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.