Infections, Chronic Disease, and the Epidemiological Transition

Infections, Chronic Disease, and the Epidemiological Transition: A New Perspective

Alexander Mercer
Copyright Date: 2014
Edition: NED - New edition
Published by: Boydell and Brewer,
Pages: 360
  • Cite this Item
  • Book Info
    Infections, Chronic Disease, and the Epidemiological Transition
    Book Description:

    This volume examines the ongoing, worldwide epidemiological transition in which acute infectious diseases are being superseded by chronic diseases as the predominant causes of morbidity and mortality; age at death has shifted from childhood to older adult ages; and life expectancy, population, and the proportion of older people are increasing. This transition constitutes a fundamental change in the human condition, and an understanding of the historical process behind it is thus of major importance. This study is the first to document the transition in a single country, drawing on records of cause-specific mortality since the eighteenth century in England, with comparative data from other Western countries. Alexander Mercer discusses possible causes of specific disease trends, reassessing the relative importance of "health interventions" and "standard of living" as determinants of increased life expectancy, and presents a new theory of how chronic diseases have developed. As specific microorganisms have been established as causal agents in chronic diseases that account for a significant proportion of "premature" deaths, the study suggests that a new conceptualization of the epidemiological transition is required, one that takes into account interrelationships between infectious diseases, between infections and chronic diseases, and between disorders underlying different chronic diseases. Alexander Mercer is an independent researcher and the author of Disease, Mortality and Population in Transition: Epidemiological-Demographic Change in England Since the Eighteenth Century as Part of a Global Phenomenon.

    eISBN: 978-1-58046-871-8
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-xii)
  4. Acknowledgments
    (pp. xiii-xiv)
  5. Introduction
    (pp. 1-7)

    The decline in mortality from infectious diseases has been one of the most significant changes in human history leading to unprecedented increases in life expectancy. There is an expectation in industrialized countries that almost all children will grow up to adulthood and that most people will live at least eighty years despite the high incidence of chronic diseases. Heart disease, stroke, cancers, diabetes mellitus, ulcers, diseases of the kidneys and liver, and other chronic diseases cause much debility, long-term sickness, and “premature” death, which to some extent detracts from the sense of progress in health that has come with the...

  6. Chapter One Background
    (pp. 8-18)

    The decline in mortality from the mid-18th century in England and other European countries and the more rapid growth in population that occurred up to the mid-20th century have been the subject of investigation and debate among historians, geographers, economists, demographers, and medical specialists. Attention has focused on the relative importance of different factors, such as treatment, care of the sick, measures to control and prevent infectious diseases, living conditions, “standard of living,” nutrition, and changes in the nature of some diseases. Historians and economists have considered the decline in mortality in the context of agricultural and industrial revolutions leading...

  7. Chapter Two Theoretical Framework, Data, and Study Outline: The Concept of Epidemiological Transition
    (pp. 19-33)

    The original concept of “epidemiologic transition” outlined by Omran in 1971 focused attention on extremely important changes in cause of death.¹ The infectious diseases that had caused very high mortality among children and adults in the past had been replaced as the main causes of death in industrialized countries by chronic diseases among adults assumed to be noninfectious in origin. There was much criticism of his concept as a “theory,” and it does appear simplistic in the light of subsequent findings about the etiology of chronic diseases. Patterns of disease, mortality, and life expectancy are more complex than a simple...

  8. Chapter Three A New Infectious Disease Environment
    (pp. 34-47)

    Human history has been marked by significant migrations and adaptation to new methods of survival, with consequences for the infectious disease environment, health, longevity, and population. This chapter briefly outlines evolutionary changes in the human condition that led to agriculture, the growth of towns, and exposure to new infections, and considers the infectious disease environment in England when the long-term decline in mortality began. The infectious diseases that contributed to high mortality in the 18th century and the relationship of mortality decline to population growth and food supply are a particular focus. Population increased despite adverse changes in the infectious...

  9. Chapter Four Mortality Decline, Food, and Population Growth: “Standard of Living” and Nutrition
    (pp. 48-57)

    Despite many limitations of the records showing cause of death and some degree of inaccuracy in the level of cause-specific mortality, the historical data indicate that infectious diseases predominated in the mid-18th century when overall mortality began to decline in England and other parts of Europe. Wrigley and Schofield’s analysis of aggregated data from several hundred parishes in England confirmed the findings of earlier studies that mortality in England declined from the mid-18th century. All of the 11 severe mortality crises (30% above trend) occurred before 1750, and the last secondary crisis (20–30% above trend) was in 1762–63....

  10. Chapter Five Smallpox
    (pp. 58-76)

    The mortality decline in England between the mid-18th and the mid-19th century does not appear to have coincided with any consistent improvement in the economic standard of living, and there is no convincing evidence of a significant improvement in diet and nutrition that could have increased resistance to the major infectious diseases. The pattern of cause of death in England and other parts of Europe in the 18th century was characterized by severe infectious diseases such as smallpox, typhus, typhoid, dysentery, and tuberculosis. Although plague caused a dramatic reduction in population in the 14th century, and periodically massive mortality until...

