The 21st century began with the first draft of the human genome, and with it, the promise of immense new powers to treat, prevent and cure disease.
In high-income countries like Australia, rates of heart disease were falling, and life expectancy was rising.
Over the past two decades, lots has changed about the factors that affect our health, wellbeing and how long (and well) we live.
So what do we know now that we didn’t then, and how far have we come?
As part of Radio National’s Big 20 series, Dr Norman Swan speaks to three leaders in their field to find out what’s happened in dementia research, cancer care and chronic disease over the last 20 years.
Chronic disease has been getting worse
Dr Norman Swan talks to Professor Chris Murray, director of the Institute of Health Metrics and Evaluation at the University of Washington.
Dr Swan: Take us back to the year 2000. What was the pattern of disease?
Professor Chris Murray: In the year 2000, right before the big push globally on reducing health problems in low income settings, we were pretty much nearing the peak of the HIV epidemic and, particularly in sub-Saharan Africa, we still had a very large number of deaths under age five — 12 million or so a year.
We hadn’t yet had the big efforts to control malaria. And many middle-income countries were right in that transition from a profile of disease burden dominated by infectious diseases and starting that shift towards cancer, heart disease, chronic kidney disease.
Listen to the podcast
Hear the full interviews with Dr Norman Swan on the Health Report podcast.
In the high-income world — Australia, Europe, North America — the [disease burden] looked pretty similar. It was already heavily dominated by heart disease and cancer, chronic kidney disease, but there was less obesity back then, there was less diabetes, and we were still back in the heyday of heart disease coming down pretty rapidly.
Dr Swan: What has happened in the two decades since?
Professor Murray: We’ve seen really dramatic progress bringing down child death rates.
In a place like Niger in West Africa, the improvements are just spectacular. You’ve probably halved child death rates in that period … bringing [it] down below the 5 million mark because of antiretrovirals for HIV.
There has been real progress on controlling malaria because of bed-net programs. So just lots of progress racked up, until COVID, on a number of fronts in the low-income world.
Then at the other end of the spectrum in the high-income world, we’ve seen heart disease progress slow, and in some places reverse.
We’ve seen this steady rise of obesity and bringing with it diabetes, high blood sugar, bringing up blood pressure levels in some countries, despite all the therapies that exist for them.
In the middle-income world we’ve seen progress but we’ve seen the rise of ambient air pollution in the last two decades. It’s becoming a bigger and