One of the predictions made in global health was that as low/mid income countries became wealthier, their populations would adopt the illnesses characteristic of high income counties. Causes of death would shift away from neonatal conditions, violence and communicable disease to obesity, heart disease, stroke, cancer and other what are often called lifestyle conditions.These were called diseases of affluence. Then we learnt better.

The great disease shift has largely been borne out – many countries have overcome these causes of death. As lifespan increases and consumption and living patterns change we see some of the expected disease pattern where most diseases are those of old age. But we have another problem: that many of these conditions are now detached from affluence. They are concentrated in lower income groups within higher income countries. They spread throughout the globe and are most prevalent where countries are most connected into the global economic and cultural system. Chronic mental health problems, problems of long term addiction, and chronic life diseases are not diseases of affluence. Hence concepts like affluenza do not really capture the processes at work. While these inequalities are a result of the operation of the global economy, they affect those who are most disadvantaged by it, whose communities are most hollowed out by it.