We don't have a crystal ball, but as journalists covering global health and development, we have a pretty good nose for emerging trends (with some help from our favorite expert sources).
Some likely trends give cause for optimism — signs of progress in solving the world's problems. Other trends are pessimistic — threats and challenges that are expected to worsen in the year ahead.
Here are 11 trend lines we'll be watching in 2020. First we'll give you the bad news — then the hopeful predictions.
Grim trends
A record number of people will need humanitarian assistance
The United Nations is predicting that 168 million people, a record, will need humanitarian assistance in 2020 because of extreme weather, large infectious-disease outbreaks and intensifying, protracted conflicts across more than 50 countries. That's around a million more people than were in need of assistance in 2019, and the number is expected to continue to rise, up to 200 million people by 2022. The U.N. expects that providing this assistance in 2020 could cost up to $29 billion.
Hot spots include Burkina Faso, where a surge in violence by religious extremists has displaced more than half a million people; the Philippines, where a Christmas Eve typhoon killed more than two dozen; and Venezuela, where an economic collapse has resulted in the exodus of nearly 5 million people in the last five years.
Shannon Scribner, associate director for humanitarian policy and programs at Oxfam America, says that funding to respond to these crises "is not keeping pace with the need, and that will continue to be a challenge."
Scribner says another concern is an increasing number of restrictions on international NGOs that make it harder to enter and operate in conflict-affected areas such as Syria and Yemen.
"Humanitarian law isn't being upheld in some of the countries where we're working," says Scribner. "And we don't see world leaders talking about human rights the way they once did."
One key solution, she says: Channel more funding to small local groups that know the terrain intimately, rather than big international NGOs. — Tim McDonnell
Second-tier diseases will go gangbusters
Over the last 12 months, the world made steady progress against the big infectious killers — HIV, malaria and tuberculosis. But other illnesses, some of them easily preventable, stole the limelight.
Those second-tier diseases include measles and dengue, which did gangbusters in the tropics. Cholera raged in Yemen. Polio clawed its way back from the brink of defeat. In Pakistan, polio cases were up more than tenfold from a low of just nine in 2018. In a cruel unintended consequence of the polio eradication effort, a dozen countries that had been polio free (including China, Angola and the Philippines) reported cases of vaccine-derived polio in 2019. Venezuela reported its first yellow fever case in more than a decade as that country's health care system continues its downward spiral. Despite efforts to rein it in, a few cases of Middle East respiratory syndrome are reported each month in the Middle East, and that will probably continue in the coming year.
Recent high-profile measles outbreaks in the U.S., Europe, the Philippines and Samoa should push health officials to make sure more kids are immunized this year. To prevent outbreaks, the World Health Organization says that roughly 95% of a community needs to be vaccinated against measles. More than half the countries in the world, including the U.S. at 94%, haven't reached that threshold, according to UNICEF. Where might there be a measles outbreak in 2020? Afghanistan, Angola, Bolivia and Haiti all have dismally low immunization rates below 40%.
But there are some signs of progress: This year, a new dengue vaccine might finally make a dent in the roughly 100 million cases of the disease that occur most years. And the world is more prepared to deal with Ebola than at any time in history: Two vaccines and several experimental treatments are in use, all developed after the 2014 West Africa outbreak. The current Ebola outbreak in eastern Democratic Republic of Congo appears to say more about the dismal social conditions there than about the world's ability to battle this virus. If there's an Ebola outbreak outside a conflict zone in 2020, it would likely be contained and crushed quickly. — Jason Beaubien
Aid will become even more political
"It seems we're returning to the bad old days of the Cold War when we used aid as a glorified payoff for [political] friends and allies," says Jeremy Konyndyk, a senior fellow at the Center for Global Development and former U.S. foreign disaster assistance chief under the Obama administration.
Instead of providing aid to improve health and foster economic development, Konyndyk says there's a growing mentality in the U.S. that aid can be used as a "goody bag" to incentivize foreign leaders to fall in line. Examples include Trump's freezing and reinstatement of aid to El Salvador, Guatemala and Honduras in 2019 based on their immigration policies; his threats to cut off countries that don't vote with the U.S. at the United Nations; and his withdrawal of aid to Palestinians to pressure them to reconsider his peace plan.
The U.K. has also announced plans to merge its Department for International Development into its Foreign Office, a move that more than 100 charities say risks politicizing U.K. aid. These shifts by the U.S. and U.K., two of the world's largest aid donors, could set the tone for a lot of aid policy around the world, says Konyndyk. — Joanne Lu
Unrest over inequality will grow
2019 was marked by angry protests over inequality around the world, and according to some experts, the demonstrations will grow more violent in 2020.
Since the 1980s, income inequality has been on the rise, says Lucas Chancel, co-director of the World Inequality Lab at the Paris School of Economics. In the U.S., for example, Chancel says the richest 1% owned about 40% of the nation's wealth in 2016 — up from 20% in the 1980s — and Trump's 2017 tax policies have only "turbocharged" inequality, with the richest 400 families paying a lower average tax rate in 2018 than the poorest half of American households.
