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The Mckeown Thesis. Summary of the paper Szreter, S. (2000) The McKeown Thesis. Journal of Health Services Research & Policy. [Online] 5 (2), 119–121. [online]. Available from: http://journals.sagepub.com/doi/10.1177/135581960000500211 (Accessed 18 March 2021). McKeown was a professor of social medicine in the mid-20 th century. He was an effective opponent of the domination by technological curative models of medical practice. His theories/visions emphasised the importance of a humanist and preventative approach, seeking to understand people’s contexts. He looked at behaviour modification to promote health. The main basis for his research (which culminated in a very influential book released in 1976 called The Modern Rise of population) was analysing the detailed official epidemiological data for England and wales running back to 1850. Through the analysis of this data, and other UK+European data reaching back to 1750, McKeown would create his general explanation for the expansion of the world population through falling mortality rates. His theory had a positive and negative dimension. The negative aimed to challenge the leading belief that scientific medicine had been the major factor in reducing mortality. He unequivocally demonstrated that almost every major cause of death (eg TB, measles, scarlet fever ect) had all but disappeared in the UK before medical science had produced effective cures/procedures. These solutions came in the 1930’s and 1950’s and the life expectancy from 1850-1930 rose from 40-60. The positive looked to explain the negative. It was much more controversial. He split the main ailments of the time into several categories, but there were two major groupings: those due to airborne micro-organisms and those due to food and water borne micro-organisms. Mckeown argued that any reduction in water and food borne diseases were attributable to the public health movement (this movement improved sanitation in Victorian Britain). However, he argued that such measures would not have affected the airborne diseases. Thus, he attributed these reductions to improved host resistance. He envisaged this being due to improved diet (rising per capita nutritional uptake) which was delivered by economic growth. His theories were popular and seen as progressive, emphasising that unless the wages rose for the majority then average health could not improve. However, this was interpretated by the 1980’s right as legitimising their promotion of market forces in delivering increased national income with the assumption that growth would ‘trickle down’. This has since been criticised as studies have shown that completely free markets guarantee gains for the relatively rich and powerful. Furthermore, McKeown was criticised for producing little to no evidence to support his thesis that real wages and diet improved in the 19th century and was responsible for increased health. He argued his case by elimination like Sherlock Holmes. McKeown missed an abundance of real wage data going back into the 18th century. Thus, there has been a complete debunking of part of his positive theory through revealing a lack of consistent link between wages and mortality. Furthermore, he overestimated the importance of airborne diseases and ignored the extent to which those diseases may have been reduced by late nineteenth-century housing regulations and isolation procedures. In conclusion, McKeown legacy lies in his refutation of the simplistic assumption of medical sciences significance to mortality rates. Furthermore, he brought attention to the richness of British historical evidence. However, he utilised a flawed methodology and carelessly glossed over evidence. This led to overestimating the benefits of simple economic growth and underestimating the positive effects of public health....