摘要：In an accompanying commentary, Colgrove indicates that McKeown's thesis—that dramatic reductions in mortality over the past 2 centuries were due to improved socioeconomic conditions rather than to medical or public health interventions—has been “overturned” and his theory “discredited.” McKeown sought to explain a very prominent trend in population health and did so with a strong emphasis on the importance of basic social and economic conditions. If Colgrove is right about the McKeown thesis, social epidemiology is left with a gaping hole in its explanatory repertoire and a challenge to a cherished principle about the importance of social factors in health. We return to the trend McKeown focused upon—post-McKeown and post-Colgrove—to indicate how and why social conditions must continue to be seen as fundamental causes of disease. THE MCKEOWN THESIS STATES that the enormous increase in population and dramatic improvements in health that humans have experienced over the past 2 centuries owe more to changes in broad economic and social conditions than to specific medical advances or public health initiatives. 1 The thesis gives center stage to social conditions as root causes of the health of populations. On the basis of new data and numerous revisitations, however, Colgrove 2 tells us that the thesis has been “overturned” and the theory “discredited.” Whither, then, the idea that social conditions require prominence in any complete understanding of the health of populations? When we turn away from “the thesis,” do we accept an “antithesis” asserting that the role of social conditions is insignificant?
