TIME global health

This Species Is Close to Extinction and That’s a Good Thing

This July 28, 2004 picture shows volunteers Moises Matos and Helen Hand help assemble medical kits to fight Guinea worm disease at a warehouse in Atlanta.
Volunteers Moises Matos and Helen Hand help assemble medical kits to fight Guinea worm disease at a warehouse on July 28, 2004 in Atlanta, Georgia. John Bazemore—AP

The disappearance would mark the scouring of a disease from the face of the earth

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The Guinea worm is inching ever closer to extinction, but unlike just about every other endangered species, no one is going to try to save it, least of all scientists. On the contrary, the worm’s disappearance would mark the scouring of a disease from the face of the earth—a feat humanity’s only been able to celebrate twice before, with the end of smallpox in 1980 and of the cattle disease rinderpest in 2011. (Polio, despite the fact that a vaccine’s been around for more than half a century, has managed to hang on by its microscopic threads.)

What Is Guinea Worm Disease?

The Guinea worm is a parasite that enters the human body when the unwitting host-to-be drinks water contaminated with tiny water fleas in which Guinea worm larvae lurk. Once ingested, the fleas die and the Guinea worm larvae enter the host’s abdominal cavity and, unbeknownst to the host, begin maturing into a worm or worms that grow up to three feet in length. After about a year a painful blister forms on the host’s skin accompanied by itching and a burning sensation. Within about 10 to 15 days, one or more worms erupt from the person’s skin in a painful and drawn-out process. The emergence can occur from different parts of the body, including the roof of the mouth, the genitals, or the eye sockets, but around 90 percent of the worms emerge from the lower legs, according to the World Health Organization (WHO). (There are plenty of videos of Guinea worm extractions on YouTube, but be warned they’re quite unsettling.)

While the disease rarely kills, it can leave the host debilitated and weakened for a short or long period of time.

“The lesions caused by the worms often develop secondary bacterial infections that migrate all along the tract where the worm was,” says Ernesto Ruiz-Tiben, the director of the Carter Center’s Guinea worm eradication program. “The pain and agony can last for weeks.”

To alleviate the pain, the infected person often dips the part of the body from which the worm has emerged into water, where the female worm that is emerging can lay more larvae, and begin the process anew.

A Disease on the Decline

Thanks in large part to the work of the Carter Center, the incidence of Guinea worm disease (also known as dracunculiasis, which is Latin for “affliction with little dragons”) has plummeted in recent years, falling from an estimated 3.5 million cases worldwide in the mid-1980s to just 148 in 2013 and 126 in 2014, according to the WHO.

How has such success been achieved? It’s taken the concerted effort of all involved—the scientists who have figured out how to contain it, community organizers who have helped spread the word on preventative solutions, and the people in areas where Guinea worm disease has been a big problem who are implementing the necessary changes to keep the parasite at bay.

“Guinea worm eradication is like an orchestra: Every player has to play their own instrument but play from the same page of music,” says Ruiz-Tiben.

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There’s No Cure for the Long-Lived Dracunculiasis, but Preventive Measures Are Finding Success

While it could disappear in the near future, dracunculiasis is a disease that has been around for centuries. It is believed to be the “fiery serpents” referenced in the Old Testament, and the calcified remains of a male Guinea worm were found in an Egyptian mummy.

The treatment has been around a long time too. A description found on an Egyptian papyrus from 1,500 BC outlines the treatment that’s followed today: Wind the worm around a stick as it emerges.

But unlike rinderpest and smallpox, Guinea worm disease cannot be vaccinated against. Preventing its infection is a matter of making sure people don’t drink the contaminated water. To that end, education and water filtration are key. Both cloth filters, used to filter large amounts of water in containers, and smaller pipe filters, used like a straw when drinking, can screen out the water fleas that carry the Guinea worm larvae. There are also ways of chemically treating water sources to reduce populations of water fleas, but the microorganisms eventually return.

“There’s no magic bullet against this disease,” Ruiz-Taben says. But “the more barriers we can put out there to interrupt the life cycle of this disease, the greater likelihood there is that we can interrupt transmission.”

Once spread across Africa, the worm is now holding on only in South Sudan, Mali, Chad, and Ethiopia. Stamping out those last few strongholds, says Ruiz-Taben, is just a matter of continuing the cooperative work that’s been going on since the 1990s. As the journalist Julius Cavendish wrote in the Bulletin of the World Health Organization this past December:

“Not only is guinea-worm disease relatively easy to control, in theory, but the benefits of eradication far outweigh the costs. … According to a 1997 World Bank study, the economic rate of return on the investment in Guinea-worm disease eradication will be about 29% per year once the disease is eradicated… removing guinea-worm disease translates into hundreds of thousands of communities better able to work their fields, send their children to school and escape the cycle of poverty and disease.”

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If Wiped Out, Could It Recrudesce?

If the number of cases drops to zero, there should be little chance of dracunculiasis coming back. There could be hurdles to its total annhilation, however. While Guinea worms (unlike Ebola) don’t seem to have a widespread tendency to hide out in animals when they’re not infecting humans, there have been a few reports of dogs with the worms reported in Chad; if this turns out to be a more common phenomenon, eradication efforts may have to turn to preventing those canine cases too. And if those countries that host the last areas of Guinea worm infestation were to suffer from war, famine, or other kinds of instability, that could slow the process of eradication. In Mali, for example, just seven cases were reported in 2012—but those numbers increased slightly in 2013 and 2014, when conflict with Islamist rebels hampered eradication efforts.

