Hans Rosling’s 200 Years of Global Health in Four Minutes

I’m of the school that PowerPoint has served as the breeding ground for many misguided efforts to gussy up simple messages with unproductive or even worse, confusing and misleading graphics. This is an example of the opposite, a very good use of visualization of a large and complex data set by Hans Rosling, who has made a near art form of this sort of thing. Notice how the tradeoff between wealth and life expectancy flattens once a reasonable level of wealth has been achieved.

This did get linked to on some finance/econ blogs a few weeks ago, but I managed to miss it, and \suspect a few readers did as well, so consider this to be a turn of year catchup item. Hat tip reader Paul S. Enjoy!

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  1. Greg

    Very good video!

    What I find most interesting, and Ill be interested to see what commenters here have to say, is that the first two places (a couple weeks a go at least) that I saw links to this were very Austrian economics type sites. The site owners were very quick to use this presentation as evidence that laissez faire economic policies should get the most credit for the state of the world today. They took this video as clear evidence that capitalism (as they understand it) is the best system for improving peoples welfare.

    Upon my viewing it I came away with a very different message; Investments in health care/disease prevention is one of the better ways to improve the wealth of a society. These investments come from private sector, public sector and public/private partnerships. The focus is on improving health though, which will lead to greater wealth. No surer way to lose your wealth than to be unhealthy.

    1. Samuel Morales Jr.

      Yes wealth for the pharmaceuticals. Government collusion with pharmaceuticals giving them tax payer dollars. Real wealth comes from supply, not simply higher incomes. Hence health care inflation in the USA, and “poor” health coverage. Supply increases wealth, which is associated with falling “deflationary” prices. IP laws actually increase the costs of health care supply.

  2. Dave of Maryland

    His starting point is absurd. On the one hand, in 1810, life expectancy was merely 30 or 40 years.

    On the other, it was well-known that up to a century ago, puberty did not arrive until 18 or so. Indeed, 21 as age of majority was based on the fact that most people had reached puberty by that age.

    So if Rosling’s graphs are accurate, we have the strange spectacle that most people were orphans by their wedding day, and that most families were then, are now, and forever will be nuclear, that only two generations have ever lived under the same roof: Parents and their minor children.

    There are many, many historical reports mourning the deaths of notable persons in their 40’s or 50’s. Such people were invariably considered young. Not as great wise seniors.

    One needs to factor out infant mortality. Those who died less than a year old, less than five years, less than ten years, etc. Infant life expectancy is what has improved. Overall adult life expectancy, in far too many lands, in far too many cultures, has hardly changed at all, has in fact remained virtually unchanged for centuries.

    1. Yves Smith Post author

      I can give some anecdotal support. My father did a genealogy. His 18th century ancestors lived into their eighties and nineties virtually without exception. Interestingly, lifespans among his ancestors fell in the 19th century.

      1. Dave of Maryland

        There were isolated places where adult life expectancy fell for periods of time. One was Dickensian London, where overcrowding, streets clogged with horse manure & periodic pea soupers combined to lower life expectancy. Which eventually led to what is termed, among city planners, as the Radiant Garden City & what we more popularly know as the modern suburb.

        Another were the “cowboy” settlements of the American west. Americans are unaware the entire country did not live in sod houses like Laura Ignalls Wilder. That there were actual cities back east, just as there were around the world, with all the usual mod cons of the day. Sewers, running water, even flush toilets.

        The decrease in infant mortality, late 19th century / early 20th had a lot to do with improved sanitation & improved food supply.

        1. Yves Smith Post author

          Interesting, but not applicable in this particular small data set. In both time periods, they stayed in the same non-urban geographic area, Casco Bay in Maine.

        2. Dikaios Logos

          I am pretty sure adult male life expectancy fell in Russia during the 1990s, too. It might have gotten better in the past few years, perhaps because of oil wealth…

      2. Jim the Skeptic

        Very nice display of the data but average lifespan is deceptive. His data would be very heavily influenced by infant mortality.

        I started doing genealogy as a hobby, it’s a puzzle, and I like puzzles. (There are an amazing amount of records for the last 300 years.)

        Early on, I found a data base for everyone in Kentucky who had died since 1911. I collected all those with my surname.

        I was stunned by the number of children who died under 1 year old and the deaths happened at a slower rate up to adulthood. Then about 1940 those deaths just stopped, not a reduction, they stopped. (Very small sample size but it repeated in another family.) I thought the most likely cause was penicillin. But this family was in a somewhat isolated eastern Kentucky county. I think part of the answer was that during the depression a visiting nurse program was instituted. Then penicillin came along and gave them a better weapon.

