Global Health and the Changing Contours of Human Life

The “contours of human life” include childhood and adolescence, reproduction, the experiences of health, illness, disability, and death. These stages and aspects of life are universal and will remain so. However, social, environmental, and scientific changes are transforming their timing, texture, and patterns-and these transformations are not universally shared. Serious inequalities persist, among and within countries and regions, in longevity, morbidity, and disability, control over reproduction and sexuality, and care at the end of life. This chapter addresses these changing contours of human life in six sections: coming into being; longevity; diminished health; reproduction; enhancement; and death and dying. We come into being as infants, children, and adolescents. In most parts of the world, life expectancy of infants and children has improved. Yet an infant’s chances of surviving to adulthood are strongly linked to country of birth. The persistence of unmet need for disease intervention and avoidable suffering among millions of children is concentrated in poor regions and countries. There, adolescents also, whose numbers are at an all-time global high, are vulnerable to infectious diseases affecting other children, as well as harm from injury, violence, and alcohol and drug abuse. Globally, on average, we live longer and better lives. Success in reducing infant and child mortality contributes greatly to increasing life expectancy and the convergence in age at death globally. Yet some countries and groups lag behind or even experience rising mortality. In rich countries, those with more education tend to live longer than those with less education; shorter lives are more common in many poor countries, among those burdened by the HIV/AIDS pandemic, and in post-communist Eastern Europe. While overall gains in life expectancy and longevity are substantial and promising, national and global data indicate divergence as well as convergence. Diminished health compromises the value of longevity. Diminished health is also of concern for occasioning pain and discomfort, limitations or impediments to important activities, and social isolation and stigma; and often for the need to seek and pay for care, which may be both urgent and financially catastrophic. The most vulnerable adult populations are people from the poorest wealth quintile, women, older people, and people who are unemployed with low educational qualifications. In low-and middle-income countries, these groups bear a significant proportion of the cost of diminished health and disabilities because weak health and social care systems undermine lived experiences and health/social outcomes. The extent to which people can make choices about their sexual and reproductive health is invariably intertwined with issues of disadvantage, inequity, and rights violations. This stratification of reproduction is evident in forms of access to maternal health services, global fertility control strategies, abortion and contraception management, and access to assisted reproductive technologies. Across these domains, poor women in poor countries are the most disadvantaged. The important changes to the human condition that enhancement is likely to bring about will be social and cultural, rather than biological. This is likely to be mediated through the social effects of the widespread adoption of practices such as off-label use of stimulants like Ritalin. Still, these changes raise issues of inequality and will require regulation and rethinking of long-established principles in health policy. Death and dying constitute an intimate and complex admixture of biomedical, social, cultural, and personal elements that are in a dynamic process of change and transformation. Wealth and poverty-at personal, social, and national levels-determine not only when and from what cause death will occur but also the experience of dying. In poor countries there is a notable deficit in palliation. In rich countries there is an abundance of resources, which also has drawbacks in the form of overreliance on institutional care and life-extending efforts that go past the point of diminishing returns. The chapter sections illustrate that the value of longevity is compromised by an increasing number of people living with diminished health under inequitable systems of health and social care. Vigilant monitoring of these inequalities, combined with forceful engagement with their economic and social determinants, are needed to ensure that the favorable trends in the contours of human life become each person’s birthright.