Looking back over more than 30 years working in public health globally and in the United States, I can't recall a year with as pronounced a divergence: big advances and big setbacks.

Heart health improved in parts of the world, but in the US, the decline in cardiovascular deaths stalled, contributing to a shocking decline in life expectancy. We know more about epidemic preparedness than ever, but preventable infectious disease outbreaks continue.

More countries are reducing smoking, but e-cigarettes are hooking a new generation of kids into lifelong nicotine addiction.

Here's the good, the bad and the ugly of 2019.

The good...
  • Industrially produced transfat, an artificial chemical in food, kills 500,000 people every year, but this year, Thailand, the European Union and Brazil banned it, bringing to nearly 3 billion the number of people who will be protected from it..
  • In 2019, many countries passed taxes on sugar-sweetened beverages, a major step to reduce obesity. Chile has led the way and more recently, Peru mandated warnings on foods high in salt, sugar and fat. Many other countries are working to do the same.
  • India, China, Ethiopia, Bangladesh, Vietnam and countries throughout the Americas are improving care of people with hypertension, which kills 10 million people a year — more than all infectious diseases combined.
  • The World Health Organization added combinations of two anti-hypertensive drugs in one pill to its essential medicines list, which will increase access, reduce costs and improve treatment quality.
The bad...
  • The world is still not ready for a disease epidemic. Ebola has killed more than 2,000 people in the Democratic Republic of Congo, and the epidemic is not over. 
  • Measles still kills more than 100,000 children a year, and cases increased 17% as misinformation about vaccines spread and vaccination systems underperformed.
  • The recent decline in malaria deaths has slowed. New approaches and energy are needed to reduce the number of people malaria kills annually to less than 400,000.
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