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.

TIME global health

Global Youth Population Swells to Record 1.8 Billion

INDIA-EDUCATION-STUDY
Indian students prepare for competitive exams in an open space of the City Central Library in Hyderabad on February 7, 2014. NOAH SEELAM—AFP/Getty Images

The challenges are most acute for less developed countries, where 89% of the world's young people reside.

A swell in the global population of young people has the potential to transform economies for better or worse, depending on the decisions of today’s policy makers, according to a new United Nations report.

In a report released Tuesday, the UN Population Fund estimates that the global population of young people between the ages of 10 and 24 has hit 1.8 billion, a historic high.

“Never again is there likely to be such potential for economic and social progress,” the report states. But the authors warn that this demographic surge could also have the potential to destabilize nations unless young people can secure access to health services, education and jobs.

The challenges are most acute for less developed countries, where nearly 9 out of 10 of the world’s young people reside. India alone has a youth population of 356 million. The report’s authors called on governments and donors to invest in this population’s education, employment and health, particularly sexual and reproductive health.

“International support can unlock the potential of the next generation of innovators, entrepreneurs, change agents and leaders,” write the report’s authors.

TIME Research

Your State Bird Could Be Gone By 2080

birds
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If our climate continues to change, many birds will lose significant portions of their habitat

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By 2080, the skies over North America could be much emptier. A new report from the National Audubon Society, compiled from data collected over 30 years of bird counts and surveys, shows that more than half of North America’s most iconic birds are in serious danger. Of the 588 bird species surveyed, 314 are at risk for losing significant amounts of their habitat to a changing climate.

“Birds are a good barometer of the overall health and wellbeing of the natural systems we depend on for food, water, and clear air,” Audubon chief scientist Gary Langham wrote in an email. “If half the birds are at risk, the natural systems we depend upon are at risk too.”

Ken Rosenberg, a conservation scientist at Cornell University’s Lab of Ornithology, cautions that it can be hard to tie any one specific effect on bird populations directly to climate change—other factors like human development, pollution, and invasive species play big roles. However, both Rosenberg and Langham point to clear examples of climate change affecting the avian landscape. Many birds are shifting their ranges farther north; some migratory species are arriving in the northern areas and the endpoints of their spring migrations earlier and earlier. Higher tides and storm surges are wreaking havoc on the nesting grounds of birds like the Saltmarsh Sparrow and the albatross. And foraging birds that live in Arctic sea ice environments are in decline.

“Some land birds, like the Broad-tailed Hummingbird, are finding that the availability of food supplies no longer matches their migration cycles,” Langham says. “And some seabirds, like Atlantic Puffins, are starting to run out of food as ocean temperatures change, causing adults and young to starve.”

If our climate continues to change, many birds will lose significant portions of their habitat, especially those birds that live in marshes and beaches, low-lying islands and snowy mountaintops. Tropical forests could dry out, spoiling the wintering spots for migratory birds. Drought and fire could devastate the habitats of prairie birds like the sage grouse. Even tiny differences in temperature can have big impacts. The gray jay, for example, hoards perishable food to get it through the winter, relying on freezing temperatures to keep it from spoiling, but a warmer climate will short-circuit its natural refrigerator.

“Every bird species has a ‘tolerance zone’ for climate conditions,” Langham says. “If the climate gets too hot, too cold, too wet or too dry, birds will be forced to leave their homes—but many will have nowhere else to go.”

These climate trends are set to impact birds big and small. By 2080, Audubon’s model predicts the summer range for bald eagles will shrink to 26 percent of the current extent. New areas could open up for them as areas get warmer, but it isn’t certain that food and nesting areas will be available to them in the new spots. Allen’s hummingbird could lose up to 90 percent of its summer range. The spotted owl, already a poster child for endangered birds, is expected to lose 98 percent of its wintering grounds. 10 states could lose their state birds—Maryland’s Baltimore Oriole, Vermont’s Hermit Thrush and the Mountain Bluebird (claimed by both Idaho and Nevada) are all among the imperiled.

