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Stephen J Kunitz, Commentary: Samuel Preston's ‘The changing relation between mortality and level of economic development’, International Journal of Epidemiology, Volume 36, Issue 3, June 2007, Pages 491–492, https://doi.org/10.1093/ije/dym076
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Extract
Professor Preston's article1 is rightly regarded as an important contribution to the debate about the role of economic development and health services (broadly defined) in the decline of mortality. Like so much of his other work, it combines imaginative and innovative use of data with methodological rigour, in this case to argue the point that public and personal health interventions have had a measurable impact upon mortality over and above what would have been expected from economic expansion alone. In addition to this main point, however, the article touches on several related issues that are also of continuing importance: the association between income inequality and mortality, and the diffusion of innovations. I shall discuss the latter briefly, leaving for others a consideration of the former, but first I should like to consider the influence this article has, or hasn't, had.
Shortly after Professor Preston's article appeared, Thomas McKeown's two influential books that argued the other side were published.2,3 In them, he elaborated on the argument he had made in earlier articles, and against which Professor Preston had argued: that the modern rise of population had virtually nothing to do with personal or public health services and almost everything to do with economic growth and a rising standard of living. Despite what I think are persuasive arguments, Professor Preston's article and the book in which the same material appeared4 have been less widely known, and I believe less influential in respect of policy, than Professor McKeown's have been. For instance, a search of the Science Citation Index in early 2006 indicates that the article had been cited 131 times and book slightly more than 300. This does not indicate neglect by any means, but it is substantially less than the citations of Professor McKeown's two books: 489 (The Modern Rise of Population) and 466 (The Role of Medicine). And this doesn't include all of Professor McKeown's other articles on the same or similar topics. It was not the elegance of the analyses that account for the difference. If that had been the case, the numbers would certainly have been reversed. It was, rather, the audience and changing views of the importance of personal and public health services that account for it.