Still, the ultimate end looks to be within reach. Does Ruiz-Taben think he’ll see Guinea worm disease completely eliminated in his lifetime?

“I am very hopeful—more than hopeful,” he says.

WORLD SCIENCE FESTIVAL: What Will Happen to Your Body in 2015?

This article originally appeared on World Science Festival.

TIME global health

What the Gates Foundation Has Achieved, 15 Years On

Sunny days: Melinda and Bill Gates in 2014, one year before their self-imposed deadline arrived
Sunny days: Melinda and Bill Gates in 2014, one year before their self-imposed deadline arrived Scott Olson; Getty Images

Jeffrey Kluger is Editor at Large for TIME.

Much has been done over the foundation's first decade and a half — with more still to do

There are a whole lot of things you may or may not get to do in the next 15 years, but a few of them you can take for granted: eating, for one. Having access to a bank, for another. And then there’s the simple business of not dying of a preventable or treatable disease. Good for you—and good for most of us in the developed world. But the developed world isn’t the whole story.

The bad—and familiar—news is that developing nations lag far behind in income, public health, food production, education and more. The much, much better news is that all of that is changing—and fast. The just-released Annual Letter from the Bill and Melinda Gates Foundation makes a good case for hoping there is still more to come.

The 2015 letter represents something of a threshold moment for the Foundation. It was in 2000 that the Gateses began their work and set themselves a very public 15-year deadline: show meaningful progress in narrowing the health, income and resource gap between the world’s privileged and underprivileged people, or be prepared to explain why not. So far, nobody—neither the Gates Foundation nor the numerous other global health groups like the World Health Organization and UNICEF—have much explaining to do.

The number of children under five who die each year worldwide has been nearly cut in half, from a high of nearly 13 million to 6.5 million today. Polio has been chased to the very brink of extinction, and elephantiasis, river blindness and Guinea worm are close behind. Drought-tolerant seeds are dramatically increasing agricultural yields; economies in the once-desperate countries in sub-Saharan Africa are now matching the developed world in rate of annual growth. Up to 70% of people across the developing world now have access to wireless service, making mobile banking possible—a luxury in the West but a necessity in places there is no other banking infrastructure.

The trick of course is that progress isn’t the same as success. The 13 million babies who were dying a year in the years before the Foundation began, for example, factored out to a horrific 35,000 every single day. Slashing that in half leaves you with 17,500—still an intolerable figure. For that reason and others, the Gateses are turning the 15-year chronometer back to zero, setting targets—and framing ways to achieve them—for 2030.

The most pressing concern involves those 17,500 kids. The overwhelming share of the recent reduction in mortality is due to better delivery of vaccines and treatments for diseases that are vastly less common or even nonexistent in much of the developed world—measles, pneumonia, malaria, cholera and other diarrheal ills. Those are still the cause of 60% of the remaining deaths. But the other 40%—or 2.6 million children—involve neonates, babies who die in the first 30 days of life and often on the very first day. The interventions in these cases can be remarkably simple.

“The baby must be kept warm immediately after birth, which too often doesn’t happen,” Melinda Gates told TIME. “This is basic skin-to-skin contact. Breast-feeding exclusively is the next big thing, as is basic cord care. The umbilical cord must be cut cleanly and kept clean to prevent infections.”

HIV may similarly be brought to heel, if not as easily as neonate mortality. A vaccine or a complete cure—one that would simply eliminate the virus from the body the way an antibiotic can eliminate a bacterium—remain the gold standards. But in much of the world, anti-retrovirals (ARVs) have served as what is known as a functional cure, allowing an infected person to live healthily and indefinitely while always carrying a bit of the pathogen. Gates looks forward to making ARVs more widely available, as well as to the development of other treatment protocols that we may not even be considering now.

“We’re already moving toward an HIV tipping point,” she says, “when the number of HIV-positive people in sub-Saharan Africa who are in treatment will exceed the number of people becoming newly infected.”

Food security is another achievable goal. Even as Africa remains heavily agrarian—70% of people in the sub-Saharan region are farmers compared to 2% in the U.S.—yields remain low. An acre of farmland here in America may produce 150 bushels of corn; in Africa it’s just 30. The problem is largely rooted in our increasingly unstable climate, with severe droughts burning out harvests or heavy rainstorms destroying them.

“Millions of people eat rice in Africa,” says Gates, “and rice has to be kept much wetter than other crops. At the equator it’s staying drier longer, but when the rains do come, they hit harder.”

In the case of rice and corn and all other crops, the answer is seeds engineered for the conditions in which they will have to grow, not for the more forgiving farmlands of the West. In Tanzania, site-specific seed corn has been made available and is already changing lives. “That seed,” one farmer told Gates when she visited in 2012, “made the difference between hunger and prosperity.”

Finally comes banking. Across Africa, only 37% of people are part of the formal banking system, but up to 90%, depending on the area, are part of the M-Pesa network—a mobile banking link accessible via cellphone. The Pesa part of the name is Swahili for money and the M is simply for mobile.

“Today too many people put their money in a cow or in jewelry,” Gates says. “But it’s impossible to take just a little of that money out. If someone gets sick or you have another emergency, you simply sell the cow.” Mobile banking changes all of that, making it much easier to save—and in a part of the world where even $1 set aside a day can mean economic security, that’s a very big deal.

