This photo illustration shows a customer smoking at a vape store in Manila on November 20, 2019. - Just hours after Philippine President Rodrigo Duterte announced he would ban e-cigarette use, police were ordered on November 20 to begin arresting people caught vaping in public and to confiscate the devices. (Photo by DANTE DIOSINA JR / AFP) (Photo by DANTE DIOSINA JR/AFP via Getty Images)
This photo illustration shows a customer smoking at a vape store in Manila on November 20, 2019. - Just hours after Philippine President Rodrigo Duterte announced he would ban e-cigarette use, police were ordered on November 20 to begin arresting people caught vaping in public and to confiscate the devices. (Photo by DANTE DIOSINA JR / AFP) (Photo by DANTE DIOSINA JR/AFP via Getty Images)
PHOTO: DANTE DIOSINA JR/AFP/AFP via Getty Images
Now playing
05:30
Top health stories of 2019
PHOTO: CNN
Now playing
02:03
CNN reporter carried to tiki bar by men in speedos
WASHINGTON, DC - SEPTEMBER 20: Activists gather in John Marshall Park for the Global Climate Strike protests on September 20, 2019 in Washington, United States. In what could be the largest climate protest in history and inspired by the teenage Swedish activist Greta Thunberg, people around the world are taking to the streets to demand action to combat climate change.  (Photo by Samuel Corum/Getty Images)
WASHINGTON, DC - SEPTEMBER 20: Activists gather in John Marshall Park for the Global Climate Strike protests on September 20, 2019 in Washington, United States. In what could be the largest climate protest in history and inspired by the teenage Swedish activist Greta Thunberg, people around the world are taking to the streets to demand action to combat climate change. (Photo by Samuel Corum/Getty Images)
PHOTO: Samuel Corum/Getty Images
Now playing
07:17
How climate change impacted the world in 2019
HONG KONG, CHINA - AUGUST 11:  A protester throws back tear gas fired by riot police in the Cheung Sha Wan area on August 11, 2019 in Hong Kong, China. Pro-democracy protesters have continued rallies against a controversial extradition bill since June 9, when the city was plunged into crisis after waves of demonstrations and several violent clashes. While Hong Kong
HONG KONG, CHINA - AUGUST 11: A protester throws back tear gas fired by riot police in the Cheung Sha Wan area on August 11, 2019 in Hong Kong, China. Pro-democracy protesters have continued rallies against a controversial extradition bill since June 9, when the city was plunged into crisis after waves of demonstrations and several violent clashes. While Hong Kong's Chief Executive Carrie Lam apologized for introducing the bill and declared it "dead," protests have continued to draw large crowds with demands for Lam's resignation and a complete withdrawal of the bill. (Photo by Billy H.C. Kwok/Getty Images)
PHOTO: Billy H.C. Kwok/Getty Images AsiaPac/Getty Images
Now playing
06:59
2019: A year of major protests
A woman prays at a makeshift memorial for shooting victims at the  Cielo Vista Mall Walmart, in El Paso, Texas, on August 6, 2019. - The August 3 shooting left 22 people dead. US President Donald Trump will visit the Texan border city August 7, and will also travel to Dayton, Ohio where a second mass shooting early August 4 left another nine dead. (Photo by Mark RALSTON / AFP)        (Photo credit should read MARK RALSTON/AFP/Getty Images)
A woman prays at a makeshift memorial for shooting victims at the Cielo Vista Mall Walmart, in El Paso, Texas, on August 6, 2019. - The August 3 shooting left 22 people dead. US President Donald Trump will visit the Texan border city August 7, and will also travel to Dayton, Ohio where a second mass shooting early August 4 left another nine dead. (Photo by Mark RALSTON / AFP) (Photo credit should read MARK RALSTON/AFP/Getty Images)
PHOTO: MARK RALSTON/AFP/Getty Images
Now playing
08:21
The top nine crime stories of 2019
This photo illustration shows a customer smoking at a vape store in Manila on November 20, 2019. - Just hours after Philippine President Rodrigo Duterte announced he would ban e-cigarette use, police were ordered on November 20 to begin arresting people caught vaping in public and to confiscate the devices. (Photo by DANTE DIOSINA JR / AFP) (Photo by DANTE DIOSINA JR/AFP via Getty Images)
This photo illustration shows a customer smoking at a vape store in Manila on November 20, 2019. - Just hours after Philippine President Rodrigo Duterte announced he would ban e-cigarette use, police were ordered on November 20 to begin arresting people caught vaping in public and to confiscate the devices. (Photo by DANTE DIOSINA JR / AFP) (Photo by DANTE DIOSINA JR/AFP via Getty Images)
