Plagues and the Paradox of Progress: Why the World Is Getting Healthier in Worrisome Ways

by Thomas J. Bollyky

Why the news about the global decline of infectious diseases is not all good. Plagues and parasites have played a central role in world affairs, shaping the evolution of the modern state, the growth of cities, and the disparate fortunes of national economies. This book tells that story, but it is not about the resurgence of pestilence. It is the story of its decline. For the first time in recorded history, virus, bacteria, and other infectious diseases are not the leading cause of death or disability in any region of the world. People are living longer, and fewer mothers are giving birth to many children in the hopes that some might survive. And yet, the news is not all good. Recent reductions in infectious disease have not been accompanied by the same improvements in income, job opportunities, and governance that occurred with these changes in wealthier countries decades ago. There have also been unintended consequences. In this book, Thomas Bollyky explores the paradox in our fight against infectious the world is getting healthier in ways that should make us worry. Bollyky interweaves a grand historical narrative about the rise and fall of plagues in human societies with contemporary case studies of the consequences. Bollyky visits Dhaka—one of the most densely populated places on the planet—to show how low-cost health tools helped enable the phenomenon of poor world megacities. He visits China and Kenya to illustrate how dramatic declines in plagues have affected national economies. Bollyky traces the role of infectious disease in the migrations from Ireland before the potato famine and to Europe from Africa and elsewhere today. Historic health achievements are remaking a world that is both worrisome and full of opportunities. Whether the peril or promise of that progress prevails, Bollyky explains, depends on what we do next. A Council on Foreign Relations Book

Genres: Science, Nonfiction, Health, Medicine, History, Economics, Health Care

259 pages, Hardcover

Published October 9, 2018

Reviews

[Brooke · Rating 5 out of 5]

On the rarest of occasions, when I look up from a book, I find the world changed. This is one of those books. The author weaves a compelling, engaging story - backed by rigorous research - that tells the story of a great human accomplishment, and the unintended consequences it has wrought. I take in the world around me with a fundamentally different lens. A must-read for anyone with a curious mind.

[Brahm · Rating 5 out of 5]

Fantastic, short read: 177 pages before references & index.

The author does a great job covering issues caused by pandemics and global health issues, particularly the unintended consequences of reducing child mortality due to infectious diseases (mostly by aid, immunization, etc). For example "poor world cities" like Dhaka, Bangladesh, ultra-dense urban environments that have arisen in the last few decades. These cities would have been historically unsustainable due to disease, but modernity allows for these dense environments to grow, unconstrained by communicable diseases, but also without historical levels of economic development or opportunities associated with huge urban centres.

Another consequence is: hey, now we have all these additional people, but no one has really figured out what to do with them. Issues in education, immigration/emigration, job creation (in an increasingly automated world), sustainable public infrastructure, and so many more are arising and will continue to become issues.

The most interesting fact I learned is something like 1% of all health outreach funding is NOT directed at communicable diseases/initiatives (citation needed, I can't find the page). So there's a TON of funding for malaria prevention but not a lot of support for heart disease and most cancers in less developed countries.

Usually I complain about short books being broad but not deep. Well these 177 packed a big punch. Every sentence was concise, meaningful, and well-referenced (seemingly every other sentence had an end-note). Great read.

Another good one found on Bill Gates' reading list.

[Benji · Rating 3 out of 5]

Many governments and nonprofits working to promote better health in poorer nations fail to consider that declining mortality rates from infectious disease - the goal that many count as their primary index of progress - will also bring profound challenges if not paired with broader gains in economic development, governance, education, and infrastructure.

Thoughtful, redoubled efforts to reduce immigration will put many Western nations in the perverse situation of working hard to restrict the movement of immigrants who are, in part, the natural result of the progress in health that those same Western nations helped fund.

The decline in infectious disease has remade and keeps remaking the world through emigration.

[Jacques · Rating 5 out of 5]

Have had this book in my library for a long time and have finally got around to reading it...

Plagues and the Paradox of Progress gives a fantastic breakdown of the world disease, infection, and medicine and the crossroads with the economic and political scene through time.

Bollyky including a multitude of citations and references was fantastic for further reading, and great for bolstering the insights into the aforementioned topics.