But don’t count nature out of the game just yet. “A big ‘wild card’ is the ability of the birds themselves to adapt in ways we can’t predict,” Rosenberg told us. “For example, some Laysan Albatrosses have begun to nest in suburban yards and rooftops in Hawaii, as their usual nesting areas become more threatened.”

Rosenberg is also concerned about how humanity’s response to climate change will affect birds. In many areas, he says, sea walls are being built to protect coastal areas without taking into account how they will affect the ecosystem around them. The flow of water, nourishment of marches, and shaping of seaside habitats could all be negatively impacted by hastily built walls. And the rush to create alternative sources of energy has to be done in a smart way, he says. “Paving over fragile desert ecosystems for solar-panel fields, or placing wind farms in critical migration corridors and bottlenecks, or destroying natural habitats around the world to plant biofuels such as corn for ethanol, are NOT smart alternatives” to fossil fuels, Rosenberg says. “We will just be creating new environmental problems in an attempt to solve another.”

Langham urges bird lovers concerned about climate change to speak up.

“We can’t afford to sit quietly on the sidelines while a well-funded oil lobby gets a small number of people to intimidate the rest of us,” he says. “Decide what you want to say to your child or grandchild in 20 years. The day will come when that generation asks: What did you do to leave a better world when the science was clear? I think about my answer a lot and it motivates me to act boldly.”

This article originally appeared on World Science Festival.

TIME global health

Plant-Based Diet Is Best for the Planet, New Science Says

vegetables
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Alternative diets could, if widely adopted, reduce global agricultural greenhouse gas emissions

Good food advocates have long argued that what’s good for your health is also good for the planet, but new science now backs up the claim. A paper published in the journal Nature by scientists at the University of Minnesota, presents numbers that suggest eating less meat, less refined fat, and less sugar will also reduce the climate change impacts of food production.

Using about 50 years’ worth of data from the world’s 100 most populous countries, UM Professor of Ecology G. David Tilman and graduate student Michael Clark show how current diet trends are contributing, not only to diet-related illnesses such as diabetes and heart disease, but also to dangerously increasing agricultural greenhouse gas emissions (GHGs).

“This is the first time this data has been put together to show these links are real and strong and not just the mutterings of food lovers and environmental advocates,” explains Tilman.

“Alternative diets that offer substantial health benefits could, if widely adopted, reduce global agricultural greenhouse gas emissions, reduce land clearing and resultant species extinctions, and help prevent such diet-related chronic non-communicable diseases,” write Tilman and Clark in the Nature article.

Agriculture currently contributes about 25 percent of the GHG emissions that are driving climate change. Grain-based livestock production–which involves clearing land and raising grain for animal feed, particularly in the world’s tropical regions–contribute more than 75 percent of those emissions.

As the rest of the world adopts American dietary habits, the rates of meat, sugar, and processed food consumption have been on to rise. (In China alone, the numbers have skyrocketed.) If the trend continues, all those burgers and pork chops are projected to be responsible for an 80 percent increase in agricultural GHG emissions by 2050.

At the same time, thanks to the exporting of American dietary habits, more than 2.1 billion of the world’s 7.2 billion people are now either overweight or obese. Tilman explains that “empty calories”—sugar, fat, oils and alcohol—now account for almost 40 percent of food purchased in the world’s 15 wealthiest countries, which helps explain the resulting health effects.

According to the data Tilman and Clark examined, which corrected for other lifestyle factors, a vegetarian diet reduced incidence of type II diabetes by 41 percent, followed by a vegetarian diet that includes seafood (25 percent), and a Mediterranean diet that combines moderate meat consumption and is rich in fruit, vegetables, and seafood (16 percent). All three diets appeared to reduce coronary heart disease deaths between 20 and 26 percent and cancer rates by between 7 and 13 percent compared to diets that included at least twice as much meat and processed foods.

