WELCOME Assalamu Alaikum

PRESENTATION ONPUBLIC HEALTH, NUTRITION AND THE DECLINE OF

MORTALITY: THE MCKEOWN THESIS REVISITED

Presented by:

Md. Yeasir Yunus Roll: MM-044-025 2nd year, 3rd semester (B.S.S) Department of population sciences, University of Dhaka.

IntroductionPublic health, nutrition and the decline of mortality: The McKeown thesis revisited

by Bernard HarrisOn the base of McKeown thesis. McKeown thesis is about the reasons for the decline of

mortality and the ‘modern rise of population’ in Britain and other countries from the early-eighteenth century onwards.

BASIC 4 PARTS OF PUBLIC HEALTH, NUTRITION AND THE DECLINE OF MORTALITY: THE MCKEOWN THESIS REVISITED

1. The synergistic relationship between nutrition, infection and mortality2. Nutrition and the decline of mortality before 18203. Mortality change c. 1820-18504. Nutrition and the decline of mortality 1850-1914

THE SYNERGISTIC RELATIONSHIP BETWEEN NUTRITION, INFECTION AND MORTALITY

• Before second world war, Seebohm Rowntree told that the only nutrients were fats, carbohydrates and proteins.

• During the interwar period, nutrition researchers became increasingly interested in the role played by vitamins and minerals.

• After the second world war researchers found many elements as protein-energy malnutrition.

THE SYNERGISTIC RELATIONSHIP BETWEEN NUTRITION, INFECTION AND MORTALITY (CONT'D)

• Temperature control, the circulation of the blood, and breathing were thought to control anyone’s health.• Nutrition researchers have also drawn an important distinction

between the concept of nutrition, or diet, and nutritional status.• It varies from male to female, children to adult.

THE SYNERGISTIC RELATIONSHIP BETWEEN NUTRITION, INFECTION AND MORTALITY (CONT'D)

• Aaby argued that nutritional factors played a very limited role in the outcome of measles epidemics.

• According to Scrimshaw and SanGiovanni, infection can have an adverse effect on nutrition.

• In 1982, many scholars decided that nutritional status had relatively little effect on the development of such diseases as plague, typhoid, tetanus, smallpox or malaria.

NUTRITION AND THE DECLINE OF MORTALITY BEFORE 1820

• Razzle told that the mortality has declined during the first half of the eighteenth century. But Wrigley, Davies and Schofield rejected it thinking that it depended largely on the behavior of adult mortality.

• Sanitary improvement or therapeutic intervention had no impact on mortality before 1800. It was also challenged many times. Razzell and Mercer argued that both inoculation and vaccination reduced mortality. McKeown and his colleagues were accused of their arguments than direct evidence.

• Individuals whose diets contain large proportions of dietary are only able to digest eighty per cent of the nutrients they consume.

NUTRITION AND THE DECLINE OF MORTALITY BEFORE 1820 (CONT'D)

• Later in McKeown findings, people argued that dietary would have increased during the second half of the eighteenth century because the average value of real wages was falling.• Davies and Eden presented information about the consumption

patterns of 213 households, and these data have been analyzed by modern historians to produce new estimates of the nutritional value of the diets available to laborers’ families in the preindustrial period.• It is difficult to reach any categorical decisions from dietary

standards before 1800, but it looks clear that the average level of nutrition was low. There are some grounds for believing that the quality of the average diet may have declined.

NUTRITION AND THE DECLINE OF MORTALITY BEFORE 1820(CONT'D)

“If one assumes that there was little or no relationship between nutrition and mortality in the eighteenth century, it is difficult to see how improved nutrition certainly did play a positive role in increasing life expectancy during the second half of the nineteenth century,

unless one is also prepared to argue that there was a significant reduction in the level of food consumption, or an increase in dietary needs.”

