-Pestilence and famine: pre-modern period, if crops eating by insects, flooding, etc. it would
lead to famine. Women tend to survive famine more than men in pre-modern period because
they were the last to eat after men in many societies.
-low life expectancy, high mortality rates, high swings in mortality, little population
-he fails to emphasize the role of warfare and violence (infections). Fatalities were more
a result of infections following battle wounds than because of the weapons.
-fails to emphasize the interaction of food insecurity with contagious respiratory
-receding pandemics: a range of factors lead to pandemic mortality. Quarantine measures,
improvement in social conditions, etc.
- epidemics less frequent, infectious disease diminishes, degenerative diseases slowly
rise, living start improvements
-fails to realise that 19th century industrialization/urbanization also generated increased
industrial deaths and increased urban/trade linked infections such as respiratory
(crowding, malnutrition) and gastrointestinal (poor sanitation, less breast feeding).
-degenerative and human-made disease:
-environmental toxins/food production patterns: cancer, diabetes, congenital problems
-work, stress, and social inequality: cardiovascular diseases
-capitalism and globalization?: all of the above + resurgence of infectious diseases.
McKeown Thesis: how to explain the modern decline of mortality (Box 2-3)
-spontaneous change in the virulence of micro-organisms
-medical measures: suggested that yes, many medical measures are effective, but for the most part they
took place after mortality declines were initiated.
-public health measures (state policies around sanitation, etc.): says they were effective, but in the case
of England and Wales, majority of mortality decline, was due to respiratory ailments, but they did not
take that into account (figure 2-2). His argument is flawed, as today there is a rise in TB, his thesis is
-Improvements in standards of living made all the difference: improved living conditions and nutrition,
food distribution, inspections of food brought to market, etc.
P.245 key questions
-approximately 47 million deaths per year: leading cause of death coronary heart disease, followed by
cancer (figure 6-1)
-approximately 10 million child deaths per year: important demographically. Societies with high infant
child mortality means lower life expectancy. Children are most vulnerable to infectious diseases because
they have underdeveloped immune systems. It can take up to five to ten years to have a fully developed
-over half of child deaths in developing countries is associated with malnutrition (54%).
Health of Adults (255-259)
-aging (CVD, diabetes, cancer, COPD, mental health conditions, musculoskeletal, visual impairment)
-Injecting drug use