Tilman and Clark caution that while the links between what makes healthy diet and what will help lower agricultural greenhouse gas emissions are clear, it’s also possible to eat “a pure junk food diet,”–think French fries, donuts, and tortilla chips–that has low GHG emissions.

So the solution to what the scientists call the “diet-environment-health trilemma” will require choosing menus high in plant-based, whole foods like those that fit in a Meditarrean, “pescetarian” or vegetarian diet. If these diets become the norm by 2050, Tilman and Clark say “there would be no net increase in food production emissions.”

But they also note that making such a change won’t necessarily be easy. “The dietary choices that individuals make are influenced by culture, nutritional knowledge, price, availability, taste and convenience, all of which must be considered if the dietary transition that is taking place is to be counteracted,” write Tilman and Clark.

So, how do we counter the trend toward eating more meat and fatty food? “There are lots of policy options,” says Doug Boucher, director of climate research at the Union of Concerned Scientists. These include carbon taxes that would include agriculture as New Zealand now does, shifting agricultural subsidies away from livestock and related feed production, and changing government dietary guidelines to include sustainability and climate change considerations, as the U.S. Department of Agriculture’s (USDA) 2015 guidelines are expected to.

The USDA’s climate change program director, William Hohenstein, explains that rather than addressing the “trilemma” by focusing on the menu, the agency’s preferred strategy is to work with growers and livestock producers on practices that will reduce GHGs. “Consumers always have a choice,” says Hohestein.

Tilman suggests “better education” is key to helping people of all income levels understand the impacts of their food choices. He also wonders if, given the clear trend toward convenience foods, it might be possible to develop new food that is healthy, low-carbon and he adds, “also tastes good.”

Meanwhile, the data strongly suggest that eating more like Bill Clinton post-heart surgery will not only improve personal and public health, but also help put the planet on a much needed version of a weight-reduction program for greenhouse gasses.

This story originally appeared on Civil Eats

TIME ebola

WHO Chief Says Ebola Response ‘Did Not Match’ Scale of the Outbreak

TIME sits down with WHO Director-General Margaret Chan

The Ebola outbreak in West Africa has morphed into one of our biggest health crises in years, with at least 4,900 known deaths among more than 13,000 cases and experts warning the worst could be yet to come.

Despite a growing international effort to combat the virus, outside health experts say the United Nations’ World Health Organization (WHO)—the only worldwide health institution—has been slow to react. They stress that there’s plenty of blame to go around, including with the U.S. and other regional governments, who were tragically sluggish in responding to Ebola. Still, critics complain that WHO has failed to lead the global fight—exactly the kind of crisis it has aimed to efficiently handle or prevent since its founding in 1948. In general, many say it’s “too politicized, too bureaucratic… too overstretched and too slow to adapt to change,” according to a report by the London think tank Chatham House, citing health experts and some former WHO staffers.

Armchair critics have it too easy, says WHO Director-General Margaret Chan, or “DG,” as she’s known in the graceful Geneva headquarters. WHO, she says, is only as good as the world’s 194 governments—their members, whose contributions pay their salaries and set direction—allow them to be. Governments haven’t raised their WHO dues in decades. The global financial crisis has pummeled the organization, stripping it of $1 billion in funds and about 1,000 bright minds. If the world wants a strong WHO, its staffers say, it needs to plow more money in and help it transform—and hopefully stop the next outbreak from whipping half way across the globe in just seven months.

On Oct. 28, WHO invited TIME to spend the day inside its Geneva headquarters, watching officials grapple with the Ebola epidemic and sitting in on a two-hour, top-level crisis meeting. In a wide-ranging interview with TIME’s Vivienne Walt, in her Geneva office, Chan, a 67-year-old Hong Konger, explains how she and her staff have struggled with the outbreak:

TIME: When was the moment when you thought to yourself, “Holy cow, this Ebola outbreak is big?”