        The other surprise was that people lived much longer in the 1700s and 1800s than I believed. The average death rate may have been very high in the 1700s and 1800s but those who survived childhood lived into their 60s or 70s. It was as though the immune system had to be built up but after that the death rate fell off rapidly. That would explain the dramatic impact of antibiotics after about 1940.

  3. danB

    This is an excellent way to present data. The content or message, however, is reflects the prevailing paradigm in the health sciences: economic growth and increasing wealth creation is assumed. Latest data show life expectancy in the US declined slightly last year. With the end of cheap oil we face a sustainability crisis reflected in finance, economics, and politics. Very few in public health understand or will even entertain this idea because they depend upon government for support to do their work. Peak oil officially does not exist. When a division of the US energy dept. published a study warning of peak oil -the Hirsch Report- in 2005 the DOE’s reply was: no more peak oil studies.

    1. readerOfTeaLeaves

      I don’t have time to go hunting through the stats for this visualization summary, but people that I’ve talked to have listed:
      — sanitary sewage systems (which go back less than 200 years for most cities)
      — water treatment facilities
      — sanitation/garbage services
      — food safety measures
      — hand washing (I kid you not)
      — refrigeration
      — antibiotics
      — vaccines

      Of that list, the first 4 require some kind of government oversight, standards, and investment.
      Antibiotics and vaccines, along with many lab functions, require refrigeration.

      Public health services per se don’t have to be super-expensive.
      Washing hands is cheap, once the water systems are in place.

      None of the public health experts that I’ve ever spoken with (albeit briefly) ahave ever led me to believe that health “causes” economic prosperity. But with that said, purely at the metabolic level, your body is an energy system and you are more likely to be productive if you are healthy. If you have parasites and nasty bacteria interfering with your nutrient processing, you’re probably more likely to be unproductive and laze around like a slug.

      I think you may be attributing more to public health, in economic terms, than I’ve ever heard it claim.

      But it is true that greater longevity brings a host of new opportunities, and some of those are probably economic. But many of them are not.

      1. rd

        Good post. I was going to make the same points that you and Dave of Maryland make.

        1. The single biggest improvement in average life expectancy is the ability to get kids out of childhood and into adulthood since those very early deaths trash the average.

        2. The factors that you list are huge reasons why the children survive since they are far less likely to get nasty diseases during their highly vulnerable childhood years.

        Most of the major advances required significant public input, ranging from financial to organizational to regulation. Examples include construction of sewage treatment systems, distribution of vaccines, and regulation of waste disposal.

        In general, the private sector has provided expertise and labor once the demand and financing was put in place by the public sector. Refrigeration was probably the primary advance driven largely by the private sector and market forces.

        BTW, I would also add improved transportation safety a factor, especially the improvements that we have seen in automobile safety over the last half-century. Until the past decade, most of those improvements were driven by regulation. Now car manufacturers realize that they can actually sell safety.

      2. Dikaios Logos

        Hand washing is huge, especially for maternal and child health during birth.

        And to your health leading to prosperity comment, there are reasonably good studies that support SMOKING as a way to reduce healthcare costs and improve prosperity. Basically, people don’t live to be a burden, they just die.

    2. readerOfTeaLeaves

      When a division of the US energy dept. published a study warning of peak oil -the Hirsch Report- in 2005 the DOE’s reply was: no more peak oil studies.

      Without getting all partisan about this item, it’s probably worth noting that in 2005, the US president was from a family deep in the oil biz, as was the VP. And we all saw with the BP Deepwater explosion how the MMS branch of US government had been captured by Big Oil, if not prior to the 2000s, then before that time. So I wouldn’t want to see public health get slammed simply because two oil guys were controlling a huge portion of the federal government for several years.

      I suspect that if you go look at more of Rosling’s videos and data visualizations, you’ll see that he has some very interesting things to say about sustainability and local economies.

    3. dearieme

      “the first 4 require some kind of government oversight”: yes, but it’s noteable that at least three require action by local government, not national government.

  4. Redwood

    It’s interesting to me that he noted rare but significant events that resulted in major mortality for certain populations at specific points in time, but at the end he expresses such optimism as though those types of events are unlikely to happen again or on a larger scale. It may sound extremely pessimistic, but if you believe in black swans, you believe that highly improbably events are inevitable, just not very frequent. Even as things get better, the risk of unimaginably bad things happening gets greater. We never have any idea how close we are to the tipping point until we’ve already tipped over.

  5. joe l

    Log scale on wealth? How does this affect his argument when the dots are visually close at the wealthy end, but even more desperate than at the poorer end?

