The greatest health problem of the Middle Ages? Estimating the burden of disease in medieval England

Objective

To identify the major health problems of the Middle Ages. Bubonic plague is often considered the greatest health disaster in medieval history, but this has never been systematically investigated.

Materials

We triangulate upon the problem using (i) modern WHO data on disease in the modern developing world, (ii) historical evidence for England such as post-medieval Bills of Mortality, and (iii) prevalences derived from original and published palaeopathological studies.

Methods

Systematic analysis of the consequences of these health conditions using Disability Adjusted Life Years (DALYs) according to the Global Burden of Disease methodology.

Results

Infant and child death due to varied causes had the greatest impact upon population and health, followed by a range of chronic/infectious diseases, with tuberculosis probably being the next most significant one.

Conclusions

Among medieval health problems, we estimate that plague was probably 7th–10th in overall importance. Although lethal and disruptive, it struck only periodically and had less cumulative long-term human consequences than chronically endemic conditions (e.g. bacterial and viral infections causing infant and child death, tuberculosis, and other pathogens).

Significance

In contrast to modern health regimes, medieval health was above all an ecological struggle against a diverse host of infectious pathogens; social inequality was probably also an important contributing factor.

Limitations

Methodological assumptions and use of proxy data mean that only approximate modelling of prevalences is possible.

Suggestions for further research

Progress in understanding medieval health really depends upon understanding ancient infectious disease through further development of biomolecular methods.