Nothing about the past 15 years guarantees that the next 15 will see as much progress. The doctrine of low-hanging fruit means that in almost all enterprises, the early successes come easier. But 15 years is a smart timeframe. It’s far enough away that it creates room for different strategies to be tried and fail before one succeeds, but it’s close enough that you still can’t afford to waste the time you have. Wasting time, clearly, is not something the folks at the Gates Foundation have been doing so far, and they likely won’t in the 15 years to come either.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME global health

How To Stop Chikungunya

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The mosquito-borne disease chikungunya infected more than one million people in 2014 (including actress Lindsay Lohan), and is continuing to spread across the globe. But a new study from scientists at Smithsonian Tropical Research Institute (STRI) suggests a strategy for squashing the disease.

Eradicating mosquito-borne diseases is notoriously tricky. Countries around the world are home to the same types of mosquitos, which means that if someone is bitten and infected with a disease while on vacation, they might return home and be bitten by native mosquitos. Those mosquitos may mate or bite someone else, spreading the disease. That’s how chikungunya, which causes debilitating joint pain, appears to have hopped around the globe in recent years.

MORE: Chikungunya: 1 Million People Have a Disease You’ve Never Heard Of

In their new study, the researchers looked specifically at the spread of chikungunya in Panama. They observe that it started in Panama when people got the disease on vacation and brought it into the country, but now the disease is now spreading across Panama via roadways. To combat this, the scientists say vehicles should be fumigated at check points to prevent mosquito transport and stop the disease from reaching areas in Panama that haven’t seen cases yet.

Other strategies need to be implemented delicately, the researchers say. Chikungunya spreads with the help of two types of mosquitos: Aedes aegypti and Aedes albopictus, the same mosquitos that spread dengue fever. Many countries, Panama included, have fought dengue in ways that could unintentionally complicate chikungunya efforts. For example, in May 2014, Panama allowed the company Oxitec to release genetically modified sterile male mosquitos. When the mosquitos mate, offspring do not survive into adulthood and mosquito populations will die out.

The worry is that when the genetically modified mosquitos lower the populations of Aedes aegypti, Aedes albopictus mosquito populations could grow because of the lack of competition. It hasn’t happened yet, but the researchers worry it’s a potential consequence.

While understanding the full spectrum of mosquito-borne diseases may lead to pathways for prevention, this study shows just how complicated that process can be.

TIME global health

This Is Now the Average Life Expectancy Worldwide

Southern sub-Saharan Africa was the only region worldwide to have a decline in life expectancy

Life expectancy across the globe has increased by more than six years since 1990 to 71.5 years, according to a new study.

“The progress we are seeing against a variety of illnesses and injuries is good, even remarkable, but we can and must do even better,” said lead study author Christopher Murray, a University of Washington professor, in a press release.

The study, published Wednesday in the Lancet journal, showed declines in the number of deaths from cancer and cardiovascular disease in high-income countries as well as in deaths from diarrhea and neonatal complications elsewhere. Both of these trends contributed to the overall decline. Importantly, medical funding for fighting infectious diseases has grown since 1990 and helped drive the improvement, according to Murray.

Still, despite the improvement, the number of deaths from a number of ailments increased. Perhaps most dramatically, deaths from HIV/AIDS joined the list of the top 10 causes of premature death. The number of annual deaths from the ailment rose from 2.07 million in 1990 to 2.63 million in 2013, the equivalent of a 344% increase in years of lost life. The increase in deaths from HIV/AIDS made southern sub-Saharan Africa the only region worldwide to experience a decline in life expectancy.

Other ailments that caused an increased loss of life include liver cancer caused by hepatitis C, which soared 125% since 1990, and deaths from disorders related to drug use, which increased by 63%.

TIME Obesity

The 10 Healthiest and 10 Least-Healthy States

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Here are the states that are doing it right—and those in real need of a checkup

In some ways, Americans today are healthier than they were in 1990, when the United Health Foundation first published America’s Health Rankings, an annual state-by-state assessment of our nation’s health. Cardiovascular and cancer deaths are down, and the smoking rate has decreased 36%. Plus, life expectancy is at an all-time high—78.7 years. “But although we’re living longer, we’re also living sicker, with preventable illness at an alarming level,” says Reed Tuckson, MD, external senior medical advisor to United Health Foundation. The number-one reason: Obesity. “Since 1990, the obesity rate went from 11.6% to 29.4%, a 153% increase,” Dr. Tuckson says. In the last year alone, it rose 7%. Physical inactivity is also at a new high: 23.5% of Americans do not exercise at all.

Read on for the states that are doing it right—and the 10 that have a lot more work to do to improve their health.

The 10 Most Healthy States

10. Nebraska

2013 Rank: 11
Change: +1

Nebraska is among the healthiest states in America in 2014, coming in at number 10 (a slight increase over last year). Nebraska has a low rate of drug deaths, high rate of high school graduation, and high immunization coverage among children.

Challenges:
High prevalence of binge drinking
High incidence of Salmonella
Large disparity in health status by education level

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9. North Dakota

2013 Rank: 9
Change: None

North Dakota is the ninth most-healthy state in the U.S. this year, thanks to its low rate of drug deaths, high immunization coverage among teens, and low prevalence of low birth weight. North Dakota also came in ninth in 2013.

Challenges:
High prevalence of binge drinking
High prevalence of obesity
High occupational fatalities rate

8. Colorado

2013 Rank: 8
Change: None

Colorado is known for its outdoor activities—hiking, skiing, biking—so it should come as no surprise that the state has the lowest rates for obesity and diabetes in the United States. It ranks eighth for the second year in a row.

