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Masterful History Tour: How and Why the Public Health Approach to Disease Has Evolved and Improved The Public Health Approach: Population Thinking From the Black Death to COVID-19 By Alfredo Morabia Baltimore, MDJohns Hopkins University Press; 2023 232 pp.; $29.95 ISBN-10: 1421446782 ISBN-13: 978-1421446783
Alfredo Morabia's engaging new book confronts a major controversy within medicine and fills the need for a clearer understanding of health and disease in whole populations as well as in individuals. As a physician, epidemiologist, and historian at the center of modern public health, Morabia is well-equipped to cover the evolution of a population view and public health approach from antiquity to the policy and action needed today. This fresh perspective is particularly welcome today when personalized "precision medicine" for individuals is the dominant theme in medical teaching, research, and practice. That he writes short chapters-fascinating stories about successive pandemics of civilization and with rich insights-represents mastery of thinking, organization, and writing.
WHAT IS "POPULATION THINKING"?
Morabia notes that people usually cite individual experiences in arriving at their understanding of health and disease. But anecdotal information about one or a few cases is not helpful in assessing health status or making recommendations for an entire society A population view, on the other hand, allows useful comparisons and even predictions when systematic measurements of physical and behavioral characteristics among representative groups across varied cultures are followed for subsequent rates of disease and death.1(p3)
THE PANDEMIC CHAPTERS
Although an appendix to the book delves into "Precursors to Population Thinking" gleaned from ancient literature, Morabia posits that the first great departure from medicine's preoccupation with sick individuals came with the plague-the Black Death of the 16th century. England's Henry VIII quarantined its ports but also ordered local officials to report each week "how many had died and whereof they died."1(p23) The Weekly Bills of Mortality-quantitative data collected in a similar fashion overtime- "provided the platform for a shift to population thinking ... a decisive first step in public health science."1(p24)
By the 17th century, John Graunt, a haberdasher and perhaps the first demographerand epidemiologist, recognized "astonishing regularities" in London deaths per year, which allowed prompt recognition of and potential explanations for irregularities. Morabia considers Graunt's analyses of the reports in his 1662 National and...