Pathogenesis: A History of the World in Eight Plagues

by Jonathan Kennedy

If I jump on a train at Euston station that is heading north, I can be in the seaside resort of Blackpool in less than three hours. Male life expectancy in the town is a full twenty-seven years lower than in Kensington and Chelsea—the same as the difference between the UK or the U.S. and the unhealthiest countries in sub-Saharan Africa. Prior to the Covid-19 pandemic, the disparities in life expectancy within the UK were not explained by the differential impact of infectious diseases, as they killed far too few people to make a mark. Rather, inequalities in health outcomes were the result of disparities in premature deaths from non-communicable diseases, most notably cardiovascular disease, cancers and diabetes. While such illnesses obviously aren’t transmitted from one person to another by pathogens, their distribution is not random. Just as the urban working classes in Victorian slums were more likely to be affected by cholera or TB, these modern “plagues” disproportionately impact the poor—hence the inequalities in health outcomes between places like Kensington and Chelsea on the one hand and Blackpool on the other. According to the Office for National Statistics, men and women in the most deprived areas of England were, respectively, 4.5 times and 3.9 times more likely to die young from preventable causes than those in the wealthiest areas.[52] Health is so closely linked to wealth and social status that Michael Marmot, the influential British epidemiologist, has liken...