Medical and Demographic History: Inseparable?

Summary. The case is made for forms of medical history that focus explicitly on sickness, health and life chances; ones that explore the effects of health interventions by examining their impact on mor- tality risks. Using a series of examples drawn from environmental health, midwifery and obstetric care, the paper illustrates various ways in which long-term trends in health and mortality may be read together. But it also demonstrates how fraught with problems of description and interpretation this process is likely to be. Finally, a plea is made for evidence-based medical history where 'progress', 'outcomes' and 'results' are given privileged positions. That part of medical history concerned with illness and health is obliged to consider con- sequences; the impact of medical interventions on life chances. Health impact assessment (HIA) needs to occupy a central position in medical history, just as it does in contemporary medical practice. This paper makes the case for such a repositioned medical history and for its alliance with demographic history.1 It demonstrates that close readings of 'health' and 'mortality' are essential, need to be conducted in conjunction with one another, but are rarely straightforward. Four sets of examples will be employed to support the case. The first uses a recent review of medical history as a positioning device. The second focuses on how one might use mortality to assess health or sickness, while the third looks at work on the environment and public health. The fourth set of examples uses research on long-term changes in maternal, infant and fetal mortality to ask how, in these special cases, one might begin to establish the role of medicine.