This week we talk about industrialization, antibiotics, and child mortality rates.

We also discuss corruption, instability, and progress.

Recommended Book: Empire of Silence by Christopher Ruocchio

Transcript

Demographic transition is a social sciences theory that posits, based on all sorts of modern historical data, that societies tend to change, demographically, as they transition from a largely agrarian, low-industrial society, to that of a less-agrarian, high-industrial society.

Most modern, post-hunter-gatherer societies have started out plowing the vast majority of their labor into bare subsistence, human beings spending their days, throughout their whole lives, working the land in order to produce enough food to live. All sorts of social and economic systems arose around this base-level fact, including those that tied laborers to the land, allowing for the rise of a leadership or ruling class, regional militaries, and other sorts of specialists. But until relatively recent history, the majority of people in a given society labored to produce raw essentials, and that was just the shape of things.

This began to change with the dawn of the industrial revolution, and in some areas a bit before that, as precursor technologies allowed societies to produce more food and other essentials with less manual labor and using fewer foundational resources, like land. These technologies, as they became more widely distributed, more effective and efficient, and cheaper to deploy and operate, allowed more people to do more sorts of things, leading to a ballooning of industry and commerce in industrializing regions, and that allowed said regions to invest in other things, including medical knowledge, education, and so on.

Life wasn’t exactly a cakewalk in these industrializing areas, and all sorts of new abuses and issues, including long hours at factories and problems related to pollution, arose and became common. But because these sorts of societies required professionals with new types of knowledge and know-how, and because they were able to sustain an increasing number of specialities beyond working the land to generate food and other bare necessities, keeping people alive, longer, and ensuring more people had the specialized knowledge required to do all those things, became more of a priority, and one that could actually be addressed because of the concomitant ability to feed and clothe and house and address more of the needs of more people.

There were gobs of other spiraling forces in the mix, of course, including religion, politics, and so on, but that general tendency to shift away from raw subsistence into more complex and diverse economic systems was a driving factor behind a lot of what happened from around 1800 until, well, now.

What I’d like to talk about today is a specific data point, or collection of data points, that arguably, more than any other such data points, show the benefits of the industrialized, modern society we’re living in, today, despite all the accompanying downsides.

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So most societies, at this point, have undergone significant changes as a result of our widespread application of technologies that allow human beings to get more done with the same amount of effort.

We’re able to generate more value, of all kinds, than our ancestors, and though it’s possible to criticize the change in priorities and focus on all the negative knock-on effects of these changes—and there are many such negative knock-on effects, like large-scale military conflicts and rampant pollution and climate change—it would be difficult to argue that there haven’t been some fairly significant upsides for humanity, as well.

One key upside is related to that demographic transition I mentioned. As societies shift and it becomes better for everyone if more people know how to do more things, and it thus becomes a priority for more people to live long enough to use the knowledge and know-how they acquire, it has increasingly made more sense for governments to invest in our overall longevity and survivability.

We can’t just say, I’d like everyone to live longer, and then snap our fingers and make that happen. But we can, and have, invested in technologies and systems that make longer lives more likely, and from 1800 onward that’s generally been the trend, with a huge upswing arriving in the mid-20th century, when a bunch of new tools and technologies, including things like modern antiseptics and early antibiotics, first arrived on the scene, dramatically reducing the mortality rate associated with all kinds of medical procedures.

Arguably the most significant social gain during this period, though, has been the bogglingly large reduction in child mortality rates.

Child mortality refers to the death of children under the age of five, and this figure is, today, usually expressed as the likelihood of a child under five dying, per 1000 children in an area. So you might say in India, the child death rate is 92 in 1000, which means 92 of every 1000 children resulting from live births in India die before they reach the age of five. And that was actually the real child mortality rate in India back in the year 2000.

And the story of overall global child mortality rates is actually pretty well exemplified in India’s rates, as the country has seen a dramatic drop in all-cause child deaths in recent decades.

In the year 2000, as I mentioned, it was expected that 92 out of every 1000 children would die before the age of 5 in India. As of 2024, though, that number has dropped to just 32 out of every 1000; a 68% drop. If you go back as far as 1990, the progress is even more impressive, those 2024 numbers representing a 76% drop in child mortality.

This progress has largely been the consequence of intentional, targeted health interventions by the Indian government, including institutionalized child delivery services and widespread, well-funded immunization efforts that ensured more children got vaccines and other sorts of care that was previously lacking, or which was not widely disseminated beyond wealthy families. They’ve also invested in newborn care and neonatal units at hospitals, which has increased child survival outcomes in a large radius around these facilities.

Southeast Asian nations still account for about 25% of all under-five deaths, globally, but improvements in India mirror those in China, which made rapid and sustained progress on this issue beginning in the 1950s, but really hitting their stride in the 1970s, when their child mortality rate was 143 per 1000 children; that rate dropped to just 12 per 1000 by 2020.

Globally, right now, the average child mortality rate is just under 40 per 1000, which is down from 93 per 1000 in 1990.

That’s a staggering amount of progress, but it does mean that nearly 5 million children still die each year before their 5th birthday, which adds up to something like 15,000 of such deaths per day.

At the moment, the vast majority of these deaths, about 80% of them, occur in Southeast Asia and Sub-Saharan Africa. The cause of these deaths varies a bit based on location, and there’s a time component to this, too, as some areas have seen much higher rates due to epidemics, but most of the causes of child death before the age of 5 are consistent, with premature birth and pneumonia, birth asphyxia or trauma, malaria, diarrhea, congenital abnormalities, and sepsis representing about 60-70% of such deaths, globally.

Almost all of these issues are preventable, and the major barrier to reducing these numbers further is access to resources and expertise that are more widely available and accessible in the wealthier world; there are huge disparities in child mortality between rich countries and poor countries, in other words, and while the number of child deaths has decreased everywhere, including in the world’s poorest countries, over the past 100 years, countries like Finland see about 2 in every 1000 children die before they reach the age of five, while countries like Niger see nearly 115 in every 1000 children die before the age of five.

This figure was previously around 500 in every 1000, globally, so about half of all children would die before the age of five, even in relatively recent history, even in the wealthiest regions, just a few hundred years ago—so again, stunning progress in this area; and looking back, in addition to families needing more hands to work the fields, before everyone started industrializing, families would tend to have as many kids as they could because it was generally just assumed that about half of them would die within the first couple of years; some cultures still have traditions of not naming their children until they’ve lived for a few years because of that earlier child mortality trend.

There’s still plenty to be done in this space, though, and the changes necessary to dramatically drop this mortality rate even further, regionally and globally, are not revolutionary in nature, it’s just a matter of more widely and equitably disseminating tools and technologies and cultural and economic infrastructure that already exists across much of the world, to the places where it doesn’t exist yet.

That’s a tall order in some locations, though, as part of why some high child mortality rate regions still have those high rates is that they’ve also had persistent government instability, which has in turn led to persistent internal conflicts and government overthrows and long histories of grift and corruption at the top-most levels of society.

In other words, it’s extremely difficult to improve these sorts of numbers when those who are in charge of a high-mortality-rate region are seemingly incapable of keeping things st...