"It is unlikely that 2020 brings anything different," he says, meaning inequality will deepen, despite the efforts of angry protesters to stop it.
Part of the problem is that inequality has a "new face," according to a new report by the United Nations Development Programme. People are no longer just angry about income; they're concerned about inequalities in political representation and power, higher education, access to technology and the resources to survive climate change.
Chancel says the protests in Chile, France, Lebanon, Hong Kong and other countries demonstrate that "governments still do not seem to have grasped the reality of the situation" and have yet to provide adequate solutions. Until they do, the UNDP report warns, the social unrest will likely continue. — Joanne Lu
Water taps continue to run dry
In June 2019, Chennai, India, reached "Day Zero" — the day on which the city's reservoirs ran almost completely out of water. By the fall, seasonal rains had resupplied the city, at least temporarily. But the looming specter of water scarcity is certain to continue in cities around the world in 2020.
In India alone, 21 cities are at risk of running dry in 2020, according to a government report. And an August report from the World Resources Institute found that a group of 17 countries that together are home to one-quarter of the global population — including Botswana, India, Iran and Mexico — are using as much or more water than they can replace.
Upmanu Lall, director of the Columbia Water Center, says that while droughts linked to climate change can create water scarcity, in many cases Day Zero events are caused more by government mismanagement of water resources.
"I haven't seen any reasonable improvement," he says. "So I think there will continue to be places that are stressed and at least one will pop up as a Day Zero this year."
The Indian subcontinent is a prime candidate, he says. But on the plus side, climate scientists expect 2020 to be an off year for El Niño and La Niña, the weather patterns that occur every few years and can cause flooding in some areas and droughts in others. The absence of those extremes might help stave off some instances of water scarcity.
Either way, Victoria Beard, an urban planning professor at Cornell University and World Resources Institute fellow, says water scarcity will continue to be a problem, especially in cities, until governments of high-risk localities pay to massively overhaul their water systems.
"People are demanding of their leaders to see investments in basic services," she says. "There's no self-provision [of bottled water] that's going to solve this problem in the long term. There are no examples where it's a free-for-all and it works out well. You need coordinated massive public investment." — Tim McDonnell
Gender equality is not on the horizon
The U.N. calls gender equality a "necessary foundation" for a peaceful and prosperous world. Yet no country in the world is on track to achieve gender equality, as defined by the U.N.'s sustainable development goals, by 2030.
2020 will mark an important milestone in the long road to gender equality: It's the 25th anniversary of the Beijing Declaration and Platform for Action, which is considered a landmark progressive blueprint for advancing women's rights. The global community will be taking stock of progress — and lack thereof — at gatherings such as that of the U.N. Commission on the Status of Women in March.
Worldwide, women continue to face disproportionate rates of discrimination and violence, less access to economic and educational opportunities, and exclusion from decision-making roles at the community and governmental levels.
By one measure, the world will not achieve gender equality for nearly a century. The most current estimate by the World Economic Forum — which publishes an annual report to track country-by-country progress across economic, educational, health and political dimensions — is that achieving parity across all four dimensions will take an average of 99.5 years at the current rate.
While the WEF report found that achieving parity is relatively close at hand for educational attainment, which could be possible in as soon as 12 years, progress toward closing the economic opportunities gap is actually backsliding. By that metric, parity is a "lowly 57.8%" and will take 257 years to overcome. — Emily Vaughn
Hopeful trends
Global health will get woke
This year, expect more people in the global health and development community to address the injustices and inequities that can be traced to the era when Western countries colonized poor countries, stripping them of resources and autonomy. People who work in the field know that much of the money, influence and decision-making about how to help low-income countries still comes from wealthy countries — with little input from the people who receive the assistance.
One reason for this mindset, says Renzo Guinto, a Filipino physician and a member of The Lancet Planetary Health's editorial board, is the colonial roots of tropical medicine. In the colonial era, European researchers studied diseases in the colonies to protect the colonizers — not the people living in those places — from getting sick.
Over the past couple of years, he and a growing number of global health staffers have been working to make a change. They aim to give medical professionals in low-income countries real leadership roles. At the university level, students are calling on faculty to acknowledge the field's colonial history in global health curriculum. And communications managers at charitable groups are trying to portray the recipients of aid with dignity and respect in messages sent to donors and the media. Many of these conversations can be found on social media with the hashtags #ShiftThePower and #DecolonizeGlobalHealth.
Jennifer Lentfer, a communications strategist who has worked in the field for two decades, says she has never seen so much excitement around decolonizing global development. There are already events scheduled in 2020 to tackle the subject. In the coming weeks, Lentfer is hosting a couple of online workshops on topics that question Western motives to "make a difference" and help because it is our "moral imperative." And in January, graduate students at Duke University are organizing a conference called Decolonizing Global Health 2020.
"There's a real question as to how to flip the leadership," says Lentfer. "And that's coming to a big head." — Malaka Gharib
Satellite imagery could improve global health
This year, expect to see more research on global health and development from a sky-high point of view. Imagery produced by satellites is becoming more ubiquitous and inexpensive — and an increasingly vital source of data on poverty, disease and environmental challenges.