This is a must read for anyone with an interest in global health, or anyone who wants an insight into how the various areas of global health has shifted through time.

[Griffin Barriss · Rating 5 out of 5]

Required reading for Global Health Organizations and Regulations, but I really enjoyed it! Bollyky lays out the case for the growing burden of NCDs being the future of global health in LMICs and the complex demographic challenges compounding them. Also outlines some compelling solutions/how the system can adapt to improve built environment, development assistance, and political economy to solve these issues.

[Laura · Rating 4 out of 5]

It’s funny that I added this to my to-read May 8th, 2019, not knowing that within less than a year there would be a pandemic! (This was written in 2018 and at one point he says “by 2019 pandemic preparedness spending will be at its lowest level in a decade” lmao) This book examines the ways in which progress and development have created new issues, whack-a-mole style, that we are ill-equipped and ill-prepared for. The thesis is this: for most of humanity, (at least since the advent of agriculture and settlements), infectious disease has been a scourge killing millions of people per year. Disease has had a major role in shaping human history and conflicts. We all know how disease was wielded to the colonists advantage in the rape and pillage of the New World. Infectious diseases are, by nature, infectious, so they require extreme levels of coordination to combat. Bollkyky argues that this coordination helped states develop. In the last few decades, humanity has made ASTRONOMICAL improvements in reducing the effects of infectious disease and therefore reducing the infant mortality rate. There is no denying what an achievement this is, there are literally BILLIONS of people alive today because of innovations like vaccines, rehydration solutions, and mosquito pesticides. However, there is a cost to this progress. The reductions in infectious disease and the survival of more babies leads to a higher population, which is good because it means less people are dying preventable deaths. Bollyky argues that in higher income countries, the reductions in infectious disease that lead to a boom in population were accompanied by improvements in industrialization and infrastructure. However, most of the health improvements in the Global South have happened because of targeted aid programs, which do not come with the necessary structural improvements. So, there is a huge explosion in population thanks to all these innovations, but none of the means to support that population. He starts with the history of infectious disease in humanity and its role in development, he looks at several case studies, and he suggests some solutions at the end.

Until I read Planet of Slums by Mike Davis earlier this year, I had always thought of cities as a sign of progress. I imagine people living in caves and hunter gathering until they get the bright idea to make farms which attracts more people, which attracts trade, which attracts more people and so on and so forth until great civilizations are formed. However, these books point out that cities are actually horrible for human health! When you think about it, it makes sense. Hunter gatherers spend most of their time outside, and sunlight kills germs. Smaller groups of people mean less vectors for germs. Moving around means you’re never in one stagnant place among your waste for too long. Once you start crowding people together and living life indoors, germs are in the perfect environment, and you can add all the human excrement and garbage to the mix, especially before the advent of sewage systems. On top of that, domesticating animals means more chances for zoonotic diseases to jump to humans. “Despite more reliable access to food, there is no evidence of any sustained increase in life expectancy for thousands of years after the shift to agriculture in any region of the world” 19. During the so-called Dark Ages, when there was less robust trade and less cities, life expectancies actually got longer. In the long arc of history, even if things are going better for the species as a whole, things are not great for the individual.

Things got even worse during Industrialization. Cities like London were basically cesspools of disease with extremely short life expectancy. You were more likely to live longer if you stayed in the countryside. But farming sucks! So many people kept migrating to the city for jobs that the numbers still grew despite the high death rate. Enlightenment ideals like Bentham’s utilitarianism started to arise and people thought maybe we should do something about all of this garbage and poverty and raw sewage and dying babies. Germ Theory was discovered. But scientific innovations are useless if there is no political will to implement the knowledge. People began to demand that something be done, leading to the development of public health departments and water systems. In 1870 there were only 244 waterworks depts in the US. By 1900 the feds spent more money on water systems than anything aside from the military and the mail. By 1924 there were 9,850 waterworks depts. For many cities and towns, this was their first big undertaking. A study cited in the book attributes 43% of the decline in mortality between 190-36 to the advent of water filtration systems. (32). This section illustrated the ways in which the state developed infrastructure over long periods of time to combat infectious disease, which had excellent results.