Challenges:
High prevalence of binge drinking
High prevalence of low birth weight
Large disparity in health status by education level

7. New Hampshire

2013 Rank: 5
Change: -2

New Hampshire comes in at number seven, and is just one of several New England states to rank in the top 10 for 2014. New Hampshire residents are more active than most Americans, enjoy a low rate of infectious disease, and have a low infant mortality rate. There is also high immunization coverage among teens.

Challenges:
High prevalence of binge drinking
High rate of drug deaths
Low per capita public health funding

6. Minnesota

2013 Rank: 3
Change: -3

Minnesota is known for its bitterly cold winters, but that doesn’t stop residents of this snowy state from keeping active, which also helps the state have one of the lowest obesity and diabetes rates in the nation. Minnesota also has a low rate of drug deaths.

Challenges:
High prevalence of binge drinking
High incidence of pertussis
Low per capita health funding

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5. Utah

2013 Rank: 6
Change: +1

Fewer people smoke in Utah than in any other state. Utah also has the second-lowest diabetes rate, the fourth-lowest obesity rate, a low percentage of children in poverty, and a low rate of preventable hospitalizations.

Challenges:
High rate of drug deaths
Low immunization coverage among teens
Limited availability of primary care physicians

4. Connecticut

2013 Rank: 7
Change: +3

Connecticut, the 4th-healthiest state in the U.S. this year, has a low prevalence of smoking, high immunization coverage among children, and a low occupational fatalities rate.

Challenges:
High prevalence of binge drinking
High rate of preventable hospitalizations
Large disparity in health status by education level

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3. Massachusetts

2013 Rank: 4
Change: +1

Massachusetts is the third-healthiest state in the nation in 2014. In the past two years, drug deaths have decreased by 9% and the rate of physical inactivity has decreased 11%. Massachusetts also has more residents with health insurance than any other state.

Challenges:
High prevalence of binge drinking
High rate of preventable hospitalizations
Large disparity in health status by education level

2. Vermont

2013 Rank: 2
Change: None

The runner-up—and the healthiest state in the continental U.S.—is Vermont. Vermont has the highest high school graduation rate in the country, a low percentage of children in poverty, and a low violent crime rate. In the last year, binge drinking has decreased 11% (though it’s still a challenge), and in the last two years, smoking has declined by 13%.

Challenges:
High prevalence of binge drinking
Low immunization coverage among children
Large disparity in health status by education level

1. Hawaii

2013 Rank: 1
Change: None

For the second year in a row, Hawaii earns the honor of healthiest state in America. Relatively few people in the Aloha State are obese, the cancer rate is low, and the state has the lowest rate of preventable hospitalizations in the country. Smoking has decreased by 21% in the last two years, and binge drinking has declined by 15%.

Challenges:
High prevalence of binge drinking
High incidence of infectious disease
Low immunization coverage among children

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The 10 Least Healthy States

41. Indiana

2013 Rank: 41
Change: None

With 31.8% of adults obese, 28.3% of adults never exercising, and a huge air pollution problem, Indiana comes in at number 41.

Strengths:
Low incidence of infectious disease
Low percentage of children in poverty
High immunization coverage among teens

42. South Carolina

2013 Rank: 43
Change: +1

Coming in at 42, South Carolina is struggling to keep its children healthy: it has a low rate of high school graduation, high prevalence of low birth weight, and ranks in the bottom half of the states for the immunization of children. It also has high rates of obesity, diabetes, and physical inactivity.

Strengths:
Low prevalence of binge drinking
Low incidence of pertussis
Low rate of preventable hospitalizations

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The 10 Least Healthy States

43. Alabama

2013 Rank: 47
Change: +4

Ranking 43rd overall, Alabama has the highest diabetes rate in the nation, at 13.8% of adults—a 17% increase over the last two years. The state also has a high prevalence of low birth weight and a limited availability of dentists.

Strengths:
Low prevalence of binge drinking
High immunization coverage among children
Small disparity in health status by education level

44. West Virginia

2013 Rank: 46
Change: +2

With 27.3% of the adult population lighting up, West Virginia has the highest prevalence of smoking in America. It also has more drug deaths than any other state, as well as the second-highest obesity rate.

Strengths:
Low prevalence of binge drinking
Low incidence of infectious disease
High per capita health funding

45. Tennessee

2013 Rank: 42
Change: -3

Tennessee ranks 50th for violent crime, 49th for physical inactivity, 47th for obesity, and 45th overall.

Strengths:
Low prevalence of binge drinking
Low incidence of pertussis
Ready availability of primary care physicians

46. Oklahoma

2013 Rank: 44
Change: -2

Ranking 46th, the Sooner State has a high prevalence of physical inactivity, low immunization coverage among children, and a limited availability of primary care physicians. Since 1990, violent crime has increased 12%, while the nationwide rate dropped 37% during the same time period.

Strengths:
Low prevalence of binge drinking
Low incidence of pertussis
Low prevalence of low birth weight

47. Kentucky

2013 Rank: 45
Change: -2

While lots of people in Kentucky smoke, very few of them exercise, a combination that lands the Bluegrass State at number 47. Kentucky also suffers from a high percentage of children in poverty and a high rate of preventable hospitalizations.