Marshall Burke, deputy director of Stanford University's Center on Food Security and the Environment, is one of a growing number of researchers who are training artificial intelligence software to scan through millions of satellite images to look for clues about where these challenges exist and test solutions to them.
Let's say you run a government agency in a low-income country and want to identify the poorest 10% of villages — or determine how many people live within easy reach of a medical facility or close to bodies of water that could be a source of mosquito-borne diseases. Satellite imagery can help you answer those questions, Burke says, in a way that's much less expensive and time-consuming than traditional boots-on-the-ground surveys. Cars, large buildings and well-tended farms can all be indications of income and population density and are easily spotted from space.
Satellite imagery is already helping cattle herders in the Sahel look for water and assisting regulators in West Africa in cracking down on illegal gold mining. It can help humanitarian agencies navigate in the aftermath of natural disasters. In some cases, it might help us peer into the future: In December, the World Resources Institute unveiled an online tool that uses satellite imagery, in conjunction with other data, to predict water shortages and conflicts.
In 2020, Burke says, expect to see more satellite-based software tools move out of research labs and into the hands of aid agencies and policymakers. And although today most of the images come from satellites owned by the U.S. and the European Union, more may soon come from satellites operated by developing countries — including Ethiopia's first observatory satellite, launched in late December. — Tim McDonnell
Youth activists will lead the fight for a better world
It's not just Greta Thunberg, the 16-year-old Swedish climate activist who seized Time's Person of the Year cover for 2019. Helena Gualinga, a teen Indigenous activist from the Ecuadorian Amazon, took world leaders to task at the COP 25 climate summit and accused oil companies of "violating our human rights." University students in India are protesting a new citizenship law that excludes Muslim migrants.
"Young people are in the lead," said U.N. Secretary-General António Guterres in a statement on Human Rights Day. "Everywhere, they are marching against corruption, repression and inequality, and for human rights and human dignity."
In 2020, youth activists will continue to speak up for the world they want to see, says Jessica Taft, a youth-movement researcher and professor of Latin American studies at the University of California, Santa Cruz.
That kind of involvement by young people isn't new, Taft says. But what has changed, she says, is that today's social media platforms make their contributions more visible to the world and to each other. With their phones set to retweet, they can instantly amplify movements that are half a world away.
A common refrain from young activists is that the failures of previous generations have left them stuck in a flawed version of the world that an older generation helped make.
"Many of the issues that they're focusing on right now are ones that they're able to claim moral authority around as young people," says Taft. That includes topics such as climate change and gun violence, which young people can address from personal experience, like the students at Stoneman Douglas High School in Parkland, Fla., who captured the world's attention after the shooting at their school.
Matt Deitsch, a graduate of the school and an organizer of the March For Our Lives rally in Washington, D.C., told NPR in an interview in 2019: "If we're not standing up and organizing ourselves, then we're not doing enough to save lives in America." — Pien Huang
Cash will be king (of aid)
It's an idea that has been gaining popularity for more than two decades: Instead of giving poor people goods and services — say, a cow or job training — why not just give them money and let them decide how best to spend it?
Interest in "cash transfers" — as this form of aid is often referred to — is likely to get even bigger over the coming decade, says David Evans, a senior fellow at the Washington, D.C., think tank Center for Global Development.
One reason is that researchers will increasingly be able to study the long-term effects of some of the earliest large-scale cash transfer programs — a series of government assistance schemes that began in Latin America in the late 1990s. Already "we're starting to see the first wave of long-term evaluations," says Evans, who is on leave as a lead economist at the World Bank.
So far the evidence suggests that poor people who received this cash aid mainly used it to meet short-term needs — like giving their families enough food each day — rather than finding ways to lift themselves out of poverty in a permanent way. But these families were also able to give their children more schooling. And now that the kids are aging into the workforce, it will become clear whether the extra education translates into enough additional income to vault this next generation out of poverty. If so, says Evans, "that will be an exciting thing to find." — Nurith Aizenman
Access to college will boom
More and more people are going to college. Access to higher education has expanded rapidly across the globe over the last five years, says Michael Green, CEO of Social Progress Imperative, and he expects it to continue in 2020.
Green and his organization, through its Social Progress Index, have been tracking this every year since 2014. Higher education has traditionally been concentrated in wealthy countries, says Green, but many countries are making significant leaps, both in terms of enrollment and quality, and it's leading to a growing global middle class. Some of the biggest improvers, according to their data, include Morocco, Slovakia and Turkey.
Our World in Data, an online publication based at Oxford University, also expects the number of people around the world with higher-education degrees to increase as advanced skills become more important in both developing and developed economies. The International Institute for Applied Systems Analysis projects that this number will reach 1 billion by 2030 and 3 billion by 2100, compared with 725 million in 2015. Although the improvement isn't in every country, Green says the rise in the global average is still a "striking" win. — Joanne Lu
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