PHOTO: DANTE DIOSINA JR/AFP/AFP via Getty Images
Now playing
05:30
Top health stories of 2019
Jake Tapper Fact Check biggest whoppers of 2019 orig _00001020.jpg
Jake Tapper Fact Check biggest whoppers of 2019 orig _00001020.jpg
Now playing
05:05
Fact checking the biggest whoppers of 2019
Britain
Britain's Prince Andrew, Duke of York, attends a ceremony commemorating the 75th anniversary of the liberation of Bruges on September 7, 2019 in Bruges. (Photo by JOHN THYS / AFP) (Photo credit should read JOHN THYS/AFP via Getty Images)
PHOTO: JOHN THYS/AFP/AFP via Getty Images
Now playing
02:28
2019: A tumultuous year for the British royal family
Now playing
06:32
How Extinction Rebellion was born
CINCINNATI, OH - AUGUST 01: President Donald Trump speaks at a campaign rally at U.S. Bank Arena on August 1, 2019 in Cincinnati, Ohio. The president was critical of his Democratic rivals, condemning what he called "wasted money" that has contributed to blight in inner cities run by Democrats, according to published reports.  (Photo by Andrew Spear/Getty Images)
CINCINNATI, OH - AUGUST 01: President Donald Trump speaks at a campaign rally at U.S. Bank Arena on August 1, 2019 in Cincinnati, Ohio. The president was critical of his Democratic rivals, condemning what he called "wasted money" that has contributed to blight in inner cities run by Democrats, according to published reports. (Photo by Andrew Spear/Getty Images)
PHOTO: Andrew Spear/Getty Images
Now playing
11:04
Trump's wildest lines of 2019
US captain Megan Rapinoe celebrates  scoring her team
US captain Megan Rapinoe celebrates scoring her team's ninth goal against Thailand in the World Cup. Apart from leading the team to triumph on the field, Rapinoe has used her platform to fight for equality off of it.
PHOTO: Robert Cianflone/Getty Images Europe/Getty Images
Now playing
01:17
Big names in 2019 you may have mispronounced
top media stories of 2019 _00001024.jpg
top media stories of 2019 _00001024.jpg
Now playing
08:11
Top 9 media stories of 2019
NEW YORK, NEW YORK - NOVEMBER 12: President Donald Trump delivers a speech at the Economic Club Of New York in the Grand Ballroom of the Midtown Hilton Hotel on November 12, 2019 in New York City. (Photo by Steven Ferdman/WireImage)
NEW YORK, NEW YORK - NOVEMBER 12: President Donald Trump delivers a speech at the Economic Club Of New York in the Grand Ballroom of the Midtown Hilton Hotel on November 12, 2019 in New York City. (Photo by Steven Ferdman/WireImage)
PHOTO: Steven Ferdman/WireImage/WireImage
Now playing
02:50
The Trump economy is good for his reelection. Will trade stand in the way?
PHOTO: Paramount Pictures
Now playing
02:53
The most anticipated movies and shows of 2020
PHOTO: FRANCK FIFE/AFP/AFP via Getty Images
Now playing
02:15
Megan Rapinoe's iconic 2019
james charles. youtube best 2019.
james charles. youtube best 2019.
Now playing
01:52
Relive your favorite YouTube moments of 2019
2019 economy year in review orig_00010530.jpg
2019 economy year in review orig_00010530.jpg
Now playing
08:06
Top 9 business stories of 2019
Shetland Isles, UK - May 2018. Birdwatchers watching gannets and great skua soaring past sea cliffs and stacks at seabird colony at Hermaness, Unst, Shetland Islands, Scotland, UK
Shetland Isles, UK - May 2018. Birdwatchers watching gannets and great skua soaring past sea cliffs and stacks at seabird colony at Hermaness, Unst, Shetland Islands, Scotland, UK
PHOTO: Shutterstock
Now playing
01:50
Lonely Planet chooses the best destinations for 2020
Barbadian singer Rihanna poses on the red carpet upon arrival at The Fashion Awards 2019 in London on December 2, 2019. - The Fashion Awards are an annual celebration of creativity and innovation will shine a spotlight on exceptional individuals and influential businesses that have made significant contributions to the global fashion industry over the past twelve months. (Photo by ISABEL INFANTES / AFP) / RESTRICTED TO EDITORIAL USE -  NO MARKETING NO ADVERTISING CAMPAIGNS (Photo by ISABEL INFANTES/AFP via Getty Images)
Barbadian singer Rihanna poses on the red carpet upon arrival at The Fashion Awards 2019 in London on December 2, 2019. - The Fashion Awards are an annual celebration of creativity and innovation will shine a spotlight on exceptional individuals and influential businesses that have made significant contributions to the global fashion industry over the past twelve months. (Photo by ISABEL INFANTES / AFP) / RESTRICTED TO EDITORIAL USE - NO MARKETING NO ADVERTISING CAMPAIGNS (Photo by ISABEL INFANTES/AFP via Getty Images)
PHOTO: ISABEL INFANTES/AFP/AFP via Getty Images
Now playing
02:51
The best moments from the 2019 British Fashion Awards

