Are we beating disease and death?

Across the centuries, how many children lived to grow up — and where do they still die?

Two centuries ago, nearly half of all children died before five. Now it is under four in a hundred — but where you are born still swings the odds ninefold.

Picture a hundred babies born in the year 1800. Before their fifth birthday, about forty-three of them would be dead. A mother who carried six children to term could expect to bury two or three; burying a child was not a tragedy that befell the unlucky, it was the ordinary texture of a life. Today that number is 3.67 in a hundred and still falling, pulled down by a stack of unglamorous wins: clean water, the germ theory, oral rehydration salts, antibiotics, and above all vaccines.

But the world line is an average, and the average is a lie of composition. Split it by region and it splinters into different centuries living at once. In Europe and Central Asia about 8 children in a thousand die before five; in Sub-Saharan Africa it is 71, nine times higher, roughly where the rich world stood in the 1950s. Drop to single countries and the spread widens again: a child in Nigeria is about 48 times more likely to die than a child in Finland or Japan. None of that gap is mystery. It tracks the things that travel with poverty, a clinic an hour away or a day away, a fever treated or not.

The hopeful half is that every one of these lines is falling, and falling fastest where it started highest, so the gap narrows even as it stays wide. The grim half is the level. Of all the lines on this site, the world curve is the one to remember; the regional and country ones are the reminder that the work is unfinished, and exactly where.

And how long does a single life last — the same everywhere?

A life lasted under thirty years in 1770; now it lasts past seventy. But a baby in Switzerland is handed thirty years more than one in Nigeria.

For most of human history the average life ran out before the average person finished being young. Around 1770 a newborn could expect roughly twenty-eight years, and that barely moved for a century. Then, over a few generations, it more than doubled, to 73 today. The catch lives inside the word average: life expectancy at birth is pulled down hard by every baby who dies, so most of that doubling is simply children surviving who once would not have. What changed was less that the old got much older and more that far more people got to grow old at all.

The world figure hides a familiar split. Sub-Saharan Africa sits at about 63 years; Europe and Central Asia at nearly 79, a gap of sixteen years between regions. By country the distance stretches to thirty: Switzerland and Japan clear 84, while Nigeria, Chad, and the Central African Republic sit in the mid-50s, about where Europe was a century ago. The line also remembers its wounds. The deep notch in 1918 is the influenza pandemic, which killed enough young adults to knock years off the world in a single season, a preview of a smaller dip this article reaches later.

Why did the dying stop — and who does the engine still miss?

In 1980 one infant in five got the basic vaccines; now five in six do. South Asia has overtaken the world average; Central Africa still trails it.

In 1974 the World Health Organization launched something with a dull name and an enormous reach: the Expanded Programme on Immunization. Fewer than one child in twenty in poor countries was then vaccinated against the routine killers. The idea was simple and relentless, get a handful of cheap vaccines to every child on the planet, cold chain by cold chain. Coverage for the three-dose diphtheria-tetanus-pertussis course, the standard test of whether a health system reaches its babies, climbed from 20 percent in 1980 to about 85 today; measles tracks just behind. The basic vaccines travel together, given at the same infant visits, so hepatitis B and polio coverage sit within a point of that figure, and one line stands in for the whole routine schedule. Each point is millions of children who never caught what used to be a death sentence.

The regional picture carries the surprise. South Asia, once a byword for unreached children, now vaccinates 94 percent of its infants, several points above the world average, the fruit of India’s vast immunization drives. Sub-Saharan Africa trails at 74. By country the laggards are specific and knowable: Japan, Bangladesh, China, and India clear the mid-90s, while the Democratic Republic of Congo, Nigeria, and Somalia sit in the high 60s. That is the whole story of the stalled global line in miniature. The engine works; it has simply not reached the last, hardest places, which are exactly where the health system is weakest. A vaccine only works if it reaches an arm.

Are the epidemics in retreat — and are they everyone’s?

