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November 17, 1989

The Origins of Human Disease

JAMA. 1989;262(19):2752-2753. doi:10.1001/jama.1989.03430190136050

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"Origins," as used in the title of this book, has two distinct meanings. It may refer to the time, place, and social circumstances under which various kinds of diseases arise among human communities, but it may also mean the circumstances under which diseases become likely to affect individuals. McKeown addresses both of these themes in this posthumous work.

Part I, "Disease History" establishes the proposition that human society has passed through three stages—hunting and gathering, agriculture, and industry—and that each stage has its corresponding array of characteristic diseases. Hunters and gatherers suffered mainly from lack of food. Infectious diseases became the predominant causes of sickness and death in the agricultural age. Noncommunicable diseases have taken over pride of place in the age of industry.

Throughout this typology, McKeown emphasizes nutrition as the main, ruling factor in human encounters with disease. But his claim that hunger was the main cause of