Commentary: History in the search

controversy about the sources of the long-term reduction in mortality, beginning sometime in the 18th century, that, in his view, was undeniably the impetus for the modern rise of population. On one side of the debate, McKeown argues that a changing economic environment, specifically increases in food production resulting in better nutrition, was the most important factor in the downward shift in mortality levels, while medicine, focused on providing individual immunizations and treatments, had little on no impact on the decline1,2 McKeown’s argument is part of a long tradition linking economic conditions to the growth of population. It incorporates the Malthusian notion that an increase in food supplies increased the population dramatically through lowered mortality levels while birth rates remained high. However, implicit in McKeown’s model is the necessity of a decline i