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.