摘要：The historical analyses of Thomas McKeown attributed the modern rise in the world population from the 1700s to the present to broad economic and social changes rather than to targeted public health or medical interventions. His work generated considerable controversy in the 1970s and 1980s, and it continues to stimulate support, criticism, and commentary to the present day, in spite of his conclusions' having been largely discredited by subsequent research. The ongoing resonance of his work is due primarily to the importance of the question that underlay it: Are public health ends better served by targeted interventions or by broad-based efforts to redistribute the social, political, and economic resources that determine the health of populations? IN A BODY OF RESEARCH published from the 1950s to the 1980s, the physician and demographic historian Thomas McKeown put forth the view that the growth in population in the industrialized world from the late 1700s to the present was due not to life-saving advancements in the field of medicine or public health, but instead to improvements in overall standards of living, especially diet and nutritional status, resulting from better economic conditions. His historical analysis called into question the effectiveness of some of the most basic and widely applied techniques in the public health armamentarium, including sanitary reforms, vaccination, and quarantine. The “McKeown thesis” sparked the inquiries and shaped the research hypotheses of many scholars and became the subject of an extended controversy. McKeown's work may be seen in the context of the debate over the relationship between food supply, economic development, and population growth that has engaged the natural and social sciences since the days of Thomas Malthus. McKeown's research also came to play a prominent role in the debate that emerged in the United States and Great Britain following World War II, and that intensified in the 1970s, over the appropriate focus and allocation of medical resources. Sophisticated analyses in the field of historical demography effectively overturned the McKeown thesis in the early 1980s. Yet it has shown remarkable staying power, continuing to draw support and commentary throughout the 1990s. The purpose of this article is to examine the controversy over Thomas McKeown's work and its ongoing influence on public health research and policy. Even though its empirical foundation and conclusions are now considered flawed, the questions at the heart of the McKeown thesis—What are the most important determinants of a society's patterns of morbidity and mortality? and How should public health practitioners most effectively focus their efforts?—remain as relevant today as when they were first proposed.