Margaret Chan: I heard about it moving up at the end of June, when the analysis [inside WHO headquarters] was presented. I was very concerned. I asked my scientists to give me an assessment. After that we scaled up unprecedentedly. We have managed many outbreaks in the past but this has got to be the biggest. If you are going to war with Ebola, you need soldiers, weapons, and you need a war chest. WHO is well geared and has the capacity to do outbreaks on a smaller scale. We have been doing this for many, many years, protecting the world from pandemics. But this, the complexity and the scale of things, outstripped the capacity of WHO.

TIME: You say it was the end of June when you thought, oh my God. But people I’ve interviewed in the U.S. and elsewhere tell me that for months they were raising the alarm, from back in March, and that somehow the sense of urgency was not felt here at WHO in Geneva. Is that a fair criticism?

Chan: Well, with the benefit of hindsight, in retrospect…. We are doing a retrospective study on a regular basis, with all this information of colleagues around the world. And they realize, actually, cases of Ebola were spreading in a hidden manner. And now, looking back, all of us would say, yes, the scale of the response did not match the scale of the outbreak. And that is fair. And of course all of us underestimated the complexity.

When you look at this outbreak, thousands of people in Africa died and it didn’t get the attention it deserved until recently. People were saying, quite rightly, it takes a few cases outside of Africa to get attention. This was a perfect storm in the making. In the past, Ebola outbreaks happened in the bush in small villages. Twenty, 30, 40 years ago, there were less people in these countries, and less movement of people. It happened in three countries which came out of long-term conflict. Health systems were destroyed. And in terms of doctors and nurses, they have one or two per 100,000.

TIME: Yes, that’s certainly true. But others say you in Geneva did not get the information from the field when the outbreak occurred, that the details did not reach you. One person we’ve interviewed describe some WHO regional offices are “awful.”

Chan: I’ve promised to do a review and get all the documentation… and will identify what mistakes were made, and correct them. That’s my commitment. But now the most important thing for me is to bring the whole team together, to bring the total assets of the organization together to fight Ebola. There will be plenty of time for history, and we really need to do it in a transparent and accountable manner. But it is important that we move on and get the job done first and foremost.

TIME: You’re dealing with this unprecedented outbreak. Do you think it is going to change the way WHO works?

Chan: This has to be the turning point. It’s not only Ebola. You have to look at what other crises we are dealing with. We have crises in Central African Republic, Iraq, Syria, South Sudan. My staff are truly, truly at [a] breaking point. Members [governments] need to look at what kind of WHO is appropriate for the 21st century. With climate change, which is the defining issue for the 21st century, and a highly interconnected world, we should expect to see more crises of different sizes, magnitude and geographic location.

When a crisis gets to a certain level the D.G. [Director General] has [to have] the ability to deploy the entire assets of the organization. At this point, I need to consult, ask, urge. We don’t have the money. When I talk to member states, I tell them, the system does not provide the flexibility and the agility for the Director General to manage the organization. I said to them, if you want a credible, strong WHO, we need a WHO reform.

TIME: Do you think pre-recession WHO might have been able to handle the Ebola crisis better? Or with all the money in the world, are you up against something too complex, too difficult?

Chan: This is too big and it’s happening in countries with a lot of factors that amplify it. There are lessons the world’s countries need to learn, like the reliance on old experience to deal with Ebola in a new context. What worked 20, 30, 40 years ago will not work. Another lesson: I was not able and also MSF [Doctors Without Borders] we were not able to mobilize people. For the typhoon in the Philippines [in 2013] 150 medical teams came to help. For the Haiti earthquake, more than 125,000 aid workers came. With Ebola, the fear factor, the lack of formal medevac, lack of quality health care…. Outbreaks are human-resource intensive. To manage an Ebola treatment center of 80 beds you need 200 health workers. And I need foreign medical teams to manage them. The U.S. and U.K. governments are building state-of-the-art treatment centers to take care of health care workers in Liberia and Sierra Leone. So there are some good signs and things that are coming.

TIME: Any regrets about decisions made early on or not made early on?

Chan: If people think WHO alone can prevent this crisis I think people are trivializing the reality on the ground. In the initial phase, we sent experts right away. We sent commodities, we sent equipment, we supported governments.… But, as I said, the transmission of the disease was spreading hidden through the movement of people.