Wealthier countries were also occupied with colonialism and imperialism, and they started expanding their public health efforts into their colonies. They did this for several reasons, not all altruistically as you can imagine. A healthier workforce is a more productive workforce. You also don’t want your own guys to keep dying in their posts as officers and overlords or whatever. Also, providing health interventions makes you look good and can prevent insurrections or rebellions. There were some fascinating examples like the smallpox voyage of 1803 (Spain sent out boats on a ship around the world to spread the new Smallpox vaccine, saving millions of lives. Refrigeration hadn’t been invented yet though, so in order to keep the vaccine incubated they just used basically a relay race of orphans, basically rotating them out because it takes 10 days for the vaccine to cause pustules, and then you can use those pustules to vaccinate the next batch of people and so on and so forth. Sucks for the orphans).

These logics are still the motivation today for organizations like the Bill and Melinda Gates foundation, or various aid programs from the global north to the global south. And these programs have been WILDLY SUCCESSFUL. They have saved millions and possibly billions of lives through vaccination campaigns, or mosquito pesticide campaigns for malaria, or rehydration tablet campaigns for Cholera. The nice thing about infectious diseases is that we have a very direct cure/vaccine for a lot of them. We have a sexy silver bullet that can stop the danger and the numbers all look great on the reports. And this is no small potatoes, the book stresses that these are all basically miracles. However, this is a classic “teach a man to fish and he’ll eat for a day” way of solving global problems. The aid programs save a lot of lives, but they are not capable (and nor was this their goal) of implementing sustainable public health systems or developing infrastructure. They’re targeting just one thing, and while they’re often very successful at that one thing, they create lots of new problems in their wake.

One of those problems is the rise of noncommunicable disease. In countries like the US, the leading causes of death are things like heart disease and cancer. Now that the infant mortality rate and rate of infectious disease is going down, people still have to die from something, so it makes sense that longer lives lead to new types of diseases. But unfortunately many of these places with drastic reductions in infectious disease are now facing the rise of these chronic conditions, with no public health systems to take care of it. So people will continue to die prematurely and needlessly, just a little bit later. These types of conditions are not appealing to aid groups, because they require long term systemic care. For something like a vaccine, you can set up clinics in a population center for only a week and save a ton of lives and move on to the next stop. One and Done! You can’t just set up a van and have a pop-up chemo station, you need long term treatments, which are very expensive. And all of this is still focused on cures rather than preventative care Also, aid groups are often not able to efficiently allocate resources. 30% of global health initiative spending is allocated for HIV, but because of successful programs HIV only accounts for 5% of infectious disease deaths. (65).

Many states are in debt to the IMF and World Bank and have enacted austerity measures. Because they were receiving aid for healthcare, health was one of the easiest places in the budget to cut. Why spend money on it if you’re getting it solved by someone else? But what happens when aid groups are no longer willing to help because the health needs cannot be responded to by outside aid? This shows the danger of helping one specific problem without ensuring that there are structures in place to continue after the aid is gone.

And this doesn’t even touch the problems caused by the sheer number of people. Bollyky is careful to not be a Malthusian. The real concern is timing and the shape of your demographic chart. Economies and infrastructure have not kept pace with the successes in tamping down disease. He gives the example of China, as a nation that had good timing: they were able to put their population boom to work, in a manufacturing boom which launched the nation out of poverty (a recurring theme in this book is that he’ll mention countries like China and Cuba and there will be a sentence like, *somehow* their health metrics are so good despite not having aid and they got all these people out of poverty and the infant mortality rate is so low somehow gee. Ok he gives the communists some credit there was an interesting section on Mao’s Hygiene Programs). In countries that are currently experiencing their population booms, mostly in SubSaharan Africa and South Asia, they can’t really compete in manufacturing since other places like East Asia already cornered the market, and there’s also competition from rising automation.

