global Burden of Disease Study 2019. The Lancet 396: 1135-1159.

Murray, Christopher J. L. and collaborators 2020 Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet 396: 1204.1222.

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