Blighted by disease
JOHN MANTON enjoys a unique and timely look at the history of epidemics and our handling of them, which shines a light on the political economy of disease control
In the wake of the SARS and MERS outbreaks earlier this century, as well as the dangers of new strains of influenza, the Ebola epidemic, and popular concerns with threats to the viability of antibiotics, there was already a strong audience for popular medical history. Unsurprisingly, that has grown hugely in the past year. The exposure of grievous inequality by the Covid-19 pandemic, and forced trade-offs between a wide range of social factors, brings the political economy of disease control into focus as never before. Charles Kenny’s book, in the planning since 2015, gains resonance from being able to reckon with the significance and potential aftermaths of the current crisis. It discusses the coronavirus pandemic throughout.
Despite its subtitle, this book does not present the story of human infection as an unending war. Kenny opens his account of humans’ experience of infectious disease with a gloss on Thomas Malthus’s 1798 treatise on political economy, An Essay on the Principle of Population. In Kenny’s opinion, a political economy based on Malthus’s pessimistic equation between agricultural production, urbanisation, starvation and illness became obsolete shortly after its publication. Technical improvements both in medicine and social organisation during the 19th century made European and North American urban flourishing possible, but it also gave rise to the wave of imperialism at the root of many of today’s health inequalities and developmental puzzles.
Through the first chapters, Kenny, formerly a development economist with the World Bank, provides an accessible account of the history of human accommodations to the infectious toll of sedentary agriculture and the growth of trade, drawing on anthropology
The book’s major strength is in its explicit linking of the history of medical progress to the lessons of international development
and economic history. He looks at military campaigns such as Napoleon’s invasion of Russia, and the emergence of quarantine in early modern Europe. In the middle portion of the book, he turns his gaze to the 19th-century development of international agreement on health regulation, which happened alongside technical developments in diagnosis and treatment. As he approaches the present day in the last chapters, he pivots to the evidence provided by evaluative social sciences such as health economics, and away from the work of historians of medicine concerned with disease control in the 20th century.
Kenny’s book provides very readable, appealing and sometimes grotesque accounts of some of the more spectacular epidemics and infectious threats through our history. The author is also keen to recognise non-western and non-biomedical contributions to effective control of disease, for instance in his account of smallpox variolation in China and India and its translation into vaccination technologies.
Readers will need to consult other recent histories of infectious disease and global health for a cultural history of epidemics and pandemics, a discussion of the role of climate and environmental pressures on the course of human health and disease, or an account of ground-level infection and disease control. The major strength and unique contribution of this book, however, is in Kenny’s explicit linking of a history of medical progress and resulting vulnerabilities and inequalities, to the lessons and demands of international development, at a time when finding solutions to our infectious problems could not be more urgent.