Bollyky compares the situation of Niger in the 2010s to that of 1800s Ireland, which also had a population explosion it wasn’t able to keep up with. But the big difference is that Ireland had (and Mike Davis brought this up as well) the release valve of migration. Millions of people left for the United States, which on a demographic level was good for the US and good for Ireland. Bollyky argues that, though there’s obviously many things that drive immigration like war, famine, persecution etc, a consistent pattern emerges where a country has a huge drop in infant mortality and then 20 years later a rise in immigration. Economies just can’t expand quick enough to accommodate the influx of working age adults. In Planet of Slums Davis reports that odds of a working age person getting a job in the formal economy of Zimbabwe are less than 3%. We are facing a situation where literally millions, if not billions, of people will not have even the possibility of participating in the formal economy. An obvious solution is immigration, because the population tables in Europe are like the damn Devo hats, but people would rather invent robots to do jobs and let boats of migrants drown than let them in.

While reading this, I felt a mix of amazement at the achievement of the stories within (I didn’t go into too much detail, but it is incredibly cool how such simple things like salt and sugar water solutions can save millions of lives. There are several very inspiring tales and the book never wavers in its assertion that these life saving programs are miracles. He is not trying to say that people would be better off dead or that these programs should’ve never existed, just that they didn’t always have the most altruistic of motives and that they have caused problems that are not being dealt with.) and despair at how to solve these problems. I’m not an economist or an International Relations person so idk. One of his solutions was an idea that Mike Davis dedicated a whole section to debunking (the idea of giving slum dwellers legal land titles so they can build capital). Bollyky correctly says that aid programs are often hubristic and don’t listen to the people they’re supposed to help, and he understands that there is no way to solve these major systemic problems piecemeal. Another solution was to privatize education, which I was like ???? I also thought it was funny that one of the negatives, the illegibility of slum cities, was one of the only positive things Mike Davis could muster up about the state of impoverished megacities. Actually, iirc Davis said that the spatial politics of slums could lead to revolutions and insurgency because of how difficult it is for large bureaucratic militaries to fight in that terrain, while in this book there was a section where he said the exact same thing except “oh no”. (to be fair Bollyky said that sometimes there could be positive changes from these social movements, and he also said that the chaos makes people vulnerable to appeals to order which is how people like Duterte come to power. Which is true). But I knew going into it that this is like a Bloomberg funded think tank guy so of course he is not going to advocate for a Maoist Third Worldist revolution, there other authors I can go to to learn about that. I still learned sooooo much about public health programs and their flaws, and the ways in which public health, politics, history, international relations, and economics are intertwined!

[Jessica · Rating 3 out of 5]

A good book outlining how advances in medicine around the world has changed based on geography. Plagues and the Paradox of Progress: Why the World Is Getting Healthier in Worrisome Ways shows how the need to contain pandemics historically helped countries develop infrastructure and governance. It then uses contemporary case studies to show how when outsiders provide medical assistance they save lives while potentially hampering economic and social development.

[Jean-Paul Chretien · Rating 5 out of 5]

This remarkable book opens with an historical fact that even those who work in global health may find surprising—that it used to be the wealthier countries, not the poorer ones, that bore the greater burden of infectious diseases. Beginning in the 14th century, Europe’s economically developed commercial hubs likely were among the least healthy places in the world. This began to change in the 17th century, in Europe and then America.

Bollyky identifies the key agents of the transformation—the germ theory of disease, coupled with populations demanding healthier conditions and governments that were responsive to those demands. The resulting sanitation systems, safe water systems, and other public health measures reduced the infectious disease burden, and extended life spans, before discovery of medical treatments.

Meanwhile, poor countries, with weak post-colonial governments, could not keep up. By 2003, the gap in life expectancy between wealthy and poor countries, Bollyky writes, likely was the largest in human history. Someone could expect to live 80 years in the likes of Japan, Iceland, Australia, and Italy, countries where infectious diseases no longer had much of an impact on longevity, versus 44 years in sub-Saharan African countries devastated by HIV/AIDS.

