Verified by 
Today, I would like to take a moment to focus on the good in the world and on being better at admitting that much is better in this moment. In doing so, I will draw on work recently published with my colleague, Salma Abdalla, with whom I co-wrote a paper, The Case for Optimism in Health and Health Care.
We argue that, for all the problems we face, there is much data supporting an optimistic view of the future of our efforts to create health. Echoing this argument, I will present three points which, I think, support this view. I will then suggest why I think this matters and why it is important to encourage optimism in our work and to admit when we are doing better.
So, what is there to be optimistic about? First, this is very likely the healthiest time to live in the world. The average life expectancy for a child born in 1900 was 32 years. In 2021, the average life expectancy was 71 years.
The rise in global life expectancy reflects improvement in a range of areas that support the health of populations. These include improved nutrition, education, and medicine, as well as a rise in living standards supported by technological developments and the expansion of free markets and global trade.
To be sure, the forces that have supported this improvement have not been unalloyed goods. Technology has made life better for many, but it has also destabilized much, creating more effective weapons of war and underwriting societal trends that have made us more atomized and less connected to the human bonds that provide meaning.
Global trade has enabled a rise in living standards, but it has not solved inequality, and, in many cases, it has deepened the divides between those with much and those with little. Nevertheless, the broad picture of the world in 2024 is one of a healthier, better place than at perhaps any time in history.
Second, and building on the first point, we can see these improvements in a range of health indicators domestically and globally. Globally, we have seen declines in poverty and child mortality and a rise in basic education, literacy, vaccination, and democracy.
Domestically, we have seen similar encouraging improvements. At the start of the 20th century, life expectancy in the U.S. was around 47 years. At the turn of the 21st century, it had risen to nearly 77 years. While health in the U.S. remains characterized by deep disparities, such as the health gap between black and white Americans, indicators nevertheless continue to improve.
Indeed, even the black-white life expectancy gap is far narrower now than it used to be, going from 14.6 years in 1900 to four years in 2019. We also see improvement in other areas. For example, in 2000, about 80 percent of U.S. residents aged 25 years or older attained a high school education, compared to about 41 percent in 1960.
And about 11 percent lived in poverty in 2000, a decline from about 22 percent in 1960. Such indicators reflect a country that, for all its challenges, is much healthier now in many ways than ever.
Third, we have seen a shift in the public conversation toward addressing our society's root causes of health. When I started my career in public health two decades ago, it was not so common to hear subjects like education, politics, the economy, racial injustice, climate change, and gun violence discussed as determinants of health. This has changed.
The conversation about the intersection of health and the foundational forces that shape it is now well within the mainstream of the public debate. This has led to institutions taking steps to engage with these forces to create and sustain a healthier world by closing health gaps. The World Economic Forum, for example, has advanced this work in its Zero Health Gaps Pledge, through which corporate signatories pledge to place the pursuit of health equity at the heart of all they do.
Such initiatives reflect a sea change in how we talk about health and take steps to support a healthier world across society and sectors.
So, there is much to be optimistic about, even as we remain mindful of health inequities. But why does this matter? It is nice to feel optimistic, but is it necessary? I would argue that it is indeed necessary, even indispensable, for the project of creating health for the following reasons.
First, if we are not optimistic, people will stop listening to us. After all, who wants to listen to someone who is unfailingly negative? Creating a big-tent movement for building a healthier world means projecting a sense of optimism people want to engage with.
Even when times are difficult, to be optimistic is not to deny challenges but to shine a light that can help us find a path through them. We should be in the business of shining such a light.
Second, when we do not emphasize the positive, we lose capital with political decision-makers whose partnership we need to enact policies that support health. Politicians are accountable to voters. This means that decision-makers must be able to deliver good news to their constituents consistently and, when the news is not so good, project optimism regardless.
It follows, then, that they will gravitate towards what can help them provide good news. If our tone is consistently negative, it will misrepresent the true state of health in the present moment and alienate the policymakers who can help us build on progress to make the moment even healthier.
Third, when we keep talking about bad health, we risk forgetting what health is fundamentally for—to enable the living of a rich, full, meaningful life. Imagine being healthy is like having a car. Most people would, I think, agree that the proper action to take when one has a car is to go for long, scenic drives with family and friends.
It is not to leave the car in the garage while we spend all our time talking about what the mechanic had to do to get it in proper working order. Yet this is essentially what we are doing when we keep talking about poor health at the expense of the more hopeful news we could be delivering.
Yes, it is important to be real about challenges, but it is also important to remember why we pursue health and invite others to join us.
A version of this post also appears on Substack.
