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What if there were no such thing as illness?

Listen to epidemiologist Larry Brilliant talk about stamping out smallpox.
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Imagine a world where disease doesn't exist. Those infectious, chronic or mental conditions that disrupt our bodies and that we identify by specific symptoms would vanish.

If we never got sick, would we still die? Yep. We'd meet our maker thanks to murders and suicides. We'd fatally overdose on drugs. We'd be hit by cars and killed in other accidents. We'd die in natural disasters and man-made ones, too, such as war. Without food, we'd starve to death.

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Would we age in this fantastic world? That depends on whether getting old and getting sick are separate processes. In some ways, they're not. As we age, our bodies lose resilience: They struggle to repair themselves after being damaged (think of a bruise) and to return to normal after being offset (think of staying warm in a cold room) [source: Kennedy]. Plenty of this reduced functionality can lead to disease, such as osteoporosis, but not every age-related change ends in illness. Gray hair, anyone?

We also could probably die of old age, even if there were no disease. Death from falls is a good example. Aging causes changes that aren't diseases but nonetheless lead to falls, like a loss of muscle mass or a reduced ability to correlate blood pressure with bodily position (leading to dizziness). Such modifications make older folks more likely to take a tumble [source: Fauci].

No matter where scientists stand on the relationship between aging and disease, one thing is certain: Without illness, the death rate would drop. Would the population boom so fast that we'd have housing shortages and wars? A couple of theories suggest not, says Marc Boulay, a professor in the department of health, behavior and society at the Johns Hopkins Bloomberg School of Public Health.

Take Europe's population over the past 200 years. Since 1800, sanitation and medicine cut the continent's death rate, and the population of many European countries rose in the short term. People responded by having smaller families, and the population stopped growing [source: University of Michigan]. Why did families stop having so many children? Money, according to the demographic transition theory. Over the centuries, farming families moved to cities, where raising children cost more than it did in rural areas [source: Teitelbaum]. Families had fewer children because they couldn't afford more. By the same logic, if population stretched resources thin in our hypothetical world, families likely would have fewer children.

The small-family trend also may have spread across Europe the way gossip does: by word of mouth. It traveled through areas populated by people who spoke the same language. "If people in France started reducing their fertility, it moved to French-speaking Belgium, but not Flemish-speaking Belgium," explains Boulay. So the world might talk itself out of a catastrophically high population, even if there were no illness.

Learn how heavily peer pressure weighs on our lives in the next section.

In a world without illness, we'd still have a need for hospitals.
In a world without illness, we'd still have a need for hospitals.
iStockphoto/Thinkstock

Disease undoubtedly influences human behavior. Someone who saw his or her chain-smoking grandfather struggle to breathe might not take up smoking. Let's reverse that: If people couldn't get sick, would more people smoke cigarettes, take illegal drugs and engage in unprotected sex? Would we take more risks in general?

Maybe not. We'd have other deterrents from unprotected sex, like unwanted pregnancies. Actually, sexually transmitted diseases barely influence our decisions about condoms, says Marc Boulay, who studies how people decide about sex and family planning, both in the developing and developed world.

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When contemplating sex, we think more about social pressures than disease risk, Boulay explains. If you're unmarried in a culture that prohibits premarital sex, you're not likely to have sex before marriage, he adds. Your friends pose another big influence. You'll probably have many partners and not use condoms if your friends do or if you think your friends want you to, Boulay says. Does that sound like teenage behavior? It's also true for adults, he says.

Let's go briefly to Uganda, where professor Hye-Jin Paek from the University of Georgia and her colleagues surveyed people about their contraceptive use. Men and women were more likely to reach for contraception if they talked to their spouses, friends or siblings about using it, but not if they listened to a radio program about family planning [source: Paek]. So, with social forces still in place, we don't predict a sexual revolution brought on by the absence of disease.

What about drugs? Would everyone use heroin? Addiction is a disease, so people wouldn't become addicted, a possible push toward drugs. They would build a tolerance, however, and that carries the risk of overdose and death. But if we apply social models like those found for sexual behavior, neither outcome would matter. People wouldn't take drugs because workplaces and governments would enforce rules against drug use. These institutions would have incentive to make rules, since driving while on cocaine would cause road chaos, and nobody would work if they were high on heroin.

Sex and drugs are interesting, but they're small issues compared to what would happen to the health care system if disease didn't exist. Would doctors, nurses, pharmacists and mental health workers lose their jobs? Again, no. We'd still need these workers, plus hospitals, for accident victims and elective surgeries, as well as births and abortions. The pharmaceutical industry probably would also get by, at the very least, by selling anesthetic for painless childbirth and cosmetic surgeries and repairing wrecked bodies after accidents. It might even market drugs for enhancing life beyond healthy.

As predictions go, ours are about as certain as a weather forecast. There's room to disagree with us and certainly more forecasts to make. Why not use the links on the next page to read up on some relevant topics, like aging, then make your own educated guesses about a world without illness and give us your take?

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Sources

  • Boulay, Marc, professor in the department of health, behavior and society at Johns Hopkins Bloomberg School of Public Health. Personal interview. July 27, 2011.
  • Encyclopedia Britannica. "Population." Encyclopedia Britannica Online. 2011.
  • Fauci et al., eds. "Harrison's Principles of Internal Medicine, 17th ed." McGraw Hill. 2008.
  • Kennedy, Brian, CEO of the Buck Institute for Research on Aging. Personal interview. July 25, 2011.
  • Paek, Hye-Jin. "The Contextual Effects of Gender Norms, Communications, and Social Capital on Family Planning Behaviors in Uganda: A Multilevel Approach." Health Education & Behavior. Vol. 35, No. 4. 2008.
  • University of Michigan. "Population Growth Over Human History." Jan. 4, 2006. (July 25, 2011) http://www.globalchange.umich.edu/globalchange2/current/lectures/human_pop/human_pop.html

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