Thomas McKeown (1912–1988)

Summary by the author (page 89): "The transformation of health and rapid rise of population in the Western world during the last three centuries have a common explanation: they resulted from a decline of mortality from infectious diseases. The infections declined mainly for two reasons: increased resistance to the diseases due to improved nutrition; and reduced exposure to infection which followed the hygienic measures introduced progressively from the late nineteenth century. The contribution of medical treatment and immunization to the decline of mortality was delayed until the twentieth century, and was small in relation to that of the other influences.

The modern advance in health was not reversed by rising members, as it had been after the first Agricultural Revolution, because the nutritional and hygienic improvements were accompanied by a reduction of fertility. Population growth was restricted to a rate consistent with the requirements of health, and for the first time it could be said that numbers and resources were in balance, so that the Malthusian adjustment through high mortality was no longer applied.

However, a price has been paid for the improvement in health during the last few centuries: the infections have been displaced as the predominant causes of premature death by non-communicable diseases such as cancer and cardiovascular disease. Whether these diseases were a consequence of the changes which led to the advance in health, or were present but concealed by the shortness of life and predominance of the infections, is a question to be decided in the light of knowledge of their origins. [end citation]"

My personal comments:
A must read for epidemiologists, demographers, health policy makers, and those interested in the philosophy and history of medicine.

Sixty years after McKeown started gathering evidence for what became known as McKeown's thesis, his theory remains thought provoking: How much does medicine contribute to better health and a longer life?

The first two-thirds of McKeown's last book gives an original historical approach to the 'Origins of Human Disease', and resumes the arguments for his thesis that a rising standard of living is the driving force behind the decline of mortality and population growth. Particularly better nutrition leading to better resistance against infections has led to a major decline in childhood mortality in the 19th century; public health measures such as clean drinking water, sewage, better housing and education did further improve survival chances, particular dropping infant mortality from the early 20th century, without substantially improving life expectancy of the adult and elderly population. Vaccins and penicilline, although they are effective in preventing death from infections, came 100 years too late to yield a measurable effect on population mortality. How effective were and are other medical innovations? Does Western history repeat itself in the same way in developing countries?

In the last chapters of the book, McKeown discusses these questions and the implications for public health to, in 1988, 'modern' society. Unfortunately McKeown died shortly before the book was published, and particularly this 'modern' preventive and therapeutic measures are outdated by present (=2016) knowledge. A reprint of the book merits an update of the last part.… (meer)

Another disappointing screed of liberal anti-industrial thinking. All diseases of the affluent are due to the poisons in the atmosphere, the food chain, and the exposure of humans, finally, to enough food and the ease of not walking that they are unprepared for by their genetic evolution. Wholegrain bread and vegetables are the answer to all. Very repetitive in his arguments, and very circumlocutatory in his prose. I did enjoy the rapid overview of diseases among hunter-gatherers, but the chapters on prenatal disease and genetics are very dated by the 1986 publication date.… (meer)