Much of the book explores the subsequent rapid decline in infectious diseases in poorer countries, contrasting it with the course that wealthy countries took in reducing their burden. In poorer countries, it was international donors, intergovernmental agencies, and local ingenuity that reduced infectious diseases. Bollyky warns that without fundamental public health and governance improvements, such countries will not be able to handle the strain of rapid population growth, fueled by economic opportunity and reduced infectious disease toll, and the rise of noncommunicable illnesses that come with longer life spans and unhealthy urbanization and industrialization. He notes the striking discrepancy between this reality and priorities of global health donors: cancer, upper respiratory illnesses, heart disease, and diabetes “already account for nearly six of ten global deaths annually, yet only 1 percent of development assistance for health is dedicated to noncommunicable illnesses.” (p. 168)

The book excels in the use, and especially the visualization, of data. Graphics illustrate the trends that Bollyky describes in ways that are compelling and capture temporal and geographic variation, yet are simple enough to grasp in a few seconds. Data support the arguments in the text as well, but narrative case-studies and personal anecdotes provide balance. Throughout, the tone is measured, reasoned, and engaging.

Bollyky offers several broad solutions for developing country governments and international development initiatives, such as strengthening of primary health-care systems and taking on noncommunicable diseases (NCDs) as a global health priority. He notes opportunities for NCD initiatives to build on the infrastructure established through targeted infectious disease programs. The foundational investments Bollyky encourages would address the dual challenges that economic development, urbanization, and globalization have brought for global health—the rise of noncommunicable diseases, but also the risk that new pathogens will emerge and spread rapidly, or that known pathogens will move to new areas and cause larger outbreaks, even as endemic infections decline throughout the world. The past 20 or so years present many examples of such surprises; Nipah, Severe Acute Respiratory Syndrome (SARS), and Middle-East Respiratory Syndrome (MERS), to name a few.

Bollyky acknowledges the risk of emerging infectious diseases like these. Many organizations, within and outside of governments, are working to strengthen defenses against them. It seems much harder to generate policy interest and funds to deal with the slower-burn crisis of NCDs. If one book could break through, it’s Plagues and the Paradox of Progress. Not only does it deliver an open-and-shut case that poorer nations are not prepared, and that the consequences of inaction will be dire—it also provides common cause for the NCD and emerging infectious disease camps, in fundamental solutions that deserve the serious attention of both communities.

[Michael F · Rating 5 out of 5]

Bollyky, the Director of the Global Health Program at the Council on Foreign Relations and a Professor of Law at Georgetown University, has written an excellent, thought-provoking book about the paradox of improving global health and the resultant potential disasters in population, migration, and chronic disease.  In language that is understandable to the lay reader and with the judicious use of graphs and statistics, he makes a compelling argument that the enormous strides made in infant and childhood mortality and in life expectancy in both the wealthy and poor nations around the world have created a demographic time bomb.  The large populations of young adults that are the result of these improvements in infectious disease management in the last 20-30  years are  now swelling the mega-cities of Africa, South Asia, and Latin America.  The  marked reduction in infant and childhood deaths from vaccine preventable diseases (primarily smallpox, measles, and polio), oral rehydration treatment of diarrheal diseases, and the 'vertical' approach of international aid to eliminate or ameliorate specific diseases (e.g. HIV-AIDS), have resulted in a 'demographic bulge' entering a world where there are no longer manufacturing jobs or agricultural opportunities.  The resulting mega-cities with their overcrowding, inadequate sanitation and water supplies, and rudimentary public health and primary care systems are creating a time-bomb of unrest and chronic illness.  When combined with the climate change and the developed world's reactionary turn away from open trade and immigration, the consequences for the world may be catastrophic with civil unrest and wars the result.   One of Bollyky's key observations is that the improvements in childhood deaths and life expectancy in the developed world occurred over many decades and at a time when manufacturing and emigration were growing.  In contrast, today's developing world has experienced these improvements in infectious disease control over a much briefer time period and at a time in history when manufacturing, immigration, trade, and climate are all negative factors.  The result is nations like Bangladesh which is growing at an incredible pace without the public health system, primary care system, and economy to mange the population.  The capitol, Dhaka, is one of 13 mega-cities (population greater than 10 million) defined by the UN as low income where most of the inhabitants live in slums without sanitation, water, or services.   In the final chapter, the author suggests steps to address these synergistic problems, but the reader, though better informed, is left with a sense of impending doom.  This is an important book for both the public health and policy expert as well as the general reader. www.epsteinreads.com

[Ethan Pastor · Rating 4 out of 5]

Takeaways:

