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IJE Advance Access originally published online on June 5, 2007
International Journal of Epidemiology 2007 36(3):496-497; doi:10.1093/ije/dym080
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2007; all rights reserved.

Commentary: Did Preston underestimate the effect of economic development on mortality?

Johan P Mackenbach

Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.

E-mail: j.mackenbach@erasmusmc.nl

Accepted 10 April 2006

The first 10% of the full text of this article appears below.


   A welcome antidote to medical nihilism ...
 
In the mid-1970s, when Preston's classic article1 appeared, the field of population health research was in the spell of Thomas McKeown, who persuasively argued that advances in medical care and public health had not made important contributions to the secular decline of mortality in Western Europe and North America. On the basis of largely indirect evidence, McKeown suggested that increased living standards were the main driving force behind mortality declines, particularly through improved nutrition.2

Preston's article concluded that world-wide increases in life expectancy between the 1930s and 1960s were unlikely to be wholly explained by increases in living standards, and suggested that advances in medical care and public health did make important contributions to mortality decline, at least world-wide and in the 20th century. Although Preston's article could have been a welcome antidote . . . [Full Text of this Article]


   ... but likely to underestimate the effects of economic development ...
 

   ... and of course based on a false dichotomy
 

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