McKeown and Social Medicine - Essay Example

SH5002 – Health Illness and Society Essay Was McKeown justified in undermining the role played by medicine in the conquest of infectious disease? Student Name Course Name Instructor Name Thomas McKeown’s thesis pertaining to the role played by medicine in combating infectious diseases in order to contribute towards significant improvements in the health of developed nations, has been subjected to intense scrutiny ever since his findings came to surface between the period of 1955 till 1988, through a number of articles and books representing his point of view, that received praise and criticism alike. The purpose of this essay is to analyze whether McKeown’s claims regarding the role of modern medicine in overcoming infectious diseases is justified in the light of evidence and comments presented by various medical writers and researchers. As a vocal critic of the medical community’s love for curative medicine, McKeown asserted that the factors which led to drastic improvements in the overall health of developed nations and the rise in population as a consequence of a decline in mortality from infectious diseases were essentially related to the “trickle-down” effect of economic growth, which directly led to an improvement in the living standards of the people as a result of which society experienced access to better nutrition facilities and a steady food supply amongst other things (Colgrove, 2002). Thus, McKeown’s analysis refuted some of the most extensive measures employed by health professionals worldwide such as vaccination, quarantine and sanitary reforms to combat the spread of infectious diseases. From a statistical and empirical point of view, however, McKeown’s findings can be termed as highly flawed and questionable hence, not justifiable, as the quantitative techniques utilized in the study of demographics witnessed a notable change from the 1950’s until the 1980’s (Preston, 1996). French and British scholars went on to establish sophisticated and thorough methods to better understand population trends such as the family reconstruction technique developed in Paris by Institute National dEtudes Démographiques but it was observed that McKeown’s studies did not incorporate these methods as a basis of quantitative data collection, a premise which was later challenged by Roger Schofield and E. A. Wrigley in the 1981 book titled The Population History of England 1541–1871 that attacked the crux of McKeown’s claim regarding the primary factor contributing towards the rise in population which was a decrease in mortality rates rather than an increase in fertility (Colgrove, 2002). Further conceptual inconsistency in McKneown’s understanding of the factors that led to a decline in infectious diseases is his definition of an improvement in living standards, which is a highly subjective term. While, some may attribute a rise in living standards to social reforms, another group may interpret it as a state of economic wellbeing which suggests that McKeown’s theory lays on the foundation that economic growth has bravely battled infectious diseases which led to an increase in the population, but what exactly constitutes economic growth is not known or defined. Moreover, McKeown’s interpretation of death records is reported to have been inadequate as he is said to have confused diseases such as pneumonia, bronchitis and tuberculosis which negatively impacted the validity of his studies. A reanalysis of the same data therefore, has produced contradictory results which imply that health initiatives such as sanitation and clean water facilities were in fact integral programs that led to a positive overall impact in the improvement of public health, which is why McKeown’s complete rejection of their role in doing so is unjustified as he let his presumptions about medicine and public health sabotage the research’s reliability (Szreter, 1988). Another critic of McKeown’s ideology came in the form of Sam Preston, a renowned US demographer whose advanced, cross-national statistical study concluded that the advancement in medical technology was the most imperative factor in increasing life expectancy rates which was a consequence of a better equipped society against infectious diseases (Szreter, 2003). It took only a quarter of a century for McKeown’s assumptions about the relationship between medicine, life expectancy, population and infectious diseases to lose their intense popularity and credibility. It seems that the writer’s justifications were a result of a popular New Right ideology of the time which was distrustful of the entire system of the welfare-state and what it stood for as it strongly supported economic growth as being the only answer against the threat of disease, thus ignoring the field of medicine as a key contributor in the revival of health on a global scale (Szester, 2002). Perhaps, the most troubling critique for McKeown’s supporters is the lack of concrete evidence the writer holds, in championing the notion that nutrition as a result of economic growth has helped to fortify the society’s immunity against infectious diseases. It appears that nutrition has risen to be a significant factor in McKeown’s theory by default, as he devalues other aspects that may have contributed towards an improved global health