I’ve been asking myself: how much time can I spend on Ebola given that it is going to be a sustained, severe outbreak? I [spend] about 70% of my time on Ebola. Would my member states accept I’m a one-issue D.G. There are more people dying of non-communicable diseases: Cancers, heart diseases, lung diseases, diabetes. There are millions suffering from mental health conditions. There are many people dying too early in road crashes. Can I drop everything? I don’t think so. I work at least 18 hours a day, even on weekends. And I’ve also learned great humility is important—to make sure we are not taken by surprise by an unforgiving virus.

TIME: It seems to me that WHO and certainly you have been talking about reforming WHO for years, and you have been running up against walls. So, is Ebola a crisis of such magnitude that this will shake the world into rethinking all this, allowing reform to happen?

Chan: This Ebola outbreak should really make them [governments] look very hard, really hard, at if outbreak control is so important, why didn’t they [WHO] have resources to do the job? The problem is that with prevention when you do a good job people say, okay that’s alright, now we need to move the money some place else.

Ebola for 40 years was an African disease. The world this time has learned a lesson: The world is ill-prepared for severe, sustained public health emergencies. That’s why I hope this is a turning point, a watershed event for people to understand that. If you want global health security, you need to invest.

In the next 2.5 years [Chan retires in 2017], I’m going correct all the mistakes before I leave this organization. I have the responsibility to the governments, but governments also have to look at how they can support WHO to do what they want it to do.

With the reforms [streamlined staff, reworked programs] I would never have been able to pull it off without the financial crisis. I’m very good at this. You know why? There are two sides to the Chinese character for crisis: One side crisis, one side opportunity. Deeper reforms will come from the Ebola crisis. I’m not going to waste this crisis.

For more, read TIME‘s feature on how the World Health Organization has come under fire for its failure to stop Ebola

TIME global health

Watch TIME’s Jeffrey Kluger Discuss How to Eradicate Polio

People in three countries still suffer from the disease

Since the development of the first polio vaccine in the 1950s, the number of cases of the devastating disease has been reduced by 99 percent. But despite that extraordinary progress, people in three countries still suffer from polio. Now, Rotary International, along with the World Health Organization, Centers for Disease Control and Prevention and UNICEF have brought the world tantalizingly close to eradicating the virus for good.

In recognition of World Polio Day, watch as TIME editor-at-large Jeffrey Kluger moderates Rotary’s live-streamed event in Chicago, on Friday at 7:30 PM, EDT.

TIME Israel

Raising the Dead: Lack of Space Forces Cemeteries Skywards

Cemetery in Petah Tikva, Israel
Cemetery in Petah Tikva, Israel Dan Balilty / AP

From Israel to Brazil, elevated cemeteries are providing the final resting place for thousands of people as space runs out at ground level

At first glance, the multi-tiered jungle of concrete off a major highway does not appear unusual in Petah Tikva, an Israeli city of bland high-rises. But the burgeoning towers are groundbreaking when you consider its future tenants: They will be homes not for the living but rather the dead.

With real estate at a premium, Israel is at the forefront of a global movement building vertical cemeteries in densely populated countries. The reality of relying on finite land resources to cope with the endless stream of the dying has brought about creative solutions…

Read the rest of the story from our partners at NBC News

TIME Education

Barbara Bush: Why Malala Gives Me Hope

Malala Yousafzai acknowledges the crowd at a press conference at the Library of Birmingham after being announced as a recipient of the Nobel Peace Prize on Friday.
Malala Yousafzai acknowledges the crowd at a press conference at the Library of Birmingham after being announced as a recipient of the Nobel Peace Prize on Friday. Christopher Furlong—Getty Images

Barbara Bush is the CEO and co-founder of Global Health Corps, an organization committed to building the next generation of global health leaders.