1. Decreases in infectious diseases in poor countries are saving millions of lives but there are new problems that arise when you treat these illnesses without setting up systems in these countries to keep people healthy over the long term.
2. Decreasing infectious diseases in poor countries through foreign aid without improved health systems in these countries has lead to overpopulation and higher rates of non communicable diseases like heart disease and cancer.
3. Increased birth rates following widespread immunization cause larger young adult populations which can have trouble finding work when opportunities are limited, spurring way more immigration.
4. Many advances in infectious diseases came before modern medications through country wide improvements such as water sanitation and education.
5. A solution to health concerns in an age where infectious disease is becoming less and less relevant is to pour more money and resources into things that will benefit people over the long term instead of making a specific disease the target. This includes setting up better public health programs, encouraging local governments to devote more resources to health care, spending more aid on non communicable diseases, increasing women’s education and encouraging decreases in fertility, improving and expanding infrastructure and encouraging other countries to be more open to immigrants.

[Mike · Rating 4 out of 5]

I came across this book some time back and left it on a shelf. Its history & how plagues have shaped human civilization. I pulled it off of the shelf during this time of COVID-19, as it seemed appropriate to learn from history. There are many parallels to other pandemics and what we are experiencing today. Except that we have a much better science backbone to identify and track COVID-19. What hasn't changed is the human default to fear and making things worse by not learning from science and history.

While parts of the book are depressing, some of it is uplifting. Each succession of pandemic has taught us valuable lessons. Science uses the urgency to develop new methods to identify and treat the infections. At the same time, it is the advent of cheap correctives that has allowed for denser and denser cities. While more people are dealing with less disease, it places them in close proximity for the next new bug to rip through the population. It is the complacency of us modern people that is the alarm the author is raising. Science keeps working forward, which gives society a false sense of security. We can see that playing out with COVID-19 throughout the world. Read the book to learn how far science has come and how little society has not in light of our 21st century pandemic.

[Erin · Rating 4 out of 5]

The book includes several interesting history chapters, country-case studies, and data overviews to back up his central thesis, which is essentially contained at a broad level in this paragraph:

“In sum, the world has gotten better in ways that should make us worry. The last two decades have brought dramatic reductions in endemic infectious disease and child mortality, but not the improvements in health-care systems, responsive governance, and employment opportunities that accompanied these changes in wealthier nations in the past. Rapid population growth, unprecedented urbanization, and an increase in the share of young adults are straining the capacity of governments and ecosystems while spurring migrations, instability, and the risk of pandemic diseases and chronic ailments. These challenges are amplified both by the sluggishness of many donors to adapt to the perils of partial success and by the more restrictive trade and immigration policies of many developed governments. It is not hard to envision that the next two decades in lower-income nations may be more violent and conflict-filled than the last, reversing some of the great progress that has recently occurred" (p. 161).

[Larkin H · Rating 5 out of 5]

A tremendous, short read on a very important topic. This should be a must read for all in the development and public health fields. It is an important reminder that ALL developments have consequences.

The recent improvements in public health can only described as incredible. Simply put, millions of humans that would have died in past decades do not die today. It is a modern scientific miracle. However, international health organizations and policy professionals cannot ignore the massive challenges that are created by saving millions of babies. They grow up, they need schooling, they want jobs. And if those opportunities are not presented, they will be pushed to join extremist groups or immigrate.

These consequential issues are not to downplay or criticize the incredible improvements in disease control, sanitation, and medicine created by the scientific and public health community. Rather this book serves as a reminder that the goal of international organizations and Western governments cannot only be to save lives, there must be consideration for the development of those lives.

[Reinaldo Lugo · Rating 5 out of 5]

Well written highly informative whose title says it all

This is the kind of book I would recommend to pretty much anyone interested in what are the current strains in the international development aid community. No easy answers offered here but the histories are laid out, the contradictions exposed, and future consequences are explained. Maybe a little too much info but we're talking the world here. So be patient and prepare to learn. Highly recommend it for anyone interested in the field of public health.

