Enlightenment Now: The Case for Reason, Science, Humanism, and Progress

Even diseases that are not obliterated are being decimated. Between 2000 and 2015, the number of deaths from malaria (which in the past killed half the people who had ever lived) fell by 60 percent. The World Health Organization has adopted a plan to reduce the rate by another 90 percent by 2030, and to eliminate it from thirty-five of the ninety-seven countries in which it is endemic today (just as it was eliminated from the United States, where it had been endemic until 1951).¹¹ The Bill & Melinda Gates Foundation has adopted the goal of eradicating it altogether.¹² As we saw in chapter 5, in the 1990s HIV/AIDS in Africa was a setback for humanity’s progress in lengthening life spans. But the tide turned in the next decade, and the global death rate for children was cut in half, emboldening the UN to agree in 2016 to a plan to end the AIDS epidemic (though not necessarily to eradicate the virus) by 2030.¹³ Figure 6-1 shows that between 2000 and 2013 the world also saw massive reductions in the number of children dying from the five most lethal infectious diseases. In all, the control of infectious disease since 1990 has saved the lives of more than a hundred million children.¹⁴

Figure 6-1: Childhood deaths from infectious disease, 2000–2013

Source: Child Health Epidemiology Reference Group of the World Health Organization, Liu et al. 2014, supplementary appendix.

And in the most ambitious plan of all, a team of global health experts led by the economists Dean Jamison and Lawrence Summers have laid out a roadmap for “a grand convergence in global health” by 2035, when infectious, maternal, and child deaths everywhere in the world could be reduced to the levels found in the healthiest middle-income countries today.¹⁵

As impressive as the conquest of infectious disease in Europe and America was, the ongoing progress among the global poor is even more astonishing. Part of the explanation lies in economic development (chapter 8), because a richer world is a healthier world. Part lies in the expanding circle of sympathy, which inspired global leaders such as Bill Gates, Jimmy Carter, and Bill Clinton to make their legacy the health of the poor in distant continents rather than glittering buildings close to home. George W. Bush, for his part, has been praised by even his harshest critics for his policy on African AIDS relief, which saved millions of lives.

But the most powerful contributor was science. “It is knowledge that is the key,” Deaton argues. “Income—although important both in and of itself and as a component of wellbeing . . .—is not the ultimate cause of wellbeing.”¹⁶ The fruits of science are not just high-tech pharmaceuticals such as vaccines, antibiotics, antiretrovirals, and deworming pills. They also comprise ideas—ideas that may be cheap to implement and obvious in retrospect, but which save millions of lives. Examples include boiling, filtering, or adding bleach to water; washing hands; giving iodine supplements to pregnant women; breast-feeding and cuddling infants; defecating in latrines rather than in fields, streets, and waterways; protecting sleeping children with insecticide-impregnated bed nets; and treating diarrhea with a solution of salt and sugar in clean water. Conversely, progress can be reversed by bad ideas, such as the conspiracy theory spread by the Taliban and Boko Haram that vaccines sterilize Muslim girls, or the one spread by affluent American activists that vaccines cause autism. Deaton notes that even the idea that lies at the core of the Enlightenment—knowledge can make us better off—may come as a revelation in the parts of the world where people are resigned to their poor health, never dreaming that changes to their institutions and norms could improve it.¹⁷

CHAPTER 7SUSTENANCE

Together with senescence, childbirth, and pathogens, another mean trick has been played on us by evolution and entropy: our ceaseless need for energy. Famine has long been part of the human condition. The Hebrew Bible tells of seven lean years in Egypt; the Christian Bible has Famine as one of the four horsemen of the apocalypse. Well into the 19th century a crop failure could bring sudden misery even to privileged parts of the world. Johan Norberg quotes the childhood reminiscence of a contemporary of one of his ancestors in Sweden in the winter of 1868: