Sep 162021

Disease Burden is a conceptulization of how much value is destroyed by ill health. It’s a topic that’s been on my mind more ever since I lost ~1/3rd of my life. Much of our progress as a species has been attributed to the increased productivity we achieved by unlocking new energy sources, and creating new tech to exploit them. But I can’t help wondering how much is attributable to the reduction of disease burden as well.


Until recently, I don’t know how many people got anything aproximating decent sleep in their lives. You know how hard it is to be fully energetic, and to think sharply and quickly, after a night of shit sleep? How the hell did anyone get really good sleep on straw mattresses, in poorly insulated homes? After a day of labor that leaves you bone-weary without aspirin?

Most people had been scarred by a major childhood disease that permanently diminished them in some way. Other common diseases were endemic. People were often hungry.

With vaccines, antibiotics, modern hygiene, and the vast wealth we create nowadays, most of these problems have been wiped away. I would wager the typical human is at least 30% more productive than their premodern counterparts, if not significantly more. As a baseline multiplier, that effect can’t be understated. No matter how much productivity a person gains with using modern tools, having the ability to use them 30% more per day just stacks with that.

Somewhat worrisome is that as the old disease burdens were cleared away, new ones have sprung up. The obesity epidemic must have some effect. Major depression is listed as the #2 disease burden at the wilipedia link above. HIV is a relatively new endemic disease. And of course, there’s COVID…

What really worries me about COVID is that it looks like eventually everyone will get it, much like the flu. I don’t know how much to believe about Long COVID. But if it exists, and chronic fatigue is one of its effects, we could see total human productivity permanently drop 20% or more. I don’t want to say this is catastrophic, but… if 20% of the work force died, the effects would be disasterous. A work force that’s 20% less productive is in the same ballpark of problem.


Disease Burden isn’t just an individual-human issue. Cost Disease is common in most organizations/civilizations. It can be as simple as corruption and graft acting as deadweight costs. More commonly, regulation and legal codes slowly accumulate cruft until it’s too expensive to do anything new in a society, and only the behemoths already in place can continue to lumber on.

I’ve seen this happen in a professional context. Someone screws up somewhere, makes a minor mistake that is very costly, and a company implements a new rule to protect against that happening again. It’s a small rule, and on its own it doesn’t matter. But these rules accumulate. Procedures get longer and more labor intensive. Two levels of approval are needed for any action, verified and filed in triplicate. Eventually work that could be done in one hour now takes one and a half, and your admin staff has to increase by 50%.

If you’ve ever been on a forum or discord server that just keeps adding more and more rules, until the Welcome doc takes 40 minutes to read through and you’ll never remember it all, you’ve been subject to this process.

One major advantage of capitalism over other economic systems is that old companies that have become ossified with all this immune-response baggage can be replaced by young upstarts that aren’t saddled with all this disease. The old die, crushed beneath thier own burden, and the young take thier place. They then start to accumulate injuries and cruft of their own, because no one ever learns.


Civilizations follow similar patterns on longer time scales. They start young, quick-moving, and nimble. As they grow in age and power, they are beset by parasites, injuries, and edge-cases. Laws and regulations and customs grow around these insults like scar tissue. They protect, but come at a cost. Slightly less efficiency, slightly less flexibility. Eventually you get an empire so enmeshed in beuarocracy that it’s name is still a synonym for absurd complexities.

Empires fall too, and when they do it’s generally a bad time for anyone in the area. But it’s never been a species-wide problem, because the world was large enough that no matter how big an empire it was, and how hard it collapsed, there was a civilization somewhere else carrying the torch of human progress. Now that we have a globally integrated system, I’m not sure how true that will remain. As COVID has shown, every single part of the modern world is incredibly interlinked with every other. It’s possible that a large enough disaster could bring down every civilization that exists. Recovery from this could take many centuries, if it’s possible at all.

In the past, humanity as a whole was protected because the spaces between civilizations were so large, they were insulated from each other to a survivable degree. Our level of tech makes that impossible on one planet. The “New World” isn’t a place that’s months away, that most people will never see. It’s right next door.

Other planets are still substantially out of reach. It is often pointed out by anti-space-colony folks that anyone who wants to colonize Mars should start with Antarctica first, because it’s much closer and less hostile. But in terms of survival-insurance, the remoteness of Mars is exactly what we’re looking for. It’s important to have a place that won’t be effected if our planet dies, specifically because it may be necessary for civilizations to periodically collapse and be replaced by new ones that aren’t strangled by their own scars. Disease burden must occasionally be cleared away or it will smother everything. If the Creative Destruction of death and replacement is the only way to do that, we better make sure that we can survive it.


Regardless of anything else, be very wary of anyone or anything that wants to implement new rules or procedures in order to solve a percieved problem. Every additional restriction is an increased disease burden. It may be necessary to ward off something very destructive. But make damn sure it is, and keep your eyes out for occasions when you can dissolve prior protections. Disease burden is cumulative, and deadly, and should not be borne lightly.

  2 Responses to “Civilization Disease Burden and Off-Planet Colonies”

  1. Hmm hopefully now with proper html.

    You have no idea. At least 80% of all common diseases in developed countries are preventable, treatable and often even curable through more healthy life style choices .

    The Global Burden of Disease Study has a great visualization tool called GBD Compare that allows you to plot disease rates for different countries. What’s so amazing about this is that they use age standardized mortality rates (ASMRs) meaning that they correct for the demographic build-up of a country. A commonly heard fallacy goes something like this: “Well we get dementia here and they don’t in African countries but that’s just because we grow old enough to get it.” GBD Compare shows that that idea is nonsense.

    By using ASMRs you can fairly compare the rates of disease of equal age distributions. Sure not a lot of people make it to 80 or 90 in Zambia but more than plenty make it for a good sample. And that sample shows they basically just don’t get dementias such as Alzheimer’s of Parkinson’s (age standardized rates are 90% lower). You can do this for 286 causes of death. Just pick one. Invariably you’ll see that rates vary by orders of magnitude from region to region. Tropical diseases like malaria, AIDS and schistosomiasis obviously hit Africa hardest. But most diseases are most prevalent in developed countries. Clearly we are doing something very very wrong in the developed world that is causing all that death. People in underdeveloped countries age much more gracefully and much more healthily (when they are not being infected by flying, crawling, squirming or swimming critters at least).

    And of course the most worrisome is that this is only going to get worse. People don’t tend to think about things they don’t want to happen. As if not thinking about it is going to stop if from happening. So it is highly unlikely that people are going to stop drinking alcohol even though there is . Or are going to give up salt . Or are going to give up smoking, give up bacon and sausage and eat more fruits and vegetables.

    Indeed. If we continue down our current tech tree there’s a good chance we’ll destabilize the planet’s climate for millennia and permanently wreck the current ecosystems. Pumping CO2 into the atmosphere is not a free action but everyone is looking at each other hoping someone else will do something first.

    Often heralded “solutions” such as solar, wind, hydro and bio-fuels are dead ends. Our civilization requires energy at certain set times of the day due to our circadian rhythms. We cannot go to work wake or go to sleep based on the random times the wind is blowing or the sun is shining. There is no electricity storage technology available that can level the load between production and demand. There is not enough lithium in the world for enough batteries. Batteries are great for cars and small appliances but they are nowhere near sufficient for grid storage to keep our civilization going. Hydro-power can do load leveling at a cost effective price were it not for the tiny problem that we’ve already used pretty much all feasible dam sites in the Western world. The same problem also prevents expanding the hydro-power production, though there’s still some room for that in developing countries. And finally bio-fuels, which would be nice if we weren’t using the land for producing the animal feed that we use to give ourselves the first problem of sky high chronic disease mortality rates. And even if that somehow magically no longer happened because people got their shit together it still wouldn’t be long term scalable since it would limit the growth potential of the planet’s energy consumption quite severely.

    I’ve studied environmental physics at university and it is so infuriating that we understand all the physics we need to solve the energy crisis but nothing is being done. Because unfortunately the solution happens to involve the word “nuclear” so it is political and economic suicide. No matter that thorium molten salt reactors can’t explode, can’t melt down (it’s meant to be molten already), solve the nuclear waste problem, can not contribute to any practical nuclear weapons proliferation and require orders of magnitude less fuel for the same energy production all while having larger proven reserves. The response to Chernobyl and Fukushima is a perfect example of an extreme autoimmune overreaction that may just mean the end of human civilization.

    In the 50s when humanity was first toying with large scale nuclear infrastructure there was a point where we had to decide between using uranium or thorium fuels. Both sources were readily available in large quantities and both had slightly different properties. Uranium was useful because it’s isotope fissile U235 could be used to make plutonium, a key weapon ingredient, which was top priority at the time. Thorium on the other hand could not easily be turned into plutonium. Thorium being a fertile fuel source and not a fissile one needed a neutron source to kick start it to turn it into U233. In other words you could literally create a thorium mountain if you wanted to and nothing would happen whereas a uranium mountain would end up in a big fiery mushroom cloud. In the Cold War geopolitical climate at the time enriched uranium (U235) was chosen as the base of the nuclear industry instead of the much safer thorium. Decades later when the inevitable lapses in handling safety precautions caught up with us it tainted the public image of the entire industry.

    The thorium cycle also solves the nuclear waste problem we’ve been creating for the past half century. Current uranium reactors burn only a very small amount of their fuel. The remaining “spent” waste is still highly radioactive having only released a small amount of its available radioactive energy. The thorium cycle does not have this problem because it uses a slightly different decay pathway which allows all of its fuel to be burnt to ash (iron or other stable nuclei). In fact while in operation spent fuel from uranium reactors can be added to the thorium reactor which would breed the material into states where it can also be burnt to ash. The remaining truly spent fuel would only be very lightly contaminated (no separation process of the ash versus the active fuel is 100% efficient of course) and would need to be stored for a handful of years instead of the thousands to tens of thousands of years for materials from conventional uranium reactors.

    The thorium cycle is simply much safer in terms of nuclear weapons proliferation. U233 which is the main fissionable product of the thorium cycle is so impractical for bomb making that it’s not worth it. It is a strong gamma emitter which means making and storing the bomb would be very hazardous for those attempting it. It couldn’t be concealed from an enemy with a geiger counter. It would prematurely detonate easily. The bomb would decay quickly leading to high maintenance costs to replace bombs which radiated away their potential. And finally the radiation would shred electronics near it so the bomb would have to be analog and couldn’t be set of remotely or launched on a guided rocket.

    The icing on the cake for thorium MSR being that they are the perfect load following power plant. If the demand goes up the generators extract more heat from the core which cools which increases reactivity which meets demand. If the demand falls away the heat extraction drops, the core heats up, which slows the reaction down. If the demand is shut down over longer periods of time the core heats up enough to unfreeze a freeze-plug which drains the core into a long term storage vessel until the plant can be restarted. Plant workers could literally go on strike and abandon their posts and the reactor would just automatically shut down, what we’d call “walk away safe”.

    Okay, rant at the civilizational inadequacies of humanity over.

  2. Huh.
    I never thought of beauracracy using an immune response paradigm before: very useful.

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