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This Is Not Normal

2025-01-28 · letter vlog · John · 5:48 · watch on YouTube

Topic: Global development · mode: News analysis · tags: timely hook, heavy topic

John argues that the fall in child mortality since 1995, and centuries of health progress before it, were not natural or inevitable but came from human choices and sustained funding, including US-funded PEPFAR and the Global Fund, and warns that the new US administration's freeze on foreign aid threatens that progress.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — The most encouraging fact John knows: global child deaths under five halved since he graduated from high school in 1995

  • ★ John notes he graduated from high school in 1995, before most viewers were born, which he calls distressing rather than encouraging. (playful) — 00:00:00
  • ★★★ John says over 11 million children died before age five in 1995, and fewer than 5 million did last year (2024). — 00:00:00 · child mortality
  • ★★ John says child mortality is still far too high and could be cut by another 50% with existing technology if we really wanted to. — 00:00:29 · child mortality
  • ★★★ John says this fall in child mortality was not natural, normal or inevitable, and represents the greatest success in human history. — 00:00:29 · progress, child mortality

00:00:58 — US child mortality history from 1800 to 1960 and the causes of its decline

  • ★★ John says about 46% of people born in the US in 1800 died before five, similar to rates thousands of years earlier, and by 1840 it had only fallen to 43%. — 00:00:58 · United States, child mortality
  • ★★ John says progress continued slowly through the 19th century thanks to better sanitation and emerging understanding of the germ theory of disease. — 00:00:58
  • ★★★ John says that between 1920 and 1960 the chance of dying under age five fell from 18% to 3%. — 00:01:27 · United States, child mortality
  • ★★ John says many things had to go right for that drop: insulin and antibiotics, safer surgery, and lower rates of absolute poverty, malnutrition and tuberculosis. — 00:01:27 · extreme poverty, tuberculosis
  • ★★★ John says that in the US and globally none of this happened naturally: it is not natural for the world to become less hungry or less sick. — 00:01:27 · progress, United States

00:01:56 — 300,000 years without progress, 99.1% survival to 20 today, and the role of falling absolute poverty

  • ★★ John says our species is about 300,000 years old, with no meaningful progress on child mortality for over 99% of that time, and most of about 120 billion humans never reached 20. — 00:01:56 · child mortality
  • ★★ John says someone born in the US now has a 99.1% chance of living to age 20. — 00:01:56 · United States
  • ★★ John says about 36% of people lived in absolute poverty in 1995 and about 10% do today. — 00:02:26 · extreme poverty
  • ★★ John says less hunger reduces both direct deaths from malnutrition and deaths from the weakened immune system that comes with it. — 00:02:26

00:02:55 — Government-funded interventions such as PEPFAR and the Global Fund, now frozen with almost all US foreign aid

  • ★ John says safer circumstances in which to give birth have decreased both maternal and infant mortality. — 00:02:55 · maternal death
  • ★ John says some small part of the story can be credited to nonprofits that fund stronger healthcare systems. — 00:02:55
  • ★★★ John says a central reason child mortality fell since 1995 is government-funded interventions, including US-funded PEPFAR and the Global Fund. — 00:02:55 · child mortality
  • ★★★ John says PEPFAR, which fights HIV/AIDS in impoverished communities, has saved over 25 million lives and kept millions of children from being born HIV positive. — 00:02:55
  • ★★ John says the Global Fund has also saved literally millions of lives. — 00:03:24
  • ★★ John says that, for alleviating suffering, these are some of the best things humans have ever done together as a species. — 00:03:24
  • ★★★ John is heartbroken that the new US administration has completely frozen PEPFAR, Global Fund funding and almost all other foreign aid. — 00:03:24

00:03:53 — Tuberculosis deaths halved since 2000 but TB rising in rich countries; progress is not guaranteed

  • ★★ John says tuberculosis still kills over 1.25 million people each year though curable and preventable, which he calls absolutely unconscionable. — 00:03:53 · tuberculosis
  • ★★★ John says 2.6 million people died of TB in 2000, the year he graduated from college, so TB deaths have fallen by over 50% in 25 years. — 00:03:53 · tuberculosis
  • ★★ John says this progress against TB has been far too slow, but it is progress. — 00:03:53 · tuberculosis
  • ★★ John says more affordable tests and treatments can accelerate TB progress, as seen in the last couple of years, but progress is not guaranteed. — 00:04:22 · tuberculosis
  • ★★ John says tuberculosis is rising in rich countries; the US will see around 10,000 active cases this year (2025), a reminder that TB is airborne. — 00:04:22 · tuberculosis, United States

  • ★★ John says TB anywhere is a threat to humans everywhere. — 00:04:22 · tuberculosis

    “TB anywhere is a threat to humans everywhere.”

00:04:52 — Deadly risks of the aid pause for HIV and TB treatment; progress results from human choices; sign-off

  • ★★★ John says that if the so-called pause on aid is not amended to exclude diagnostics and medication, many people will die. — 00:04:52
  • ★★ John says interrupting HIV medication can be life-threatening, as can stock-outs of TB drugs. — 00:04:52 · tuberculosis
  • ★★ John says even a couple of weeks without TB treatment lets the bacteria evolve resistance, making infection more likely fatal and spreading drug-resistant TB, a threat to everyone. — 00:04:52
  • ★★★ John says the progress is the result of sustained, ongoing, open-ended funding and collaboration. — 00:05:21 · progress
  • ★★ John hopes that in 30 years his most encouraging fact will be that child mortality kept falling throughout his whole lifetime. — 00:05:21 · child mortality
  • ★★★ John concludes that continued progress for human health is not natural: it will result, or fail to result, from human choices. — 00:05:21 · progress

Threads in this video

Where the stories that moved here went next

Mentioned

Central: child mortality · Development aid · Global Fund to Fight AIDS, Tuberculosis and Malaria · historical determinism · President's Emergency Plan for AIDS Relief · progress · tuberculosis

Also: Organizations: Federal government of the United States

Concepts: Antibiotic · extreme poverty · germ theory of disease · HIV/AIDS · immune system · insulin · malnutrition · maternal death · multidrug-resistant tuberculosis · sanitation

Places: United States

Only in the description or credits: Our World in Data

Also centred on Development aid: What Can't a Billion Dollars Buy?

Also centred on Global Fund to Fight AIDS, Tuberculosis and Malaria: 90,000,000 Lives for $20

Also centred on historical determinism: Billionaires and Radical Hope: Thoughts from the World Economic Forum in Davos, Switzerland · History Is Happening

Also centred on President's Emergency Plan for AIDS Relief: 90,000,000 Lives for $20

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