  6. Edward Lowe

    I played with these data when They were made available earlier in the year. What this fellow seems to have missed is that the two series do not move in tandem over time. There are major developments in national wealth of the industrial nations in the 19th century without much improvement in health. Then major improvements in health without much improvement in wealth. The correlation is spurious. What might be more useful is to consider the impact of health science and globalization as a primary driver for health outcomes. In the end, I find this guy’s Euro-Optimism overplayed, and more than a little simple minded. But, I suppose CEO’s and executive beurocrats love this sort of thing, which is where his funding comes from. I suppose what is needed is the disclaimer, “past performance is not a guarantee of future trends.”

    1. rd

      One of the reasons for the delay was that the cause of disease was still poorly understood until late in the 19th century. The germ theory of disease was largely developed between abut 1850 and 1900. By 1900 there was world-wide systematic application of concepts to manage germs. Before that, it was largely just trial-and-error without unifying theory behind it.

    2. Dikaios Logos

      A lot of the reason the series don’t move in tandem is that health is as much about political concerns as it is about economics. Cuba and the U.S. offering counterfactuals to wealth=health.

  7. Stephen_zz

    What sprung to mind was just how badly Africa is doing healthwise compared to the rest of the world. You can draw a line seperating the two.

    1. Dave of Maryland

      The tropics have parasites. They are indeed horrible. I am reminded of the fight against Swamp River Blindness, a condition which was so endemic in some locales, that it was thought normal to lose one’s eyesight by the age of 20, and to thereafter be led around by a small child.

    2. Dikaios Logos

      Life in Africa is tough for many reasons, including those parasites and the relatively poor growing environment. People migrated out for a reason.

  8. eric smith

    Very nice illustration but I agree the short rosy quip at the end using the well worn touchstone of greentech was almost ridiculous.

    This animation just heightens my sense of Malthusian dread. The population has grown immensely. The stars are overwhelmingly aligned against us without some sort of miraculous leap in human evolution. Even with such an event I’m deeply afraid that Gaia will crumple in massive ecosystem collapse no matter what we do at this point and I don’t believe there is anyway we can survive such an event in any significant way. I do not feel there is a grasp out there of just how catastrophic widescale ecosystem collapse will be for the biosphere. I believe it will be truly horrific.I hope I am mistaken. But we must try nonetheless. Permaculture practiced on a very large scale and meaningfully organized by robust government programs along with every greentech trick we can find is our best chance.

  9. moron

    Why does he have the X axis as logarithmic, and Y as linear?

    I remember seeing this and noticing something flawed about it, I forget what it was though, something to do with that graph and the axis. Let me know if you work it out.

    1. rd

      I think the primary reason why we end up with a semi-log plot is because many of the biggest advances occur with relatively small society wide expenditures. Clean drinking water, basic sewage treatment, basic garbage collection and disposal, vaccinations, hand-washing with soap, and basic antibiotics are fairly inexpensive and highly effective in preventing infant mortality as well as helping older folks.

      In the US, we now think of elaborate medical measures as the route to increased life expectancy. However, healthcare system total costs do not correlate well with life expectancy in the developed world. Some countries with per capita medical costs that are half of the US costs have higher life expectancies.

  10. Dikaios Logos

    I feel awful just writing this, but there are discussions in certain circles about the long-term impacts (hello Gaia Hypothesis peeps) of breaking the long-established pattern of infants dying in large numbers. To boot: I understand that Africans who live to 5 have longer life expectancy than Americans of the same age. Please don’t ‘credit’ me with thinking high infant mortality is good, just know that there is some discussion of the unintended consequences (i.e. black swans) that come from our modern attempts to control nature.

  11. Roger Bigod

    Just to point out the obvious, it had nothing to do with physicians in clinical practice. Abraham Flexner, famous for an influential report on medical education, estimated that only after 1900 did the average patient with an average problem seeing an average physician have a better than even chance of benefit. We could argue about definitions of “average”, but Flexner’s intuitive estimate seems reasonable.

    Most of the change in mortality is due to cleaning up the water supply. But better medical care has added greatly to quality of life and productivity.

  12. Baltimore Investment Management

    Awesome video. I passed this around a little while back to some friends and found it to be an easily digestible explanation of global health and wealth. I think that’s the most important take-away from this video. Some suggest the reason we are in the mess we’re in is because not enough people know what’s going on and the few that do are using the system, rather than letting the system work as it might.

  13. Jim the Skeptic

    How anyone can believe that lifespan is not severely affected by income is beyond me.

    So a white collar American worker will live only slightly longer than a Mexican digging food out of a dump?

    And the difference is caused by washing hands or refrigeration? :^)

  14. In the provinces

    The pre-1850 data are total guesswork; and it’s only after c. 1960, that the material is anything vaguely resembling accurate, world-wide.

  15. Karen Pendergrass

    I see that lifespan is your marker of health. I don’t know if this is exactly a good indicator of overall health. Our pre-agricultural revolution ancestors were very healthy, much healthier than we are today, with shorter average lifespans.
    Something to think about.

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