AFTERnow

This website is dedicated to deepening our understanding of the crisis we face at the beginning of the 21^st century by asking ‘what’s next for the health of society?’ In doing so, we are mounting a critique of modernity suggesting that we face a gap – an ingenuity gap – between the problems we face and our capacity to devise solutions

While mounting this critique of modernity, it is vital that we also emphasise the benefits of modernity so that we do not throw the baby out with the bathwater. To that end we have outlined four ‘waves’ of public health advances and shown how life expectancy and many other aspects of human health and well-being have improved in the modern era

In this paper we analyse four illustrative public health success stories (one from each wave) to discern what works well, and why. We will argue that the strength of modernity has been the ability to understand, predict and control. That is, modernity has been at its best when it understands how the world works, uses that understanding to predict what will happen when an intervention is introduced and then employs that knowledge to control the problem. This approach works well for many problems but we will also argue that it is subject to both diminishing returns and adverse effects.

The ideas of the Enlightenment challenged and then changed almost all of the assumptions that underpinned the medieval world Empirical observation revealed that the Earth revolved round the Sun and not vice versa and that our planet was part of a vast cosmos that was very old (vastly older than the several thousands of years that had been assumed from the account of creation in Genesis). The new sciences established cause and effect in the physical, chemical and biological spheres that left little room for forces beyond the material.

In time, the principles of empiricism (that truth is derived from observation) were combined with reductionism (that mechanisms are best understood by reducing them to their component parts) to great effect. For example, reductionism allowed the behaviour of clouds to be understood at the level of molecules; physical forces to explain the movement of planets; the growth of plants to be made manifest by the study of cells; and the external characteristics displayed by plants and animals to be explained in terms of genes. Such principles led to a dazzling array of discoveries, insights and new technologies.

Health was poor at the beginning of the Industrial Revolution so we are going to examine how the newly developing ideas and technologies of modernity have been used to improve health by examining four examples of interventions based on the principles of understand, predict, control.