Strengths:
Low prevalence of binge drinking
Low violent crime rate
High immunization coverage among children

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48. Louisiana

2013 Rank: 48
Change: None

Louisiana ranks 48th in 2014 thanks to its high incidence of infectious disease, high prevalence of low birth weight, and high rate of preventable hospitalizations.

Strengths:
Low incidence of pertussis
High immunization coverage among teens
Small disparity in health status by education level

49. Arkansas

2013 Rank: 49
Change: None

Coming in second to last—same as in 2013—Arkansas has a high incidence of infectious disease, a limited availability of dentists, and low immunization coverage among children. Additionally, obesity has increased 12% over the last two years.

Strengths:
Low prevalence of binge drinking
High per capita public health funding
Small disparity in health status by education level

50. Mississippi

2013 Rank: 50
Change: None

For the third year in a row, the least-healthy state in the U.S. is Mississippi. Mississippi ranks last on six measures: physical inactivity, rate of infectious disease, low birthweight, infant mortality, cardiovascular deaths, and premature deaths.

Strengths:
Low prevalence of binge drinking
High immunization coverage among children
Small disparity in health status by education level

This article originally appeared on Health.com

TIME global health

The 20 Best and Worst Health News Stories of 2014

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Wins, fails, and sensational headlines in medicine and public health

As far as sensational headlines go, the past 12 months provided no shortage of health-related material. Of course, 2014 had its share of doom-and-gloom stories about depression, domestic violence, untimely deaths, and disease outbreaks (at home and abroad), to name a few. But it also gave us reasons to celebrate: Promising new discoveries and legislation, inspiring role models and worthy causes, and healthy trends that are improving lives and changing the future. Here, in a nutshell, are the best and worst health stories of the year.

Best: Obamacare hits one-year milestone

Despite its rocky beginnings in 2013 (and the fact that many Americans still don’t understand it), the Affordable Care Act achieved several of its major goals in its first year, according to a study published in July by the Commonwealth Fund. The report found that the number of uninsured Americans dropped by 25% and that most people like their new plans and find it easier to find a doctor.

Separate studies this year also found that the ACA, also known as Obamacare, has helped young adults receive mental health treatment and could potentially lead to a decline in deaths.

Worst: Ebola outbreak in Africa (and freakout in America)

By far the biggest and most devastating health story this year has been the thousands of West Africans sickened and killed by the Ebola virus, which hit the areas of Liberia, Guinea, and Sierra Leone particularly hard.

And although the virus can only be spread through contact with bodily fluids—and despite the fact that no American has yet contracted Ebola who has not spent time treating patients with the disease—that didn’t stop hysteria in the United States. Amid calls for a travel ban and anger directed toward doctors and nurses returning home from Africa, mental health experts stated in October that anxiety about Ebola was now a bigger threat than the virus itself.

Best: Medical devices lose some of their stigma

Women who enter beauty pageants and pose for Internet selfies are often seen as vain and materialistic, but in 2014 two women fought to dispel those notions, while at the same time showcased health conditions that aren’t often seen as beautiful.

In July, Miss Idaho contestant (and eventual winner) Sierra Sandison wore an insulin pump she uses to treat her Type 1 diabetes clipped to her swimsuit during a competition. One month earlier, UK resident and Crohn’s disease sufferer Brittany Townsend had shared her own bikini photo on Facebook, complete with the colostomy bags she needs to remove waste from her body. Both photos went viral, sending messages that women like Sandison and Townsend don’t have to be ashamed.

Worst: Measles outbreak fueled by anti-vaccinators

The CDC reported in May that measles cases in the United States were at a 20-year high so far this year, largely due to unvaccinated people who contracted disease while traveling abroad and then returned home and spread it among unvaccinated members of their communities.

The number of parents who choose not to vaccinate their children in the United States is growing, despite a scientific consensus that childhood vaccines are safe and don’t cause serious health problems like autism or leukemia. Unvaccinated children have also contributed to recent outbreaks of whooping cough and mumps.

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Best: CVS stops selling cigarettes; FDA limits e-cigs

Customers can no longer pick up cigarettes along with their prescriptions at CVS pharmacies, thanks to a ban in all stores implemented in September—four weeks earlier than the date the chain had originally announced. Carnival Cruise lines also jumped on the bandwagon this year, banning smoking on its stateroom balconies in October.

E-cigarettes have seen plenty of regulations this year as well. In April, the FDA proposed regulations to ban the sale of electronic cigarettes to minors and to include health warnings on their packages, and in August, the World Health Organization recommended that countries regulate electronic cigarettes and ban their indoor use.

Worst: Enterovirus outbreak hits children nationwide

At last count, a severe respiratory illness called Enterovirus D68 has been reported in 43 states and the District of Columbia. More than 500 cases have been confirmed across the United States, mostly children, with four suspected deaths (and one confirmed).

ED68 has been described as a polio-like illness that can cause paralysis. Most infected children recover without serious illness, but those with lung conditions like asthma are at increased risk for severe symptoms.

Best: Orthorexia gets mainstream coverage

Being a diligently healthy eater may seem like a good problem to have, but a prominent blogger showed fans this year what can happen when it’s taken to an unhealthy extreme. Jordan Younger, also known as The Blonde Vegan, announced to her readers in June that she was moving away from her strict vegan lifestyle because she’d developed an eating disorder called orthorexia—an obsession with healthy foods that leads to more and more restrictions and, potentially, malnourishment.

