Chapter 2: The Health of Nations

Sickness and disease are part of the human condition. There will be stunning advances in health care in the coming decades – and many new challenges


IN 1980 NO ONE HAD HEARD of acquired immune deficiency syndrome. The term did not exist. But the virus that causes AIDS, having long festered in chimpanzees, had already jumped to humans. In June 1981 America’s Centres for Disease Control and Prevention (CDC) sounded a muted alarm, using a few short paragraphs to describe a rare pneumonia in five gay men in Los Angeles. Some reporters warned of “gay cancer”; in 1982 the CDC coined the term AIDS. Cases were reported in Australia and Mexico, South Africa and China. By 1992 AIDS was the leading cause of death for American men aged 25–44. The 1990s brought fervent research, frustration and public campaigns. A quilt in memory of AIDS victims cloaked the National Mall in Washington, DC. In 2001 the world’s leaders gathered at the United Nations, vowing to reverse the epidemic.

Happily, they have made progress. The number of new infections in 2009 was 19% lower than it was ten years earlier. Antiretroviral therapy (ART) has transformed the disease from an untreatable killer to a chronic condition, and with improved drugs the infection rate will continue to drop. Even more exciting would be the development of an HIV vaccine. More than 33m people were living with HIV in 2009 – but the burden is not shared evenly. Nearly 20% of South African adults are infected with HIV, compared with 0.6% of Americans and 0.2% of Britons. Too few patients receive treatment; and the rate of new infections is still too high. But in only a few decades, a deadly disease has followed an arc from terror and confusion to action and hope. Think of the threats and discoveries that the next four decades will bring.

There remains the fear of the unknown – the next pandemic, say, or a superbug so powerful as to render our medicinal swords mere toothpicks. Trends that would seem to have nothing to do with health, such as climate change and urbanisation, may have a profound impact on it, particularly in the poor world. In the rich one, a difficult battle is being fought to curb obesity among children: if the battle is lost, a generation will be doomed to a life of chronic disease. And politicians meanwhile will argue bitterly over how to pay for the care of the old.

The flip side of this anxiety is excitement. Already, as the 21st century unfolds, the field of health is brimming with anticipation. Companies are working to develop new technologies that will make health care better, cheaper and more accessible. Scientists are trying to unlock the secrets in our genetic code. Over the next 40 years, an army of demons may assault mankind – but science and hard work may yet overcome them.

Charlotte Howard is the Health Care correspondent of The Economist.