Time of Indifference

Betrayal of Trust: The Collapse of Global Public Health

Laurie Garrett
Hyperion, 754 pp., $30.00

Dying for Growth: Global Inequality and the Health of the Poor

edited by Jim Yong Kim, Joyce V. Millen, Alec Irwin, and John Gershman
Common Courage Press, 584 pp., $29.95 (paper)

Poverty, Inequality, and Health

edited by David A. Leon and Gill Walt
Oxford University Press, 358 pp., $55.00 (paper)

During the cholera epidemic of 1849, Henry Mayhew, the great observer of London life, visited the district of Bermondsey south of the Thames. He wrote that the river water the residents drank and bathed in

appeared the colour of strong green tea, and positively looked as solid as black marble in the shadow—indeed it was more like watery mud than muddy water…. As we gazed in horror at it, we saw drains and sewers emptying their filthy contents into it; we saw a whole tier of doorless privies in the open road, common to men and women, built over it; we heard bucket after bucket of filth splash into it, and the limbs of the vagrant boys bathing in it seemed by pure force of contrast, white as Parian marble.

Mayhew visits a house where an infant has died of cholera and is told that its inhabitants really do drink the water. He asks whether they have tried to get their landlord to do something about it, and is told, “‘Yes, sir, and he says he will do it, and do it, but we know him better than to believe him.'”1

Bermondsey is now a middle-income London neighborhood, but its death rate is still nearly the highest in the city.2 Like all British people, its residents have access to reasonably good health care through the National Health Service, so why are they so unhealthy? Today people in Bermondsey die not from cholera and scarlet fever, but mainly from diseases of adulthood that are not considered contagious, such as heart disease, stroke, diabetes, and cancer of the stomach and lung. Lung cancer is known to be caused by smoking, but a number of researchers have proposed that the seeds of certain other diseases of middle and old age are actually planted in childhood, or even before. As George Davey Smith, David Gunnell, and Yoav Ben-Shlomo explain in Poverty, Inequality, and Health, poverty in childhood, and even among parents and grandparents, may predispose people today to many chronic adult diseases.3 So even though no one who lived in Bermondsey during the nineteenth-century cholera epidemics survives today, the poverty and infirmity of those times haunt their descendants like a kind of genius loci.

Many common illnesses in high-income countries today may be legacies of the Industrial Revolution, a particularly unhealthy historical period. By the middle of the nineteenth century, people in the Western world were becoming, on average, slightly shorter in height. By 1900, Europeans and Americans were growing again, and since then each generation has been taller than the one before it. But between around 1820 and 1870, physical growth in the West stalled, and at the same time, rates of death and illness increased.4 The Industrial Revolution, which brought prosperity to many people, also brought crowding, poverty, malnutrition, and disease to many more.

Today, new technology and expanded markets for commodities and labor are creating new economic and social changes, and just as in the…

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