Bernard Harris

SOURCES: E.A. WRIGLEY AND R.S. SCHOFIELD, THE POPULATION HISTORY OF ENGLAND 1541-1871: A RECONSTRUCTION (CAMBRIDGE, 1981), PP. 642-4; C.H. FEINSTEIN, ‘PESSIMISMPERPETUATED: REAL WAGES AND THE STANDARD OF LIVING IN BRITAIN DURING AND AFTER THEINDUSTRIAL REVOLUTION’, JOURNAL OF ECONOMIC HISTORY, 58 (1998), 625-58, P. 648 (REALEARNINGS ADJUSTED FOR UNEMPLOYMENT IN GREAT BRITAIN).

realearnings rose by 12.5 per cent in Great Britain between 1770/2 and 1818/22, and by23.1 per cent between 1818/22 and 1848/52

MORTALITY CHANGE C. 1820-1850

• Economic condition became a huge part at this moment.• There was a debate about standard of living. Everyone’s wages

were definitely increasing between 1820 and 1850.• Declining situation in consumption of wheat, milk, cheese, and

meat because the number of cattle and sheep defeated at London’s Smithfield Market failed to keep pace with the growth of the capital’s population.

MORTALITY CHANGE C. 1820-1850 (CONT'D)

• Although real wages did increase, it does not necessarily follow that total levels of food consumption should have risen as a consequence.• The amount of food consumed by the wage-earning population

of Britain declined between 1820 and 1850.• There was a catastrophic fall in life expectancy in the largest

provincial cities during the 1830s.

NUTRITION AND THE DECLINE OF MORTALITY 1850-1914

• McKeown hypothesis was concerned with the whole of the period from 1700 onwards, much of the fiercest debate has focused on the critical period between 1850 and 1914.

• In 1976, McKeown argued that 33.30 per cent of the decline in mortality between 1848/54 and 1901 was caused by a decline in the incidence of deaths from water- and food-borne diseases, 43.63 per cent of the decline was caused by a decline in the frequency of deaths from airborne diseases.

• A large proportion of the decline in the incidence of deaths from water and food-borne diseases was caused by improvements in hygiene.

NUTRITION AND THE DECLINE OF MORTALITY 1850-1914 (CONT'D)

The decline in the death rate associated with these conditions-

respiratory tuberculosis bronchitis pneumonia Influenza whooping

cough Measles scarlet fever diphtheria smallpox

infections of the ear pharynx larynx

MY OWN VIEW ON IT

• Relationship between housing standards and tuberculosis mortality was found in the last part of the 1900th century. Concerning about the impact of nutritional factors on the decline of mortality, this paper has another view to consider the role played by sanitary improvements, especially after 1870.

• McKeown believed that up to one-third of the total decline in mortality between1848/54 and 1901 was linked with a decline from water and food-borne diseases.

• One of the most important problems for supporters of a ‘public health’ explanation for mortality change is the perseverance of high rates of infant mortality before 1900.

IN BANGLADESH,

1750 1770 1800 1850 19010

5

10

15

20

25

30

35

Population (in million)

Population (in million)

Sources: M. Obaidullah, n.d.; Bangladesh Bureau of Statistics, 1994 and 2011.

THERE WAS DECLINING MORTALITY RATE OVER TIME.

1901-11 1921-31 1931-4105

101520253035404550

CDR

CDR Linear (CDR) Linear (CDR)

Source: http://www.tradingeconomics.com/bangladesh/death-rate-crude-per-1-000-people-wb-data.html

• The first report on nutritive value of foods in Bangladesh was published in 1973 by the Institute of Nutrition (Institute of Nutrition and Food Science). This report contained tables for proximate and other nutrient values of 108 raw food items. All nutrient values of these 108 food items were analyzed values.

• Food production had fallen in two successive years, and the food deficit is the largest since the Bengal famine of 1943. Imports of 2·9 million tons of grain would be needed to give an average per-caput consumption of 1600 calories, which was only just enough to prevent frank starvation.

• On the other hand, Epidemics of smallpox and cholera began in October 1957 in the Eastern Province of Pakistan (Bangladesh), and by April 1958 about 1,500 people were dying each week. East Pakistan a total of 8,243,000 cc. of dry vaccine and 18,284,025 cc. of lymph vaccine for smallpox, and 2,475,600 cc. of vaccine for cholera.

• The Department of Public Health which faced the smallpox and cholera epidemics were small.• It is very clear from the above data that, the situation, which

was seen in East Pakistan at that time of McKeown thesis, was comparative from the present situation.• Yet the medical service played a very important role in reduction

of mortality in Bangladesh. But, the public health and peoples mind setup played the major role in reduction of mortality.

THANK YOU EVERYONE!