Historical epidemiology and the structural analysis of mortality

Abstract

Attempts to explain long-term variations in pre-transitional Western European mortality in terms of changing living standards have met with little success, and this has led to the view that such variations were biologically, or climatically determined. This conclusion can, however, be avoided by a fuller specification of the determinants of exposure to infection that incorporates the dimensions of spatial structure. This paper advances a model of the proximate determinants of exposure and resistance to infection, and derives predictions for the mortality patterns of pretransitional metropolitan centres that are tested against data from London c1670–1830. The latter generally bear out the predictions of the model whilst also demonstrating the importance of certain features of England’s political economy over this period.