How can you determine whether you are in a “developed” or a “developing” country? We used to call these latter “un- or underdeveloped” or “3rd world” countries, but those terms are no longer politically acceptable, considering the tinderbox of feelings about this topic.

If one objectively examines all 20 dozen or so of the world’s countries, a geographer would divide them into either north or south of the Equator. And if, using conventional wisdom, one lists the richest, say, 25 countries, one finds that all but maybe two are above the Equator, thus in the northern hemisphere. A couple of countries may straddle it.

A geographer may further draw lines at the parallels of 23.5 degrees north and south that divide the earth by climate into temperate zones above and below and tropical between those parallels. One finds that almost all of the recognized developed countries lie north or south of the tropics of Cancer and Capricorn, respectively, thus in the temperate zones.

If one channels one’s linguistic leanings for the richest countries, one finds that English, Spanish, French, German, or Japanese are the predominant languages.

As an observational anthropologist, one could tally markers for eons of intense sun exposure, and one would note that those countries with the least historical sun exposure for their majority population correlate with the richest countries.

Other markers like rates of literacy, infant mortality, homicide, both the nature and importance of religion, as well as artistic productivity — visual and performing — could be useful measuring sticks. These elements are all simply correlative. I could not conjure cause-and-effect relationships amongst or betwixt any of them.

If an economist studies the countries and divides them by their per capita Gross National or Domestic Product, one finds a clear mathematical list.

As a geographic pathologist, I judge whether countries are developed by the estimated lifespan at birth of their citizenry and by the nature of the main diseases that kill the inhabitants.

Everybody eats a little fecal matter every day. What the public health community does is to try to keep the quantity down and the quality up.

By examining the prevalence of serious, even fatal, diarrheal diseases in a population, one can gauge the success of that culture in separating the national fecal stream from its water and food streams. So, those that do separate them are the countries with the greatest overall success and those that don’t are those with the least success.

To elevate a country from “developing” to “developed” status, that is where you begin.

Until the populace can reliably separate those two streams, fecal and food/water, real progress with the rest of their development will prove illusory.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

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