Article Text

Download PDFPDF
The origins of human disease: a short story on “where diseases come from”
  1. Johan P Mackenbach
  1. Correspondence to:
 Professor J P Mackenbach
 Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands; j.mackenbach{at}


Most of public health is based on the working hypothesis that disease is caused by exposure to noxious factors in the external environment. While this approach has produced great successes in primary prevention, a general theory of the origins of human disease cannot be found in the textbooks of public health or epidemiology. This paper suggests that, in all its manifestations, disease is a reaction of the human organism to, and/or a failure to cope with, one or more unbalancing changes in its internal environment. These are caused by one or more unfavourable exchanges with the external environment and/or failures in the structural and functional design of the organism. In the final analysis, human disease is attributable to the dependence of organisms on a fundamentally hostile external environment and to unfortunate evolutionary legacies. While this sketch of a theory suggests that there will ultimately be some hard limits to primary prevention, it also helps in identifying possible new approaches to prevention, including interfering with disease mechanisms, and remedying human organisms’ design failures.

  • epidemiology
  • public health
  • disease aetiology
  • ecology
  • evolutionary biology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: none.

  • Conflicts of interest: none declared.

Linked Articles

  • In this issue
    Carlos Alvarez-Dardet John R Ashton