In a new book, Harsh Mander illustrates how poor social conditions can cause long-term illnesses

In the language of policy, what do we learn from the small band of enlightened colonial administrators during the deadly Bombay plague epidemic and the singular life journey of Norman Bethune? That a person’s health requires not just quality health care services but also attention to what we call the “social determinants of health”, which include nutrition, decent work, decent housing, clean water, ventilation, sanitation, social protection and so much else. Through rigorous empirical studies, many scholars helped further our understanding of the social determinants of health and consequent state responsibilities.

One of the first significant studies that identified social and economic factors that cause and fuel the spread of certain diseases was notably by Friedrich Engels, German philosopher and close collaborator of Karl Marx. Typhus, or scarlet fever, was widespread at that time among the London working classes, and Engels saw the link between the highly unsanitary conditions in which they were forced to live and their susceptibility to this deadly ailment.

Thomas McKeown a century later followed up on Engel’s work and found that as sanitation and hygiene improved in the second half of the 19th century, mortality rates by communicable diseases fell – although he hypothesised that increase in food production...

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