Some News for Mr. Malthus

Nearly a billion people are expected to be born in the next decade, mostly in regions where food and health care are scarce. The exponential nature of this growth has given new life to Thomas Malthus’ 19th-century notion that a population explosion will inevitably lead to poverty and distress. Famine and pestilence, the English clergyman argued, are nature’s ways of keeping population growth in check.

Not so, suggests an encyclopedic study released this week by Harvard’s School of Public Health. International relief efforts, it shows, have been holding the line. Campaigns to combat malnutrition, for instance, have largely been responsible for a dramatic reduction in the percentage of children dying before age 5 in sub-Saharan Africa: from 40% in the mid-1970s to 7% in 1991.

Nevertheless the study criticized current relief efforts for failing to direct money to where it is most needed: A minuscule 0.2% of health research and development funding worldwide is devoted to TB, pneumonia and diarrheal diseases, even though such conditions account for nearly 20% of global disease.

The fastest-growing illness is heart disease. And curing it, says a study published recently in the British Medical Journal, will be a cultural as well as a medical challenge. Varying popular notions about which illnesses are treatable, the journal says, have led to dramatically different cardiovascular death rates per 100,000 people: from 1,318 in Russia to 862 in Poland, 460 in the United States and 250 in France.

The consequences of a culture’s failure to view a condition as treatable may be seen in the current illness of Russian President Boris Yeltsin; medical experts say he is suffering from cardiovascular problems that for the most part could have been corrected years ago.

So while we are right to hail the Harvard study’s conclusion that “health differences between countries are narrowing,” the journal study reminds us of just how wide the cultural and medical divide continues to be.