Worst: Domestic violence rears its ugly head

The topic of domestic violence made national headlines this year when then-NFL player Ray Rice punched his then-fiancee (now wife) in an elevator; investigations since then have uncovered many more instances of spousal or partner abuse among professional football players, and cover-ups among their teams.

But a survey released in September revealed that one in five American men admits to using violence against his spouse or partner, and that domestic abuse affects people of all professions, races, and classes. A study in April also found that domestic violence can cause fear and anxiety for children who witness it, hear it, or see the resulting injuries.

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Best: Science gets wise to the dangers of sugar, white bread

Doctors and nutritionists have known for decades that added sugar is linked to diabetes and heart disease, but a study published in February really hammered home just how dangerous it can be: The average American diet contains enough added sugar to increase the risk of heart-related death by nearly 20%, reported researchers from the Centers for Disease Control and Prevention.

The health risks of white bread were exposed this year, as well: People who eat two or more servings of the refined stuff a day are more likely to become overweight or obese than those who eat less or who favor whole-grain bread, according to a Spanish study presented in May.

Worst: ‘Biggest Loser’ winner reveals shocking weight loss

When The Biggest Loser contestant Rachel Frederickson surprised viewers with her 155-pound weight loss during the show’s Season 15 finale, not everyone was pleased. Viewers expressed alarm on social media about Frederickson being too skinny, and even the show’s trainers Bob Harper and Jillian Michaels were visibly shocked at her transformation.

Frederickson has since gained back 20 pounds and found her ’perfect weight,’ but the incident seems to have had at least one permanent impact: In April, People reported that Michaels wanted to distance herself from the show because of concern for the participants’ health and wellbeing, and in June, NBC announced that Michaels would not be returning. The celebrity trainer later revealed that the show’s producers weren’t willing to make certain changes she’d requested to the show’s format.

Best: Food labels are changing for the better

The “nutrition facts” box on food packages should soon become easier to understand, thanks to a makeover first proposed by the Food and Drug Administration in February. Under the new guidelines, serving sizes will be more straightforward, calorie counts highlighted more prominently, and “daily values” for nutrients will be revised.

Some food companies have spoken out against part of the proposal that would require “added sugars” to be included on nutrition labels, but a Change.org petition submitted by the American Heart Association in November showed that public support for the measure is still strong.

It’s not yet clear if or when these measures will be put into place, but one major food-label change did happen in 2014: Beginning in August, foods can only be labeled gluten-free if they truly are free of gluten—a major win for anyone with celiac disease or gluten intolerance.

Worst: Smartphones and social media are making us sick

We can’t live without it—but more and more research is suggesting that if we’re not careful, personal technology can really mess with our health. Facebook makes us jealous of our friends and self-conscious of our bodies, texting gives us bad posture, and just having a smartphone in the same room can affect our parenting skills.

No one’s quite figured out the solution to these problems yet, but people are certainly trying; there’s no shortage of writers going on ‘digital detoxes’ and reporting back what they’ve learned. Meanwhile, a new technology-related health risk surfaced this year, as well: A paper published in October describes a man who became addicted to Google Glass.

HEALTH.COM: 11 Reasons Why You’re Not Losing Belly Fat

Best: Ice Bucket Challenge raises millions for ALS

You probably got tired of seeing the videos in your Facebook feed, but the truth is they worked: Since the Ice Bucket Challenge exploded onto the social-media scene in July, ALS nonprofits and research organizations have received more than $100 million in donations.

Amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease, is a fatal neurodegenerative disease with no cure, but ALS researchers are hoping to change that. Nancy Frates, whose son Pete dreamed up the Ice Bucket Challenge after his own ALS diagnosis in 2012, recently shared in a TED Talk how clinical trials have been fast-tracked thanks to funding from the Challenge.

Worst: Robin Williams commits suicide after Parkinson’s diagnosis

America lost one of its most beloved actors in August when Robin Williams took his own life after years of struggling with depression. After his death, Williams’ wife revealed he had also recently been diagnosed with Parkinson’s disease, and an autopsy revealed his brain showed signs of Lewy Body Disease, a form of dementia that can cause hallucinations and concentration problems.

Although it’s not confirmed that these conditions played a role in Williams’ suicide, his death has shed light on several disorders that are often linked and frequently misdiagnosed or understood.

Best: Ninja warrior, curvy ballerina become unlikely fitness stars

When it comes to athlete role models, girls now have more than just soccer players and ice skaters to look up to. In July, Kacy Catanzaro became the first female contestant to reach the finals of NBC’s fitness competition American Ninja Warrior. Catanzaro made the challenging course look easy, and her victory sparked a #MightyKacy Twitter hashtag that trended worldwide.

Then in August, UnderArmour introduced us to its newest spokesperson, American Ballet Theater soloist Misty Copeland. The brand’s first commercial starring the dancer—about how she triumphed over negativity after being told she lacked the right body and was too old to become a ballerina—has more than 6 million views on YouTube, and has been called stunning, mesmerizing, and jaw-dropping.

Worst: Joan Rivers’ death raises questions about surgery safety

Comedian Joan Rivers was known for her irreverent humor, her biting fashion critiques, and perhaps most famously, her self-proclaimed obsession with plastic surgery. She went under the knife frequently, always pushing the boundaries of what it meant to age healthfully and happily.

But when the 81-year-old stopped breathing during what should have been a routine throat procedure in September (her family eventually took her off life support), her death sparked a new controversy: whether her doctors were to blame—especially after it was suggested that her surgeon took a selfie with an unconscious Rivers before the operation. In November, TMZ reported that staff members did not weigh Rivers before sedating her, potentially giving her too much medication.

