The Burden of Prudence – Industrialisation and Disease

Thomas McKeown

  • Western Diseases: Their Emergence and Prevention edited by H.C. Trowell and D.P. Burkitt
    Arnold, 456 pp, £28.50, March 1981, ISBN 0 7131 4373 8
  • The Diseases of Civilisation by Brain Inglis
    Hodder, 371 pp, £10.95, September 1981, ISBN 0 340 21717 0

Although these books have different titles, their subjects are the same: the diseases which have replaced the infections as the predominant causes of sickness and death in technologically advanced societies. The editors of Western Diseases give two reasons for preferring their title to ‘Diseases of Civilisation’: some of the diseases were present, although uncommon, in the ancient civilisations of Egypt, Greece, Rome and China; and the implication that countries where their incidence is low are uncivilised gives offence in the Third World. Neither title is really satisfactory, however. The term ‘Western’ can be used only metaphorically in relation to developed countries such as Australia, New Zealand and South Africa, and in time will need to be applied widely in Asia, Africa and Latin America as the character of health problems changes with economic development. The objection to attributing the diseases to civilisation is that they have become significant only in the last few centuries, in some cases in the last few decades; the infections were still predominant in Renaissance Italy, Elizabethan England and 17th-century France. The common causes of sickness and death in advanced societies are therefore more accurately regarded as diseases associated with industrialisation.

Although the issues discussed in the two books are often overlaid by financial, political and professional considerations, they are arguably as fundamental as those that arise in the current debate on Darwinism. The basic questions are these: which are the influences that determine man’s health and what steps are needed to preserve it? The answers turn largely on evaluation of two approaches to the management of disease, one through control of disease origins, the other through intervention by treatment in disease mechanisms. The conclusion in both books is that the first approach has much more to offer than the second, but the grounds for this view, and the steps which it is suggested should follow from it, are quite different in the two cases.

Hugh Trowell and Denis Burkitt are a distinguished physician and surgeon who have spent most of their professional lives in Africa; with T.L. Cleave and G.D. Campbell, they have probably contributed more than anyone else to our understanding of the relation between the health problems of developed and developing countries. In Western Diseases they bring together reports by 34 contributors, who describe their experience of changes in the pattern of disease in several countries as Westernisation occurs. There are four main lines of evidence, which the editors admit are not all equally secure. 1. Until recently many of the non-communicable diseases now predominant in the West were uncommon or absent in hunter-gatherers and peasant agriculturists. 2. When these populations change from their traditional ways of life to those of the developed countries, they begin to exhibit the Western pattern of disease. 3. The incidence of some of the diseases has declined in Western populations which have reversed certain features of their lifestyle to bring it closer to that of peasant agriculturists. 4. Of the multiple influences responsible for the Western pattern of disease, dietary changes are probably the most important.

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