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The precariousness of childhood in the developing world is most visible when the media spotlight falls on famine, natural disaster or civil war, but it casts a permanent shadow over family life in that world, as it did in Europe a hundred years ago. Premature death, life-threatening sickness, irreversible stunting of growth and the loss of a mother in childbirth are some of the most tangible evils of underdevelopment. Although poverty contributes to this dismal situation, many individual contingencies are avoidable to a substantial extent if people can be drawn into primary health-care systems that encourage them to exchange detrimental customs for better ideas of managing hygiene and parenthood.

The biomedical era started when laboratory science began to shape new ways of thinking about the causes of ill health. Within half a century, knowledge of nutrition and hygiene, together with the development of medicines of unprecedented efficacy, was making a decisive contribution to better health and life expectancy. The development of a profound understanding of inheritance and cellular organisation illuminated the origin of many kinds of human frailty, and provided powerful tools with which hitherto incurable diseases could be understood and perhaps cured. While biomedicine offers unprecedented opportunities to solve existing health problems, it also has the capacity to extend many of our biological capabilities. Will we be liberated or enslaved? The forces that drive and restrain this potential cultural evolution will be considered.