ABSTRACT
This chapter begins by quoting the late Thomas McKeown, Professor of Social Medicine at Birmingham University, on his doubts regarding medical effectiveness. The meaning of the arguments marshalled by McKeown provides the clearest basis for public health and they continue to set the agenda for substantial health improvement in many of the poorest areas of the world. McKeown marshals arguments to show that the most likely explanation is provided by an improvement in general health status, secondary to improved nutrition. McKeown considered rising nutritional status to be the principal cause for the decreases in infectious diseases, mortality rates and consequent increased life expectancy observed during the nineteenth and twentieth centuries. To consolidate the health gains from improved nutrition it was important that the population level did not grow faster than food supply. Whilst McKeown’s argument has won widespread acceptance it is still possible that technological improvements since 1971 have resulted in modern medicine being the main cause of improved health.