HEALTH.COM: 14 Foods that Make You Look Older

Best: ‘Angelina effect’ increases rates of genetic testing

Actress Angelina Jolie made headlines in 2013 when she had a preventative double mastectomy after testing positive for the BRCA1 gene. But the effects of her decision had wide implications in the months that followed. In September, Canadian cancer researchers revealed that the number of women seeking genetic counseling and testing at their center rose dramatically after Jolie’s announcement.

Although cancer doctors caution that not every woman should be tested, most agree that extra education and awareness is certainly a good thing. Luckily, the increase in genetic testing is coming from women who actually do have a higher risk for breast cancer, and who will get the most benefit from what they might learn.

Worst: Antibiotics still being overprescribed

Despite warnings to physicians about the overuse of antibiotics, the drugs are still being prescribed when they’re not needed. Pediatricians, for example, dole out antibiotics twice as often as needed for throat and ear infections, found a study published in September. Researchers also discovered this year that doctors are more likely to prescribe unnecessary antibiotics later in the afternoon, as their decision-making skills wear down throughout the day.

Regardless of when it’s happening, the consequences could be deadly: Misuse of antibiotics fuels the growth of drug-resistant bacteria, reported the Centers for Disease Control and Prevention in March, as it outlined new recommendations to keep the drugs from being overused in hospitals.

HEALTH.COM: 13 Healthy Reasons to Have More Sex

Best: Air quality is improving in U.S. cities

The Environmental Protection Agency shared some good news in August: The air in American cities has become significantly cleaner since 1990, with major reductions in levels of mercury, benzene, and lead. About 3 million tons per year of pollutants have also been reduced from cars and trucks, as well.

More good news for your lungs: in November, the United States announced a climate change agreement with China that aims to cut both countries’ greenhouse gas emissions by nearly a third over the next 20 years. In announcing the deal, President Obama said he hopes other nations will be inspired to make positive environmental changes, as well.

Worst: Internet flips out over Renee Zellweger’s face

As far as celebrity scandals go, Renee Zellweger’s appearance on the red carpet in October shouldn’t be anywhere near the top of this year’s list, but you’d never know it judging by the reactions she received on Twitter and in the media.

The 45-year-old actress attended an awards ceremony meant to honor the work of talented women in Hollywood, but all anyone could talk about was how different her face looked and whether she’d had plastic surgery or just, well, gotten old. Zellweger spoke out the following week, telling People that she’s glad people noticed her new look, adding, “I am healthy. For a long time I wasn’t doing such a good job with that.”

HEALTH.COM: 5 Fat-Burning Body Weight Exercises

This article originally appeared on Health.com.

TIME global health

Chronic Diseases Are Devastating Poor Countries, Report Says

International aid in the developing world is overwhelmingly focused on infectious diseases like AIDS and malaria, but chronic diseases are the biggest killers.

Chronic diseases like cancer and heart disease have become the leading cause of death in the developing world and are becoming deadlier every year, according to a new report from the Council on Foreign Relations.

The trend marks a sharp contrast from the developed world, where preventive measures and treatment have contributed to a decline in the number of deaths from these diseases before the age of the sixty.

While declining rates of infectious diseases in the developing world could explain part of the rise—as people live longer, they have a higher chance of contracting chronic diseases—the report says that other factors are at play, including rapidly rising pollution and tobacco use and poorer nutrition. In fact, chronic diseases are disproportionately affecting younger populations in the developing world.

The disparities in health care are also evident in the report: All of the governments in sub-Saharan Africa spend roughly as much on health as the government of Poland.

See the report here.

TIME Research

These Mammals Are Hit Hard By Climate Change

Wild rabbit
Getty Images

Research suggests that smaller mammals may weather climate change better than bigger ones

WSF logo small

December’s here and snowshoe hares are putting on their white winter coats as they’ve done for countless generations. But because climate change is transforming their environment much faster than evolution can react to it, the species is increasingly out-of-sync with its landscape: As snows arrive later and melt earlier, the hares, whose coloration change is thought to be triggered by the changing length of days, not the actual temperature and precipitation around them, are turning white when their surroundings are still brown, and stand out like beacons for predators. By 2100, the discrepancy between the hares’ coat change and the timing of snow and melt could be off by as much as eight weeks, according to research by two North Carolina State University biologists.

Predators are being negatively affected as well. Wolverines need snow to make their dens, and “there is no evidence that wolverines will be able to persist in areas that lose their snow as a consequence of climate change,” researchers wrote in a paper for the U.S. Forest Service. Wolves are struggling in places like Isle Royale National Park, where a streak of unusually hot summers has caused a decline in moose, their primary prey. Declines in wolves can impact other species, too: Wolves and other apex predators have been shown to buffer against climate-related famines for scavengers like bald eagles—in milder winters, animals like elk are less likely to die of natural causes, so the leftovers from wolf kills provide a crucial source of carrion.

Bats are feeling the heat as well, quite literally, and droughts could spell disaster for many species. “Bats in arid places need freshwater to drink, especially when lactating,” says Winifred Frick, a bat researcher at the University of California Santa Cruz. As the climate changes, bat habitats that get warmer and drier will increasingly become uninhabitable. Heat waves have already caused mass die-offs among flying foxes in Australia.

