Evolutionary, historical and political economic perspectives on health and disease

This paper provides an evolutionary and political-economic framework for understanding human health and disease. By applying the concept of the epidemiological transition, the authors trace how human subsistence strategies—from Paleolithic foraging to Neolithic agriculture and modern industrialization—have fundamentally altered our ecological relationships with pathogens. The authors argue that health is not merely a biological phenomenon but is deeply embedded in social structures, where inequality acts as a primary driver of disease.

The authors categorize human history into three distinct epidemiological transitions:

1. The First Transition (Neolithic): The shift to agriculture and sedentary living increased population density and human-animal contact, leading to the emergence of endemic infectious diseases.
2. The Second Transition (Industrial): Improved public health, nutrition, and medicine in industrialized nations led to a decline in infectious diseases and a rise in chronic, degenerative conditions.
3. The Third Transition (Contemporary): We are currently witnessing the reemergence of infectious diseases, many of which are antibiotic-resistant, driven by globalization, ecological disruption, and widening social inequality.

The authors contend that the "Third Transition" is not an accidental biological event but a consequence of human-made ecological and social conditions. They introduce the concept of "macroparasitism" to describe how social stratification and global economic systems allow elites to benefit at the expense of the health of the poor. By framing extreme poverty as a central, preventable cause of disease, the paper challenges the notion that infectious diseases are simply being "eradicated" by technology. Instead, it emphasizes that addressing global health requires tackling the political and economic disparities that perpetuate vulnerability.