It’s hard to stir up activism with images of empty classrooms, but the lack of education is among the world’s greatest crises today

Five years ago, Malala Yousafzai was a 12-year-old schoolgirl reporting about life under the Taliban after they took control of her home region in Pakistan’s Swat Valley. She described her longing for an education after the Taliban closed her school and commanded women and girls to stay home. “The extremists are afraid of books and pens. The power of education frightens them,” she wrote. “That is why they are blasting schools every day—because they were and they are afraid of change.”

Malala, who on Friday became the youngest recipient ever of the Nobel Peace Prize, has said what many older, more privileged and far more powerful people haven’t: that education gives power to the powerless. It speaks to the importance and strength of her message that the worst her critics in Pakistan can say is that she’s become a “tool” of the “evil” West.

We are used to international crises dominating the news, but most of them are acute, accompanied by dramatic images of dying or suffering. It’s hard to stir up activism with images of empty classrooms. Nonetheless, the lack of education is among the world’s greatest crises today—especially the lack of education for girls. Though it may not make the news, people die every day from ignorance. Without education, basic health care can be unobtainable, as can food or work, or basic human rights.

It is well documented that when societies educate girls—as well as boys—and value educated women, all citizens are healthier and more prosperous; indeed, communities with educated women have a lower incidence of disease and stronger economies. Even so, much is left to do to make the importance of education a universally accepted truth. That Malala was shot in the head two years ago by a member of the Taliban as she left school evidences this. She will likely spend the foreseeable future living not in her home nation of Pakistan but in exile in Britain.

The awarding of the Nobel Peace Prize to Malala has given me hope. I am hopeful because I know that there are many more Malalas out there—young women and men doing everything they can to build better lives for themselves, their families, their communities and their nations.

I work every day with “rational dreamers”—the passionate, idealistic and educated young people at Global Health Corps. They work to foster hope in a dark world, knowing that they must have not only dreams but also the skills and persistence to accomplish those dreams. People ask me why I’ve focused on giving young people a stake in improving health care in Africa and parts of urban America. In my experience with Global Health Corps, I’ve learned that everyone—including the old and the young—has something to teach.

The one time I was in Malala Yousafzai’s presence, she accepted an award at the Skoll World Forum. Her words would echo those she has spoken before, wise ones of commitment, dedication and truth. Yet after she climbed the stage, she had to adjust the microphone from an adult’s height to her own—that of a teenager.

Malala reminds us that even a teenager can be a teacher. I hope her message will be embraced and spread across the globe: that no matter who you are, it is possible to change the world.

Bush is the CEO and a co-founder of Global Health Corps, an organization committed to building the next generation of global health leaders.

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 ebola

Ebola Death Toll Tops 4,000

Liberia Races To Expand Ebola Treatment Facilities, As U.S. Troops Arrive
An Ebola burial team carries the body of a woman through the New Kru Town suburb on Oct. 10, 2014 of Monrovia, Liberia. John Moore—Getty Images

More than 8,300 total cases have been confirmed

At least 4,033 people have died of Ebola in seven countries, the World Health Organization (WHO) said Friday. More than 8,300 total cases have been confirmed.

The new statistics, which include deaths in five West African countries as well as the United States and Spain, come just days after the death of the first patient to be diagnosed in the U.S. The current Ebola outbreak is the worst in history.

Numbers released last month warned that under worst-case-scenario circumstances, as many as 1.4 million people may be infected with Ebola by the end of January. And U.S. Centers for Disease Control and Prevention Director Tom Frieden warned Thursday that action was need to prevent Ebola from becoming “the world’s next AIDs.”

TIME ebola

Plagues on the Poor: What Ebola Can Learn From Malaria

The Malaria Project
The Malaria Project Courtesy Penguin/New American Library

Karen M. Masterson is the author of the forthcoming book, The Malaria Project: The U.S. Government’s Secret Mission to Find a Miracle Cure, out next week.