  11. Chapter Six Typhus, Typhoid, Cholera, Diarrhea, and Dysentery
    (pp. 77-89)

    Although smallpox epidemics predominated in the pattern of mortality fluctuations in the 18th century in England and other European countries, many deaths among children and adults were attributed to “fevers.” Hospital statistics and medical writings suggest that typhus was probably a more significant component of “fevers” mortality in England in the 18th century than typhoid.¹ Typhus and typhoid were first distinguished under national registration in 1869, by which time typhus mortality had declined and typhoid accounted for a higher proportion of deaths. Of the 18,390 “fevers” deaths in that year, 47% were attributed to typhoid, 23% to typhus, and 30%...

  12. Chapter Seven Infant Mortality
    (pp. 90-100)

    In the 18th century there was probably a great deal of fatalism about sickness in the early months of life as deaths among infants were so common. Many deaths in the first two years of life were recorded in a category labeled “infancy” in the London Bills of Mortality. A major category within this was “convulsions,” a symptom of many untreated conditions among infants, particularly certain infectious diseases and dietary deficiency.¹ Diarrhea in infants can terminate in convulsions, and many deaths would have been caused by unhygienic or inappropriate weaning foods, water or milk contaminated with fecal matter, and dehydration,...

  13. Chapter Eight Child Mortality
    (pp. 101-117)

    In the mid-19th century, about 60% of deaths among children aged 1–4 years were attributed to airborne infectious diseases and respiratory diseases that were mostly caused by microorganisms. Many of the airborne infectious diseases still common among unvaccinated children in Western countries were frequently fatal in the 19th century. As in developing countries today, children in large families with poor living conditions and inadequate nutrition, would have been at high risk of dying from a series of interrelated or concurrent airborne, respiratory, and other acute infectious diseases. The adverse effect of malnutrition on mortality risk from infectious diseases is...

  14. Chapter Nine Tuberculosis
    (pp. 118-130)

    Death rates from different acute infectious diseases began to decline at different times in the 18th and 19th centuries, reflecting the relative success of different preventive interventions and other factors. While major killers such as smallpox, typhus, cholera, and typhoid had been nearly eliminated by the end of the 19th century, measles and respiratory disease death rates did not decline. The lack of decline in death rates from respiratory disease in the second half of the 19th century (see chapter 10) contrasts with the decline in death rates from the chronic infectious disease respiratory tuberculosis considered here. This highly visible...

  15. Chapter Ten Respiratory Diseases
    (pp. 131-140)

    The continuous decline in the period death rate from respiratory tuberculosis in the second half of the 19th century contrasts with an increase in the death rate from other respiratory diseases (mainly bronchitis and pneumonia) from the 1840s to the 1870s. The respiratory disease death rate then leveled off in the 1870s and 1880s until the influenza pandemic of 1889–91, which affected all age groups (figs. 10.1 and 10.2). Apart from this epidemic, the general trend over the period 1875–1915 reflects changes in the bronchitis death rate, which declined from the 1890s, while the long-term decline for pneumonia...

  16. Chapter Eleven Cardiovascular Disease
    (pp. 141-162)

    The main focus in the next three chapters is on changes in death rates from major chronic diseases in the context of a greatly changed infectious disease environment. Although major epidemic diseases such as smallpox, typhus, typhoid, and cholera had ceased to cause high mortality and were largely eliminated from England by the end of the 19th century, many other acute infectious diseases of childhood and the chronic infectious disease tuberculosis remained prevalent. The main epidemic diseases of childhood and common respiratory and gastrointestinal infections continue to be prevalent today, although most are generally not life threatening in industrialized countries...

  17. Chapter Twelve Cancer
    (pp. 163-180)

    Cancer is not exclusively a modern disease, and paleopathological evidence of many of its forms has been found in ancient human remains. Even so, the evidence from thousands of prehistoric and ancient remains, such as fossils, mummies, and skeletons, suggests neoplasms were not common until after the medieval period in Europe.¹ Investigation of Egyptian mummies suggests malignancies were rare,² although multiple melanoma cases have been well documented, and also nasopharyngeal carcinoma, which is readily identifiable through damage to the skull.³ Hippocrates made the distinction between malignant and benign cancers in the fifth century BC.⁴ Although malignant cancers are now usually...

  18. Chapter Thirteen Other Chronic Diseases
    (pp. 181-202)

    The evidence of involvement of microorganisms in the major chronic diseases and in the underlying biophysiological disorders suggests that the infectious disease environment is still a considerable influence on health and mortality risk. The classification of only 3% of deaths in England and Wales as due to infections, including urinary tract infections, is therefore somewhat misleading. External causes (accidents, suicide, and violence) account for 4% of deaths, while other categories include many common chronic diseases that have suspected or confirmed links with infection. About 6% of deaths in 2010 were due to cancers with confirmed infectious etiology, and microbial involvement...

  19. Chapter Fourteen Epidemiological Transition: A New Perspective
    (pp. 203-222)

    Human beings have been adapting to invasive microorganisms contracted in different environments throughout their history, and long before the existence of microbes was known. The recent epidemiological transition has occurred very late in human history, along with urbanization and industrialization in the last three hundred years. Earlier changes in the predominant way of life exposed humans to new infectious diseases that challenged the immune system and people’s ingenuity as they sought to avoid or prevent them. A transition in disease patterns occurred when microorganisms transferred to humans as a result of following herds of animals for food. Later, during the...

  20. Appendixes
    (pp. 223-240)
  21. Notes
    (pp. 241-276)
  22. Bibliography
    (pp. 277-320)
  23. Index
    (pp. 321-338)
  24. Back Matter
    (pp. 339-339)