Over the past 250 years, we have witnessed huge advances in the field of medicine and healthcare, saving billions of lives. But does this progress apply to a broader view of health, and will it continue?
So, we continue our slow deep dive into Steven Pinker’s Enlightenment Now — a chapter-by-chapter analysis of the progress that humanity has (and hasn’t) made over the past 250 years. In the previous post, we looked at how life expectancy, across the globe, has increased dramatically over the past two centuries. A major factor behind this trend is huge advances in the field of medicine and healthcare. In this short chapter, Pinker lists a number of breakthroughs in the alleviation and eradication of disease. Here’s a few striking examples:
Hand-washing, midwifery, mosquito control, and especially the protection of drinking water by public sewerage and chlorination, are estimated to have saved billions of lives.
The measles vaccine is estimated to have saved 120 million lives; the smallpox vaccine, 131 million lives; diphtheria and tetanus vaccines, 60 million lives; penicillin, 82 million.
These are breakthroughs that keep on giving when we consider what life would be like without them. Smallpox killed more than 300 million people in the 20th century. Now, through a global eradication program, it has been all but defeated — a thing of the past.
In addition to the world of pharmaceuticals — vaccines, antibiotics, antiretrovirals, and deworming pills — Pinker also notes the importance of health-related ideas, such as boiling and filtering water, washing hands, defecating in latrines away from water sources and sleeping under mosquito nets. These innovations in our scientific understanding of health are invaluable and largely accessible.
Unfortunately, Pinker gives no space in his chapter to new illnesses and diseases that might be a consequence of modernity. Obviously his book was written before the coronavirus pandemic struck, though he does note at the beginning of the chapter how, throughout human history, “epidemics killed by the millions, wiping out entire civilisations, and visited sudden misery on local populations.” From this vantage point, our current situation doesn’t look so bad. In fact, if Pinker were writing his book now, I’m sure he would praise the global coordinated approach that has minimised the spread of Covid-19, in comparison to the catastrophic plagues of the past, as well as the promise of a vaccine to alleviate it. This seems to be Pinker’s general attitude towards the more problematic consequences of all the progress we’ve made: sure, all changes come with unintended consequences, but we can’t do anything about that, and now have the power to fix them too!
No doubt this is largely true, but there may still be some major exceptions to the rule (climate change being the obvious one, though we’ll leave that for his later chapter on the environment). For instance, the combination of industrial-scale livestock farming plus antibiotic resistance creates the potential for further global pandemics. This is considered to be one of the major existential threats facing humanity. The potential for bioterrorism offers similarly chilling risks to society. Pinker notes that scientific ideas can be used for good or for ill, but, again, says little about the wisdom we’ve gained over the past 250 years to steer all the progress we’ve made in the right direction.
There are a host of other illnesses and diseases we now have to deal with that previously weren’t an issue: obesity, diabetes, autoimmune diseases, heart disease, cancers, sleep disorders, chronic pains and mental disorders bought on by the challenges of living in a hyper-competitive, individualistic society. From our modern vantage point, it’s easy to look around and see a sick society. But, in assessing the progress we’ve made over the past 250 years, Pinker is only concerned with the counterfactual: we may live in a society in which far too many people are sick, but look at how much less sick people are to previous societies — where is the polio, smallpox, blinding trachoma, measles, rubella, tuberculosis, elephantiasis, river blindness, hookworm, yaws and sleeping sickness? New health issues are clearly bad, but we no longer have to consider a host of terrible illnesses and diseases that used to reek havoc on humanity.
I think Pinker is largely right in this respect. As a result of modernity, we now live longer and healthier lives. There are still many sick people in society, and much of that sickness may be caused by modernity itself. But, that doesn’t mean, on average, people aren’t much better off than they were in the past.
However, as our physical health improves, we can start to pay more attention to a broader view of health — one that includes our social, relational and mental wellbeing. These more intangible aspects of health are clearly harder to measure and treat than many infection diseases. But, it is possible that, when we consider a broader view of health, the promises of modernity have not delivered. Someone might be perfectly fit and healthy and yet feel a sense of emptiness and meaningless in their lives. They may be in good physical health, say, but feel spiritually or emotionally unhealthy.
How much progress have we made over the past 250 years according to this broader, more holistic, view of health? It’s hard to say, as mental illnesses weren’t categorised and measured in the same ways they are today. We’ll have more to say about this with the chapters on happiness and quality of later on (sneak preview: Pinker shows that both loneliness and suicide numbers are going down, not up). For now, it’s worth pointing out that things in this area are extremely complicated. People can appear to be happier and healthier on a day-to-day basis, while getting steadily unhappier and despairing below the surface. Humans have a strong capacity to distract themselves in order to cope with stresses and demands that plague their lives. For instance, according to a recent study, it is estimated that around half of the US population suffers from one or more addictions at any one time, and it’s likely that this number is increasing. Even if our physical health has dramatically improved throughout modernity, there may be some significant blindspots in our assessments of overall health that we desperately need to pay attention to.
Again, Pinker may agree with all this. In response, he may claim that we’ve made considerable progress when it comes to immediate, life-threatening diseases, such as polio and cholera, and we can now focus on other health problems, such as mental health and addiction. But, I think there’s a danger to this ‘hierarchy of health needs’. We can fall into the comforting assumption that, as soon as we get the major life-threatening and debilitating diseases out the way, then we can be fine and happy. The problem with this assumption is that we’ll never be fine and happy. The meaningless and emptiness that people experience is not a new feature of human existence to work on next — it’s part of what it means to be human. We cannot medicate our way out of it. It cannot be eradicated.
If we assume that our overall health is something that can be readily improved by scientific knowledge and medical advances, we can end up making things worse rather than better. If we can eliminate polio then why can’t we get rid of despair? If we can end malaria then why not end loneliness? Pharmaceuticals, therapies and other ‘life hacks’ are offered as quick fixes to existential problems that are never going to disappear as a result of relatively crude and short-term means. When it comes to overcoming challenges or dealing with loss, we often need to learn how to live with the limitations we face rather than attempting to live without them.
This relates to an issue at the heart of Enlightenment Now. Even if humanity has made considerable progress over the past few centuries, how much can we expect that progress to continue? Many of advances we’ve made are material and physical in nature, and may not be transferable to the kinds of advances that now matter, which are more social and mental in nature. This is not to say the progress we’ve made so far hasn’t been essential — I would much rather do without the long list of infectious diseases that are now a thing of the past. The issue is whether we can expect this progress to now be applied to a broader notion of health. I suspect it can, but not always for the better.