[Michael Summers · Rating 4 out of 5]

An important book for a number of reasons. It reminds that actions, even necessary ones undertaken with noble purpose, may have unforeseen and undesired consequences. Reduction of diseases that kill or cripple the young creates conditions for chronic diseases that afflict the elderly. Population growth in impoverished countries because of the success of vaccines and other health care advances often leads to increased emigration from those countries when they are not economically prepared to sustain greater population.

[Ilka · Rating 5 out of 5]

This book change my mind. Is very short you can read it in one day but have a powerful message about the importance of no only concentrate sources in vaccine programs or endemic illness, the most important things is have job (a good one) and not only decrease infantil death without have a plan for this people.

This people need also a job, good education, justice and proper infrastructure that can improve their quality of life. I could understand the impact of health campaigns in the world, especially in poor nations.

Everyone with interest in development and poor nation, migration ...you have to read this book.

[Henry Olders · Rating 2 out of 5]

Ultimately disappointing. I found the graphs difficult to understand, and gave up trying. The central theme took up too much of the book, and the promised solution(s), implied even on the cover, "Bollyky's book can help to save many lives", were vague. I must confess that I skipped chapters 3, 4, and 5; did I perhaps miss the answers I was seeking?

[Joseph Dieleman · Rating 5 out of 5]

Great read that is accessible to all audiences. Plagues and the Paradox of Progress marches through time and connects changes in disease patterns, population growth, and economic development with policy. Notably relevant with a fresh perspective. Strongly recommended.

[Andrew · Rating 4 out of 5]

Author takes a bit too long, for me personally, to unravel a point he is trying to make. Highly relevant in the Covid-Era. If you're a fast reader and read often, I recommend. If you only read sporadically, there are better options.

[Amanda · Rating 5 out of 5]

Accessible, engaging analysis of a critically important, complex issue. Bollyky’s writing and images convey the scope of the problem (and tractable solutions) to a wide audience.

[Laura Scrugham · Rating 5 out of 5]

Very interesting intersection of medicine, disease, sociology, and economics.

[Robert Campbell · Rating 4 out of 5]

Fascinating insights into the socio-economic consequences associated with global efforts to eradicate infectious diseases. Well researched and clearly written.

[Pat Watt · Rating 4 out of 5]

A good overview with case studies of what has gone right and gone wrong in the fight for humanity’s health.

[Patrick Heizer · Rating 5 out of 5]

A+

[Finn Shelp-Peck · Rating 3 out of 5]

I think this was a great book with good examples yet was more challenging to read than it needed to be.

[Kelli · Rating 5 out of 5]

Finished Plagues and the Paradox of Progress by Thomas Bollyky Wednesday night. Book 8 of 12 in the 2021 reading challenge.

The subject material is a mix of epidemiology, global health, history, developmental economics, demography, and migration. It’s not a long read...177 pages before source notes, index, etc...but the writing is concise and free of fluff.

Bollyky is the Director of the Global Health Program at the Council on Foreign Relations and a Georgetown Law School adjunct. He is an expert, not a journalist, but his writing style is engaging and informative. He effectively describes the complexities of global health and policy to general audiences without the unnecessary details that would bog down the reader.

The book is not a detailed explanation of the history/treatment of infectious disease, the intricacies/efficacy of developmental aid, or the benefits/pitfalls of immigration. Rather, it is an overview to describe how differences in the timing of the control of infectious diseases and the rise of urbanization/modernization created different outcomes in nations that developed years ago and those that are currently developing. Additionally, the author explores ways that countries and international aid agencies can counter the problems created from population surges due to reduced infant and child mortality rates and longer lifespans in areas without the economy or infrastructure to deal with them.

It's worth a read if you are interested in global health. It is part of the assigned reading for a grad level Health Promotion class I'm taking next semester, but I decided to jump into it now. I'm interested to see if I have different insights when I revisit it within the context of the other course materials.

[Melissa Adelman · Rating 5 out of 5]

I read this book over my winter holidays and really enjoyed it while learning a lot. It presents a well-researched and thorough overview of the global history of infectious diseases, in an easy-to-read style. Most importantly, I found the new ideas presented in the book, around the implications of how recent advances in combatting infectious diseases have been made, really compelling and interesting. I would recommend this book to anyone interested in better understanding some of the complex drivers behind some of the major headlines we see in the world today like mass migration.