New HIV infections have fallen by two-thirds. But the burden that remains is not the world’s evenly; it sits in one region and a handful of countries.

In the 1990s a positive HIV test was, across much of the world, a death sentence with a timetable. New infections worldwide peaked near 0.9 per thousand uninfected people in 1995 and now sit around 0.28, a fall of roughly two-thirds, driven by antiretroviral therapy scaled up after 2003 until the drugs reached millions who could never have paid. The success has a strange shape: the number of people living with HIV has risen, from about 0.3 percent of adults in 1990 to 0.7, because the treatment that stops the dying keeps people alive for decades. Winning, on this measure, looks like more sick people, not fewer.

What the world line buries is how concentrated the remaining burden is. Malaria is the clearest case: across Sub-Saharan Africa there are about 229 cases a year for every thousand people at risk, against roughly one in South Asia, a regional gap of more than two hundredfold. HIV is concentrated by country instead. In Eswatini about 23 percent of adults live with the virus, in Lesotho and South Africa around 17, in India 0.2. The epidemics that defined a generation have become, in effect, the burden of specific places, which is grim and also the reason they can be planned against. The danger is that the programmes holding them down depend on outside money, and a budget written elsewhere can move every line here.

Is it as safe to give birth — and where is it not?

Maternal deaths halved, then stalled. A woman in Nigeria is still about 250 times more likely to die giving birth than a woman in Sweden.

Of all the curves here, childbirth carries the cruelest gap. The world maternal death rate fell from about 460 per 100,000 births in 1985 to 197 today, but the fall stalled in the late 2010s and the pandemic briefly pushed it back up. The stall is the global story; the gap is the real one. By region, Sub-Saharan Africa loses about 448 mothers per 100,000 births while Europe and Central Asia lose 11, a fortyfold difference. By country the spread becomes almost hard to believe: Sweden loses about 4 mothers per 100,000 births, Nigeria 993, nearly one in every hundred, with Chad and South Sudan close behind.

A birth in the most dangerous country is on the order of 250 times likelier to kill the woman than the same birth in the safest. Nothing else in global health carries a rich-to-poor gap this brutal, and nothing else is as purely a problem of distribution rather than discovery. What closes it is unglamorous and known: a trained attendant, a way to stop a haemorrhage, a road to a clinic, blood to transfuse. The countries at the bottom of this chart are not waiting on a breakthrough; they are waiting on the staff and supplies to deliver the ones we already have. That makes maternal death, in principle, one of the most solvable catastrophes on this list. It has just not been solved.

Did any of this ever go backwards?

In 2020 and 2021, for the first time in a generation, human life got shorter — and in Latin America it fell off a cliff.

For most people alive today, life expectancy was a number that only ever went up. Then the world caught a new virus and in 2020 the line bent down. By 2021 the global figure had fallen from 72.6 years to 70.9, the planet aged backward by more than a year and a half, erasing roughly a decade of gains in two seasons. This is the single fact behind the verdict at the top of this piece. Progress this large is not a law of nature; it is a thing that can be lost.

The world figure understates how hard it hit some places. Latin America lost about three and a half years off its life expectancy between 2019 and 2021, falling from 75.2 to 71.8, a regional collapse with few peers in peacetime. And then, almost as fast, it came back. By 2023 the global figure had climbed past its pre-pandemic peak to 73.2. The dip and the rebound together are the honest answer to whether we are beating death: yes, on a scale that should be front-page news, and no, not safely, not permanently. The recovery is the hopeful part. The speed of the fall is the warning. This is the one section with no clean regional or country chart, because a pandemic’s toll lands in a single notch that a flat-scaled line cannot show; the numbers above come straight from the same series.

We added the years. Are they healthy years — anywhere?

We live about nine years longer than we live well, and that gap follows the same map as wealth.

