What is one of the most significant milestones to you? Why?
Discussion Early Conceptions of the Cause of Disease

DQ2 Developor illustrate a timeline of epidemiologic milestones in public health. What isone of the most significant milestones to you? Why?

Most of public health is based on the working hypothesis that disease is caused by exposure to noxious factors in the external environment. While this approach has produced great successes in primary prevention, a general theory of the origins of human disease cannot be found in the textbooks of public health or epidemiology. This paper suggests that, in all its manifestations, disease is a reaction of the human organism to, and/or a failure to cope with, one or more unbalancing changes in its internal environment. These are caused by one or more unfavourable exchanges with the external environment and/or failures in the structural and functional design of the organism. In the final analysis, human disease is attributable to the dependence of organisms on a fundamentally hostile external environment and to unfortunate evolutionary legacies. While this sketch of a theory suggests that there will ultimately be some hard limits to primary prevention, it also helps in identifying possible new approaches to prevention, including interfering with disease mechanisms, and remedying human organisms’ design failures.

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Discussion Early Conceptions of the Cause of Disease
Discussion Early Conceptions of the Cause of Disease

In early spring 2004, I had the opportunity of visiting Crete for a project meeting funded by the European Union. We had lunch in a village, and were served a Cretan meal that included one of its more mysterious ingredients: green purslane leaves salad. The fame of the Cretan diet was established in the seven countries study, which showed that men in Crete had incredibly low rates of cardiovascular disease: less than 10% of the rate in Finland and the USA.1 This has been ascribed to their consumption of olive oil, fruits, vegetables, and red wine,2 and perhaps wild greens such as purslane that are rich in cardioprotective compounds such as α linolenic acid and flavonoids.3

Stories of how our diet influences our health are part of a wider “ecological” view of what causes disease in living organisms. As many textbooks of epidemiology and public health routinely explain, this tradition goes back to Hippocrates’ treatise ”Airs, waters, places”,4 and has inspired empirical studies of variations in disease rates between different localities until late in the 19th century.5,6 Such studies are still important sources of knowledge on determinants of disease, as shown by the seven countries study, and by Doll and Peto’s famous study on the causes of cancer. This used the 10‐fold to 100‐fold worldwide variation in incidence for most cancers, and the changes in incidence upon migration from one environment to the other, to point to the potential avoidability of this disease.7 This ecological view has become a central part of the paradigm of public health as it has developed since the 19th century, and has laid the foundation for many successful primary prevention measures.