Changing climates can also affect bats’ echolocation abilities. The temperature, humidity, and pressure of the air all affect how a bat’s ultrasonic screech travels, and according to one model developed by scientists at the Max Planck Institute for Ornithology, bats living in more temperate zones at present will get less efficient at finding prey—more precisely, the volume of space they can detect prey in will shrink—while tropical bats will actually benefit and be able to cast a wider sonic net.

With widely distributed and varied mammal groups like bats, it’s hard to say whether or not climate change will spell doom for every single species in the group. Some may adapt to their altered habitats, some may migrate, and some may perish. In general, though, research suggests that smaller mammals may weather climate change better than bigger ones. A recent meta-analysis led by University of Colorado Boulder professor Christy McCain that examined 140 research projects on North American mammals found that body size is by far the best characteristic to predict how an animal responds to climate change. Bigger animals like foxes, reindeer, and bighorn sheep are in danger, but rodents may prove much more resilient.

“There may be certain traits like body size and activity behaviors that allow some smaller mammals to expand the range of temperature and humidity available to them,” McCain said in a statement. “These areas and conditions are not available to bigger mammals that live above the vegetation and experience only ambient temperatures.” This appears on the surface to be in line with what the fossil record has shown at major extinction events—some populations of small mammals survive, even as larger creatures die in droves.

This article originally appeared on World Science Festival.

TIME

Is the Menstrual Cup Going Mainstream?

Lily Cup menstrual cup
Courtesy of Lily Cup

This Kickstarter cup got funded at 4,000% of its goal

Not a whole lot seems to have changed in the menstrual market since the 1970s, when you no longer had to wear a belt to keep a pad in place.

Lily Cup menstrual cup
Courtesy of INTIMINA

But an innovation in period care—a collapsible menstrual cup called the Lily Cup Compact—was just successfully crowdfunded at more than 4,000% its goal on Kickstarter.com. The campaign, led by Swedish brand Intimina, which has five physicians on its board, aimed for $7,800. After the campaign ended Sunday, backers gave more than $325,000 to help make the Lily Cup Compact real.

Menstrual cups have existed in some form since the 1930s, though earlier iterations were nothing like the Keeper, Softcup and the Diva Cup, to name a few modern models. Still, American women have been slow to adopt them. “The very first time I heard about [menstrual cups] was a year and a half ago,” says Taraneh Shirazian, MD, assistant professor of obstetrics, gynecology and reproductive medicine at the Icahn School of Medicine at Mount Sinai in New York City. “When I talk to my patients about it, none of them are using it, and very few people know about it.”

Menstrual cups are flexible, goblet-shaped devices usually made of silicone or latex that are folded and then inserted like a tampon. Once inside, it opens up and forms a seal to stop menstrual blood from escaping from the uterus into the vagina. Other menstrual cups—the Keeper and the Diva Cup—are currently on the market, though they are not collapsible. The Lily Cup also comes with a carrying case, making it more convenient and discreet to tote around.

A 2011 survey found that 91% of women who tried a menstrual cup said they would switch to one—and recommend it to friends. The study also found that the cost of buying tampons for a year, approximately $37, was about equal to the price of a single menstrual cup, which can last for a decade. Menstrual cups come with other advantages. They can be left inside the body for 10 hours; tampons need to be changed every 8 hours to prevent the growth of the bacteria Staphylococcus aureus, a cause of toxic shock syndrome (TSS). According to a different 2011 study, women who used the Softcup saw no changes in their vaginal flora and no growth of that dangerous bacteria.

Still, the rate of menstrual cup use in the U.S. is still low, partly due to squeamishness and worries about their cleanliness. Menstrual cups need to be washed with soap and water after being removed. Because they don’t come from a package, though, fears of not getting the cup “clean enough” are one of the main reasons Shirazian’s patients don’t use it, she says. “I think there’s this misconception about sterility versus clean,” she says. “The vagina itself is not clean…things can be clean and be introduced and you’ll be fine. You won’t increase your risk of infections.”

The first menstrual cup with lasting power in the U.S. market, the Keeper, was introduced in 1987, and it’s no stranger to confronting the ick factor. “You can tell a woman about it and her first reaction’s going to be ‘Gross,’ or ‘Oh God, no way,’” says Elizabeth Moore, general manager of The Keeper Inc. “It had to come through the midwives and doulas and vegans.” But there’s evidence that the mindset is changing, particularly among young women. Most of the Keeper’s customers are 18-25 years old, Moore estimates. And they’re less shy about getting informed. “Ninety percent of the questions were done via email early on, and now we’re seeing more and more phone calls coming in,” she says. “That’s showing that women are more comfortable talking about it.”

“I think women are tired of having only two options,” says Intimina’s Amandine Pranlas-Descours. The Lily Cup Compact campaign closed with 8,530 backers.

TIME Obesity

Obesity Now Costs the World $2 Trillion a Year

Half the world's population could be obese by 2030, warns a McKinsey Global Institute report

The global cost of obesity has risen to $2 trillion annually, according to a new report, more than the combined costs of armed violence, war and terrorism.

The McKinsey Global Institute report says currently almost 30% of the world’s population is obese, and that if present trends continue, that almost half the population will be clinically overweight or obese by 2030.

The report cautioned that no single solution would reverse the problem, instead calling for a “systemic, sustained portfolio of initiatives” to tackle the crisis, such as better nutritional label, healthier food at schools, advertising restrictions on fatty foods and beverages, and public health campaigns.

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