Underneath life expectancy sits a quieter number, and it complicates the whole celebration. Healthy life expectancy counts only the years lived in good health, before chronic illness or disability sets in. Worldwide in 2021 it was about 61.9 years, while overall life expectancy was near 70.9. The gap is roughly nine years: close to a decade, on average, lived in declining health at the end of a life. It is not closing as we live longer; if anything it widens, because the diseases we are best at surviving are the slow ones.

The regional picture maps onto wealth almost exactly. Healthy life expectancy runs from about 55 years across the WHO’s African region to 66 in Europe and 68 in the Western Pacific, a thirteen-year spread in good health on top of the gap in life itself. There is no country breakdown shown here, and that is deliberate: these figures come from the World Health Observatory, whose licence lets us chart and cite them but not re-host the file, so they sit beside the rest as borrowed evidence and stop at the regional line. Read together, the lines say something true and uncomfortable: we are winning years of life faster than we are winning years of health, and most unevenly where health was already shortest.

If we are beating the old killers, what is left — and for whom?

We live long enough now to meet the slow diseases. But the world’s grey hair is spread wildly unevenly.

Hold all the good news at once and a new shape appears. As infections retreat and children survive, populations age: the share of the world over 65 has doubled from about 5 percent in 1960 to 10 today, and it is still climbing. That is success, written as a problem. The killers of an old population are not cholera and measles; they are heart disease, cancer, diabetes, and dementia, the slow conditions a body only reaches if nothing fast got there first.

Ageing, though, is mostly a rich-region story so far. Europe and Central Asia are already 18 percent over 65; Sub-Saharan Africa is 3 percent, still a young continent finishing the fight against early death the older regions won. So the frontier arrives in sequence, not all at once. Some of it is already yielding: smoking, the great accelerant, has fallen worldwide from about 34 percent of adults in 2000 to 22, and the probability of dying early from the four big chronic diseases has edged down from 22 to 18 percent. But there is no single shot for ageing, no cold chain that delivers a cure for the slow diseases, and the years we are adding are not all healthy ones. We spent a century learning to keep people from dying young. The next century’s question is quieter and harder: not whether people live, but how well, and for how long after.

As the old killers retreat, what takes their place?

In one generation the world flipped from dying of infections to dying of chronic disease — and then the pandemic flipped a piece of it back.

In 2000, about a third of all deaths on Earth came from infectious disease, childbirth, and hunger. By 2019 that share had fallen to 18 percent, while deaths from the chronic diseases, heart attacks, cancer, diabetes, climbed from 59 percent to nearly three-quarters. That flip is the epidemiological transition, the quiet signature of a world where children stop dying young. Then the pandemic put a notch in it: communicable deaths jumped back to 27 percent in 2021, the first reversal of the trend in living memory.

How far a place has traveled along that path is itself a map of development. In East Asia and Europe, around 80 and 74 percent of deaths are now chronic; across Sub-Saharan Africa it is 34 percent, with the majority of deaths still infectious. By country the spread runs from China at 91 percent to Chad at 24. None of this is simply good or bad. Dying of heart disease at 78 is the prize for not dying of measles at 2. The transition is what success looks like from the inside, and most of the world now lives in its second half, where the enemy is slow, chronic, and far harder to vaccinate against.

Zoom past the country line. Is survival equal even within one nation?

No country is one place. In India the poorest fifth’s children die at more than four times the rate of the richest fifth’s.

Take the country averages that rank every other chart here, and zoom past them entirely. Within India, children in the poorest fifth of households die before five at about 4.4 times the rate of children in the richest fifth: the same country, the same year, the same flag. Colombia and the Philippines run close behind. Every national average on this page hides a second country folded inside it, where the poor still live by older rules.

The strange part is where the gap is widest. It is not the poorest countries; it is the middle-income ones. In Niger and Ethiopia the ratio sits below two, not because they are fair but because they are poor enough that the rich bury children too. A wide internal gap is, perversely, a sign that some families have already escaped, that survival has become something money can buy inside a single border. This is the last magnification on the page, the one no global headline reaches. The average launders the spread, and even one country is never one place.