Unsung progress in global public health: a refreshing, heartening and motivating story.

Global public health in 2021 has been dominated by the COVID-19 pandemic, featuring centrally on a backdrop of concerns around social, economic and health inequalities, proliferating antimicrobial resistance, and the projected health effects of accelerating climate change. The mental health burden imbued by these issues, amplified by apocalyptic narratives and media alarmism, is impacting on healthcare professionals, children and the general public alike. However, as the world advances into 2022, pause may be taken to establish meaningful perspective. A brief tour of key global public health metrics, taken from Our World In Data and the World Health Organization, reveals spectacular progress that has been made over only a few recent decades, the acknowledgement of which has been entirely neglected by mainstream discourses.

For example, global average life expectancy – the average number of years a newborn would live if the pattern of mortality in the given year were to stay the same throughout its life – has increased from 45.7 years in 1950 to 76.2 years in 2019. Global child mortality – the proportion of children, born alive, who die before they reach 5 years of age – has decreased from 22.34% in 1950 to 3.84% in 2019. Specifically across Africa, this figure has fallen from 32.27% in 1950 to 6.80% in 2019 and remains substantially under 1% in Europe and North America. And the maternal mortality ratio – the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births – has fallen globally from 385 in 1990 to 216 in 2015 and more than halved in low-income countries across this short period.

With regard to infectious diseases, annual new cases of HIV/AIDs peaked globally at 3.16 million in 2000 and fell to 1.94 million in 2017, whereas annual deaths from this disease peaked at 1.95 million in 2006 and dipped below 1 million in 2017. The death rate from malaria in Sub-Saharan Africa fell from 89.48 per 100,000 people in 1990 to 52.53 in 2017, in under-5s from 98.69 in 2003 to 52.05 in 2017, and specifically in Malawi from 177.26 in 1994 to 46.82 in 2017. The death rate from tuberculosis per 100,000 people globally more than halved between 1990 and 2017 from 35.30 to 14.94, whereas the annual number of deaths in under-5s from diarrheal diseases fell from 1.66 million in 1990 to 533,000 in 2017, and the number of deaths in under-5s from vaccine-preventable diseases dropped from 5.5 million globally in 1990 to 1.8 million in 2017. Smallpox was eradicated in 1980, before which it had killed hundreds of thousands of people each year, whereas the number of paralytic polio cases has fallen by over 99% since the 1980s from 400,000 annually to 22 in 2017.

Markers of extreme poverty have also improved substantially. Globally, the share of individuals living below the ‘International Poverty Line’ of 1.90 international-$ per day has decreased from 42.66% in 1981 to 9.27 in 2017, whereas the proportion of individuals who are undernourished – receiving a caloric intake insufficient to meet their energy requirements – has fallen from 13.4% in 2001 to 8.8% in 2017. Even the annual number of deaths attributed to smoking reduced from 146 per 100,000 people globally in 1990 to 90 per 100,000 in 2017.

These improvements are truly spectacular. Although the figures are cherry picked, they represent incredible progress in key markers of global health, well-being and quality of life that have occurred within only a handful of years. Although they have not been equally experienced worldwide, and outstanding work is undeniably evident, the scale and speed with which these improvements have occurred, especially in low-income settings, is a magnificent story that should be elatedly publicised.

Why are these revelations so utterly surprising? While “if it bleeds, it leads” remains the driver of newsrooms, and the fear-anger complex fuels social media virality, a story of continuous, steady, gradual improvement fails to attract eyeballs and user engagement. Although there are many more improvements that are urgently required, for the vast majority of people alive on Earth, today, there is no better time in human history to be so than right now. Such a realisation is enormously empowering. Not only does it safeguard against nihilistic news outlets and apocalyptic projections that paralyse with despair, it grounds us in perspective, cultivates gratitude and fosters a motivation to extend this progress further. Rather than remaining an unsung story, the refreshing, heartening and motivating tale of public health progress should be amplified loudly and shared with the world.