"The Living Century" from The New York Times Magazine: Underreported stories of medical progress

Objectives:

Students will be able to…

• Recount the sequence of events for multiple global medical innovations, identifying key diseases and/or viruses and the solutions that led to their eradication.
• Describe how life expectancy has been affected by innovations in technology, policy, medicine, data, and community organizing throughout history.
• Examine the connections between medical advances and health inequality.
• Explore the nature of collaboration in advancing (in)equity in health care.
• Connect historical accounts of health innovation with current innovation around COVID-19.

Warm-up:

1. Make a list. What do you think have been some of the most important innovations in history? Why do you consider these some of the most important?
2. In this lesson, we’ll be talking about innovations in health care and the impact of some of those innovations. Discuss the following questions:
   • What messages did you get growing up about ways to keep yourself healthy, or to protect your health? Make a list.
   • Where do you get most of your information about ways to stay healthy?
   • What lessons have you learned in school about major health challenges in the past?
   • What stories do you hear in the news about health?
3. In this lesson, you will explore an underreported story related to health worldwide: the doubling of human life expectancy over the last century. The Centers for Disease Control and Prevention defines life expectancy as “... the average number of years of life a person who has attained a given age can expect to live.”Predict:
   • Why do you think people are now able to live longer than they did a century ago?
   • What might be the impact of humans worldwide living longer now than they did a century ago?
   • Do you think the average life expectancy is the same for people all over the world? Why or why not?

Key Vocabulary:

• Outbreak
• Life expectancy 
• Vaccine
• Ring vaccination
• Health inequalities
• Vulnerabilities
• Variolation
• Smallpox / variola major
• Industrialization
• Milk pasteurization
• Mortality rate
• Chlorine
• U.S. Food and Drug Administration
• Penicillin
• Randomized controlled trials (RCT)
• Oral Rehydration Therapy (ORT)
• World Health Organization
• Eradication
• Mortality

Introducing the Resource: The Living Century from The New York Times Magazine

A century ago, at the end of the Great Influenza, global life expectancy was in the mid-30s. In the U.S., it was 47.

Today, just 100 years later, global life expectancy is in the 70s.

“There are few measures of human progress more astonishing than this,” writes journalist Steven Johnson in “The Living Century,” published in The New York Times Magazine. “But of course, the story of our extra life span almost never appears on the front page of our actual daily newspapers, because the drama and heroism that have given us those additional years are far more evident in hindsight than they are in the moment.”

Johnson’s article explores the many innovations in technology, community organizing, policy, and medicine that have led to increased global life expectancy over the last century. It also explores the history of health inequities worldwide, and evaluates the way that an increased life expectancy may be connected to modern global challenges. Overall, Johnson asks the reader to investigate an underreported story of progress that continues to impact us all.

“By not thinking about those vanquished threats, we can be easily distracted from the underlying arc of progress — in basic human standards of health and social well‐being — that deserves to be considered the real story of the past hundred years,” Johnson writes. “And by not thinking about that past, we can’t learn from it.”

Exploring the Resource:

1. Click here to review a PDF of the article “The Living Century” by Steven Johnson. Click here to review the article on the website for The Times The article is broken up into four sections.
2. Respond to the comprehension questions below as you read each section.

• Introduction (PDF, p. 1-4)
• Section 1: Cracking Through the Ceiling (PDF, p. 4-9)
• Section 2: The Great Escape (PDF, p. 9-12)
• Section 3: The Great Equalizing (PDF, p. 12-14)
• Section 4: The Edge of Eight Billion (PDF, p. 14-15)

3. Note to teachers: One way to break up the article for students is to read the introduction with the entire class, or to assign students to read the introduction independently. Then, assign each remaining section of the article to a different group of students.

Analyzing the Resource:

1. Use the graphic organizer below to summarize the key details about the different medical innovations outlined in the article.
   • Graphic Organizer: Analyzing Key Medical Innovations Explored in “The Living Century”

2. Use the details from the graphic organizer to respond to the following questions in writing, or as part of a class discussion:

• Which details from the article most surprised you, and why?
• What connections did you notice between the ways that different medical innovations were discovered and shared?
• Based on your analysis of these different innovations, what do you think are the key components necessary for identifying solutions to the world’s greatest health challenges?

Extension Activities:

1. Watch Steven Johnson discuss life expectancy and COVID-19 with other health experts in Living Longer, Living Better, a roundtable event for the Consortium of Universities for Global Health.This full lesson plan includes a video recording of the conversation (approximately 58 minutes), and explores the concept of life expectancy, the role of the CDC, and the variables that contribute to health inequities.
2. Craft a timeline: Visualizing medical innovation. In each section of the article, Johnson describes a new virus or disease that is eventually eradicated due to medical innovation and community outreach.  Choose one of the following cases outlined in the article and craft a timeline documenting the process of eradication. Make sure to include all of the underrepresented stories that contributed to the process. Use this article and at least two other sources to craft your timeline. 
   • Influenza / the Great Influenza
   • Smallpox
   • Tuberculosis
   • Cholera
   • COVID-19

3. Research paper: Exploring medical inequality and COVID-19 COVID-19 is highlighting medical inequality domestically and internationally. Craft a research paper that examines medical inequality in your own country or internationally. You can compare a country that has many resources to a country that is under-resourced, or you can compare different communities in the same country or state. Review the Pulitzer Center COVID-19 issues portal and include at least two Pulitzer Center articles in your paper.

4. Presentation: Examining the impact of industrialization on public health: Increased industrialization has also impacted human health. People with fewer resources who live in urban areas are often subjected to increased health risks due to pollution, proximity to harmful chemicals, healthcare costs, and more. Choose an article listed below that explore this connection and develop a presentation to spread awareness about this issue:

• Uranium Linked to Cancer on Navajo Nation by Mary Calvert
• A Tale of Two Brownfields in the Midwest by Amelia Blakely
• The Cost of Cobalt by Fiona Lloyd Davies and Robert Flummerfelt
• Bhopal Gas Survivors in the Face of COVID-19 by Rohit Jain

5. Imagine the eradication of COVID-19 in your community. We are all facing a pandemic and although a vaccine has been released and some people have been vaccinated against COVID-19, many global communities are still at risk of contracting the virus and dying. Eradicating smallpox was a monumental endeavor that required a great deal of planning and teamwork. Imagine being part of a team at the World Health Organization and facing the task of ensuring everyone in your state gets vaccinated for COVID-19. Consider the following as you craft your plan:

• What are some barriers you may face in getting everyone vaccinated?
• What is a reasonable timeline to ensure everyone is vaccinated?
• What will your process look like?
• How will you use community spaces and resources?
• What systems will need to be in place to ensure your success?