If the U.S. spent more money on disease prevention and clinics—and less on vaccines and drugs—everyone in the world would stand to benefit

Our highest ranked public health officials have answered questions about Ebola. Most come from reporters centering on who dropped the ball, and why no treatment exists. Thomas Frieden, director of the Centers for Disease Control and Prevention, has tried to give the real answer: Don’t blame a lack of drugs, or bad practices at the World Health Organization; blame the absolute lack of good public health for people in poor countries.

Famous experts, ranging from Paul Farmer to Jeffery Sachs, have tried to use reason to show why investments in clinics go further to stop diseases like Ebola than do investments in vaccines and drugs. Their arguments are simple: build clinics and train medical staff to care for people, and they will be competent to tackle whatever problems emerge. (The teach-a-man-to-fish argument.) If such a clinic existed in the rural village in Guinea where the current outbreak’s original case of Ebola broke, its staff could have advised the community on how to contain the infection. That didn’t happen, and now the CDC is predicting a million infections by January.

The U.S. commits roughly $9 billion annually to global health programs that target infectious diseases that spread in poor countries like Liberia, Sierra Leone and Guinea—the three now experiencing the worst Ebola outbreak ever. More than 75 per cent of that goes to treating three diseases: malaria, HIV and tuberculosis, with the vast majority of that going to drugs and vaccines. That’s three diseases, over $6 billion dollars, from one country. By comparison, the percentage going to in-country capacity for delivering good health care is miniscule.

No better rubric illustrates why Ebola spread so rapidly and uncontrollably. This Ebola outbreak has taught us that the world needs—right now—a redistribution of global health funding that places a much higher priority on infrastructure, not new medications.

This doesn’t happen, in part, because “infrastructure” fails to produce variables that accountants need to justify dollars spent. Disease-specific programs distribute a measurable number of drugs to a measurable number of people and save a measurable number of lives—bean counters are happy, funding continues to flow.

Policy makers are trapped, tied to drug and vaccine development, even though these technologies are too imperfect to eradicate their target diseases. They require huge investments up front and large clinical trials that use people like guinea pigs, only to be neutralized by resistance.

This paradigm has held since it was first cast during World War II. Malaria, at the time, had crippled forces in the Pacific and Mediterranean theaters. A half million troops contracted the disease, mostly in the first two years of America’s role in the war. In response, the U.S. government launched the largest effort ever made to fight a single disease. Thousands of psychotic patients, incarcerated criminals, and even soldiers were used as human guinea pigs to test a hundred of the best compounds—out of 14,000 made. From these trials emerged a new malaria drug called chloroquine.

This so-called “miracle cure” was used after the war in the World Health Organization’s first attempt to control a single disease, malaria. From the 1950s to 1970, through the WHO Global Malaria Eradication Programme, people in poor countries took chloroquine like aspirin. Broadly used against the world’s most prevalent infectious disease, it is today credited with saving more lives than any synthetic drug ever made. But chloroquine failed to solve the malaria problem because nature found a way around it—the parasites that cause the disease developed resistance. This is the fate of every drug ever made to fight malaria.

Before the war, the U.S. fought this mosquito-borne disease through anti-poverty programs and health care delivery, including relocating people from swamps and into homes with screens. Yet chloroquine changed that. Despite loud objections from experts, policy makers chose the easier option, and they continue to do so today. Global health programs rely heavily on drug and vaccine development, and building capacity to deliver them to the infected—be it malaria, TB, HIV, or the so-called neglected tropical diseases, like schistosomiasis, filariasis, leischmaniasis, dengue, chagas and others.

Ebola is the newest plague on impoverished people; and now it’s the latest silo for targeted spending for drug development and delivery. But while its characteristics are far scarier than the others, Ebola has one thing in common with them all: it spreads best where people lack basic health care.

Redirect global health programming to build health care infrastructure for disease prevention—not just capacity for drug delivery—and wealthy countries will get more for the money. They will also target all at once HIV, TB, malaria, the neglected diseases, Ebola, and the next scary infectious disease to emerge from the caves.

Karen M. Masterson is the author of The Malaria Project: The U.S. Government’s Secret Mission to Find a Miracle Cure, out next week.

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.

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