The contribution of medical care to mortality decline: McKeown revisited

  • Johan P. Mackenbach
    Address reprint requests to: Johan P. Mackenbach, Department of Public Health, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
    Department of Public Health, Erasmus University Rotterdam, Rotterdam, The Netherlands
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Epidemiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • McKeown ThF
        The Role of Medicine—Dream, Mirage or Nemesis?.
        Nuffield Provincial Hospitals Trust, London1976
        • McKeown ThF
        The Modern Rise of Population.
        Edward Arnold, London1976
        • Griffiths GT
        Population Problems in the Age of Malthus.
        Frank Cass, London1967
        • Omran AR
        Epidemiologic transition in the U.S.; the health factor in population change.
        Pop Bull. 1977; 32: 3-42
        • Caselli G
        Health transition and cause-specific mortality.
        in: Schofield R. Reher D. Bideau A. The Decline in Mortality in Europe. Clarendon Press, Oxford1991
        • Mackenbach JP
        De epidemiologische transitie in Nederland.
        Nederlands Tijdschrift voor Geneeskunde. 1993; 137: 132-138
        • Mackenbach JP
        De achtergronden van de sterftedaling tussen 1875/79 en 1970 in Nederland.
        Tijdschrift Sociale Gezondheidszorg. 1993; 71: 192-197
        • Mercer AJ
        Smallpox and epidemiological-demographic change in Europe: The role of vaccination.
        Pop Studies. 1985; 39: 287-307
        • Razzell PE
        An interpretation of the modern rise of population in Europe—A critique.
        Pop Studies. 1974; 28: 5-17
        • Mackenbach JP
        • Looman CWN
        Secular trends in infectious disease mortality in The Netherlands: Quantitative estimates of changes coinciding with the introduction of antibiotics.
        Int J Epidemiol. 1988; 17: 618-624
        • Mercer A
        Disease, Mortality and Population in Transition.
        Leicester University Press, Leicester, UK1990
        • Berry B
        • Malt RA
        Appendicitis near its centenary.
        Annals Surg. 1984; 200: 567-575
        • Becker WF
        • Powell JL
        • Turner RJ
        A clinical study of 1060 patients with acute cholecystitis.
        Surg Gynaecol Obstet. 1957; 104: 491-496
        • Cohn I
        Intestinal obstruction.
        in: 3rd ed. Gastroenterology. Vol. 2. Saunders, Philadelphia1976
        • Butler NR
        • Alberman ED
        Perinatal Problems: the Second Report of the 1958 British Perinatal Mortality Survey.
        Livingstone, Edinburgh1958
        • Szrecer S
        The importance of social intervention in Britain's mortality decline c. 1850–1914.
        J Social History Med. 1988; 1: 1-37
        • Hofstee EW
        De Demografische Ontwikkeling van Nederland in de Eerste Helft van de Negentiende Eeuw.
        Van Loghum Slaterus, Deventer1979
        • Houwaart ES
        De Hygiënisten: Artsen, Staat en Volksgezondheid in Nederland 1840–1890.
        Historische Uitgeverij Groningen, Groningen1991
        • Vogelzang I
        De Drinkwatervoorziening van Nederland voor de Aanleg van de Drinkwaterleidingen.
        Academisch Proefschrift Utrecht, Utrecht1956
        • van Zon H
        Een zeer Onfrisse Geschiedenis. Studies over Niet-Industriële Vervuiling in Nederland 1850–1920.
        Academisch Proefschrift Groningen, Groningen1986
        • Rostow WW
        The World Economy: History and Prospect.
        Macmillan, London1978
        • van Stuijvenberg JH
        De economie in de Noordelijke Nederlanden 1770–1970.
        in: Algemene Geschiedenis der Nederlanden, deel 10. Van Dishoeck, Haarlem1981
        • Luckin B
        Evaluating the sanitary revolution: Typhus and typhoid in London, 1851–1900.
        in: Woods R Woodward J Urban Disease and Mortality in Nineteenth Century England. Batsford Academic and Educational, London1984
        • Reves R
        Declining fertility in England and Wales as a major cause of the twentieth century decline in mortality.
        Am J Epidemiol. 1985; 122: 112-126
        • de Regt A
        Arbeidersgezinnen en Beschavingsarbeid: Ontwikkelingen in Nederland 1870–1940.
        Van Gorcum, Meppel1984
        • Kunitz S
        Disease Change and the Role of Medicine—The Navajo Experience.
        University of California Press, Berkeley, California1983
        • Lever AF
        The role of medicine.
        Lancet. 1977; 309: 352-355
        • Beeson PB
        McKeown's 'The role of medicine'—A clinician's reaction.
        Milbank Memorial Fund Q. 1977; 55: 365-371
        • Rutstein DD
        • Berenberg W
        • Chalmers TC
        • et al.
        Measuring the quality of medical care.
        N Engl J Med. 1976; 294: 582-588
        • Mackenbach JP
        • Bouvier-Colle MW
        • Jougla E
        ‘Avoidable’ mortality and health services: A review of aggregate data studies.
        J Epidemiol Community Health. 1990; 44: 106-111
        • Goldman L
        • Cook EF
        The decline in ischaemic heart disease mortality rates.
        Annals Intern Med. 1984; 101: 825-836
        • Mackenbach JP
        • Looman CWN
        • Kunst AE
        • et al.
        Post-1950 mortality trends and medical care: Gains in life expectancy due to declines in mortality from conditions amenable to medical intervention.
        Social Sci Med. 1988; 27: 889-894