Editor’s Note: Dr. Tom Frieden is the former director of the US Centers for Disease Control and Prevention, and former commissioner of the New York City Health Department. He is currently president and CEO of Resolve to Save Lives, a global non-profit initiative housed at Vital Strategies, working with countries to prevent 100 million deaths and make the world safer from epidemics. The views expressed in this commentary are solely those of the author.

(CNN) —  

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.
  • After five decades of declines in heart attack and stroke deaths in the US, our progress has stalled. Many deaths from heart disease are preventable through control of hypertension and diabetes, better nutrition and increased physical activity. Overdoses are driving the tragic and continuing fall in life expectancy in the US, although this rise would not have been apparent without the stall in the decline of cardiovascular deaths. Rising mortality mirrors the rise in obesity, insufficient access to preventive treatment and the ongoing opioid epidemic.

The ugly

  • E-cigarette use in US teens skyrocketed 78% last year. This year’s outbreak of lung injuries associated with e-cigarettes shows how pervasive e-cigarettes have become. E-cigarettes might be a useful tool for some adults trying to quit smoking, but only if they replace cigarettes. For teens, e-cigarettes are unsafe and may start life-long addiction. Nicotine from any source harms brain development. The failure to ban all candy flavors of e-cigarettes — including menthol — is continued public health malpractice.
  • The Ebola outbreak in the Democratic Republic of Congo put a spotlight on violence against health workers. Sadly, such attacks happen every day. Hundreds of health care workers in dozens of countries have been killed while providing medical care. The fundamental concept of health care neutrality — noninterference with medical services during conflict, a core principle of the Geneva Conventions — is being lost.
  • Cases of polio quadrupled from last year, with Pakistan seeing a surge in cases. Polio was on the verge of being eradicated — a historic advance that took decades of worldwide cooperation. But continued violence combined with vaccine programs that aren’t optimally managed have moved us away from the finish line. Vaccine-derived polio has spread to 20 countries. This type of polio is difficult to control without a new vaccine, which may become available in 2020.
  • The world continued to fail to take sufficient action on climate change. In public health, we see an increase in deaths from extreme weather events and the insidious incursion of vector-borne diseases, including Lyme disease, into areas that had been untouched, among other impacts. India’s action to increase access to propane for cooking for 80 million people — which although not a renewable source causes far less air pollution than wood, dung and coal — offers a glimmer of hope.

Get CNN Health's weekly newsletter

Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.

All is not bleak. Dedicated leaders and frontline health workers are demonstrating new ways to improve heart health, reduce smoking, encourage healthier eating and prevent epidemics.

We can keep people healthy and not wait until they become sick. We can learn from our successes and from our failures. We can confront and beat the makers and marketers of tobacco, alcohol and junk food.

Instead of sliding backward, we can act strategically and urgently, implement what works and make the next decade the healthiest in human history.