Understanding Trends in Population Health

Abstract

As a theoretical background to the analysis of long-term changes in population health, this chapter presents an ‘ecological-evolutionary theory’ of the origins of disease, which stipulates that most diseases are caused by ‘unfavourable exchanges’ between the human organism and its external environment, often in combination with one or more ‘failures in the design’ of the organism. The crucial role of environmental factors implies that population health is very sensitive to economic, political and sociocultural conditions. This chapter then reviews long-term trends in these conditions, such as improvements in living standards, the rise of the modern state, and the advent of the ‘Enlightenment’, as well as changes in the organization and effectiveness of public health and medical care. All these factors have made demonstrable contributions to improvements in population health.