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IN 1619 an English captain sailing past Cape Cod reported that the Massachusetts shore was “utterly void”. The Indians “died in heapes as they lay in their houses” confirmed an English merchant. By killing much of the population of the Wampanoag confederacy, the epidemic that raged from 1616-19 made possible the first permanent European settlement in north America, that of the Pilgrim Fathers in 1620. The Indians had caught the illness, thought to have been viral hepatitis, from prior contact with Europeans, probably captured French sailors.

Europeans have been exporting their maladies throughout history. They seem to be doing it again, but in a new way. In the past, the problem was infection. Now, illnesses associated with Western living standards are the fastest growing killers in poor and middle-income countries. Chronic disease has become the poor world's greatest health problem.