Hans Rosling and Global Health

“If you want to invest in Europe, invest in museums.” –Hans Rosling

Known for his dynamic TED talks, Hans Rosling is an extremely well known figure in the world of global health. Dr. Rosling is a physician and public health expert by training and is currently a professor of public health sciences at Karolinska Institutet in Stockholm, Sweden. I was recently able to see Hans Rosling give a lecture to public health students at Karolinska Institutet. He shared his insights and viewpoints on various global health issues and also introduced his “Trendalyzer” application, Gapminder World.

Much of what Hans Rosling explained with respect to global health trends and changes was illustrated using his Gapminder World application. What is Gapminder World exactly? Think of it as a visually appealing way to present statistical information for every country of the world. With this software, it is possible to make comparisons between countries based on such measures as GDP per capita, population size, and life expectancy, as well as various economic, education, energy, health, infrastructure, and population parameters. It is then possible to visually observe how these statistics have changed over time among the various countries. My explanations will not do justice to this application, so please check it out here Gapminder World.

So then, what were some of the most interesting points that Dr. Rosling made? The key idea that Dr. Rosling was reinforcing was the fact that the rest of the world is catching up with the most developed nations. Most of the world population lives in between rich and poor countries. Those countries with the worst health problems have the fastest population growth. The rise in the West, with respect to public health, occurred only in the past 100 years or so. The West first became wealthy, then after became healthy. However, Rosling said that we are seeing a different trend today. He gave China as an example; first, the nation got healthy, then it became a wealthier country. That being said though, most middle-income nations earn diseases before they get the wealth of rich nations. We are seeing the rise of non-communicable diseases (especially cardiovascular diseases) in these middle-income countries while they simultaneously deal with difficulties in combating infectious diseases.

Hans Rosling has a very person-centered viewpoint of public health. He stated, “Take care of the people, and the population will take care of itself.” He believes that government should not interfere in the choices of people; he said there was no need for it with respect to public health. One example he gave of this was letting individuals decide how many children they want. He discussed China and Taiwan and how historically the two nations had similar birth rates. However, presently Taiwan has a rate of about one child per woman, whereas China has a rate of about 1.6 children per woman. Even though China has its one child policy to impact birth rates, it has not been extremely effective. This was the reason why he suggested that “government shouldn’t go into the bedroom,” and that if you let the population make its own choices, “you get the number of people compatible with balance.”

It was also interesting to hear about the country which has seen one of the most dramatic health transformations. I wasn’t exactly sure which country to expect, but I was surprised to hear Dr. Rosling say that it was Vietnam. Vietnam has a low child mortality rate (often a good indicator of the quality of healthcare in a country), but is a relatively poor country. What exactly was responsible for this? Rosling spoke with a government official in Vietnam who explained that it was education that had had the largest impact on the health of the nation. The effect of girls going to school is still felt 50 years later on. Rosling said that progress in public health depends less on government and more on the people and public health professionals. Using money to improve education and health can reap the greatest rewards for a nation and its people, however he gave the caveat that success is highly contextualized among countries.

However, what I was really left focusing on after Rosling’s lecture was his discussion of the changing age structures of developing and developed nations over the next several decades. He used his Gapminder World application to show how the demographics of developed and developing nations are expected to change. In short, Europe especially will have difficulties with an aging population – there will be a very large population of older people and a small population of younger people. This is what inspired Hans Rosling’s comment: “If you want to invest in Europe, invest in museums.” With fewer working young people in Europe, it will make it quite difficult to fund healthcare for the older populations within countries.

I was really left wondering how developed Western nations are going to cope with these demographic changes. The impact of age-structure changes on the medical world will be especially pronounced – as populations age, readily expanding medical training and medical infrastructure will become ever more critical. The consequences of these demographic changes cannot be overestimated. Innovative solutions will need to be developed in order to care for a large, aging population. The developed world will have a lot of tough decisions to make, as the current welfare and healthcare models in most of these countries are unsustainable. In the United States, it will be interesting to see the changes to Medicare that will have to be made in order to maintain the solvency of the program. Given the heated political rhetoric from both sides of the aisle, it is quite difficult to understand what the impact of proposed changes will be. Also, time will tell what the impact of the Affordable Care Act will be and how this deals with changing age demographics.