rather than providing any material evidence supporting the relationship between nutrition and a decline in infectious diseases (Bury, 2005). Until the last of McKeown’s thesis appeared as articles or books, he stood firmly on his assumption, failing to acknowledge movements such as improvements in water supply, housing, sanitation, vaccination campaigns and quarantine efforts as having any real significance in combating infectious diseases (Bynum, 2008). As mentioned previously, McKeown did have faithful proponents who credited his findings and praised his efforts to contribute towards the understanding of a direct relationship between social conditions and the spread of infectious diseases, asserting that it was more important to address the socioeconomic problems of our times rather than spending precious resources on full-fledged research programs and medical funding. As one thesis explains, social conditions appear to be at the root cause of the population’s health, with invisible economic forces heavily impacting social conditions on a widespread scale (Link, 2002). Resources have the ability to shape human health behavior, an average member of society who has access to, has knowledge about and can afford efforts related to health oriented behavior will successfully live a healthier life as compared to someone whose lack of resources hampers him or her from doing so. Moreover, resources alone can help build better neighborhoods, occupations, social groups and communities that are least likely to be at risk of potential factors that contribute to the transmittal of disease. Thus, in a broader sense socioeconomic conditions indeed directly impact the society’s ability to prevent and cope with global health scenarios. It can also be stated that mortality, nutrition and infection has what can be described as a synergistic relationship. Following the Second World War nutrition researchers discovered the ‘protein-energy malnutrition’ which can be categorized as a ‘deficiency disease’ which is resultant of a diet which is low on energy and protein (Harris, 2004). Moreover, the relationship between infection and nutrition is also said to be interrelated which is a result of a universal consensus amongst the epidemiological community that inadequate nutrition plays an integral role in the development of infectious diseases. An evaluation of the evidence, research and comments presented above suggests that McKeown’s thesis, assumptions and studies which were made publicly available through the medium of books and articles were essentially flawed and not backed by concrete statistical evidence to, in anyway undermine the premise that medicine was an integral part of the conquest against infectious diseases which resulted in a population increase, particularly in developed nations. The problem with McKeown’s justification arises when he solely substitutes economic growth with any other factors that may have contributed towards an improved global health situation, refuting completely the part played by medicine to enhance the scenario. Statistical and quantitative inadequacies and inconsistencies as identified by researches in the procedures employed by the medical writer to arrive at his conclusions further weaken his stance and so do parallel assessments of the situation. Certainly, many measures taken to combat the spread of infectious diseases such as vaccination campaigns, quarantine efforts, sanitation and improvement in water supply amongst others can be categorized as preventive measures that had purely medical motivations and were of immeasurable help in addressing the issue of health on an international scale. This implies that efforts undertaken by preventive and curative medicine cannot be substituted and require due recognition in addressing the aforementioned issues. While, evidence also speaks in favor of McKeown’s tenets it never supports his entire thesis which is based entirely upon a socioeconomic principle guiding public health and concerns related to the matter. Hence, McKeown’s justification in undermining the role of medicine in the conquest against infectious disease appears to be a weak one, which is destabilized by a more thorough, vigilant and sophisticated analyses of his data by opposing researchers. REFERENCES: Colgrove, J. (2002). The McKeown thesis: a historical controversy and its enduring influence. American Journal of Public Health, 92(5), 725. Preston SH. (1996) Population studies of mortality. Popul Stud. 50:525–536 Szreter S. (1988) The importance of social intervention in Britains mortality decline c. 1850-1914: a reinterpretation of the role of public health. Soc Hist Med. 1:1–38. Szreter, S. (2003) The population health approach in historical perspective.Journal Information, 93(3). Szreter, S. (2002). Rethinking McKeown: the relationship between public health and social change. Journal Information, 92(5). BURY, M. (2005). Health and illness. Cambridge, Polity. Bynum, B. (2008). The McKeown thesis. The Lancet, 371(9613), 644-645. Link, B. G., & Phelan, J. C. (2002). McKeown and the idea that social conditions are fundamental causes of disease. Journal Information, 92(5). Harris, B. (2004). Public health, nutrition, and the decline of mortality: The McKeown thesis revisited. Social history of medicine, 17(3), 379-407. Read More