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

John Robb*, Craig Cessford, Jenna Dittmar, Sarah A. Inskip, Piers D. Mitchell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)101-112
Number of pages12
JournalInternational Journal of Paleopathology
Early online date5 Jul 2021
Publication statusPublished - 1 Sep 2021


  • DALYs
  • Global Burden of Disease
  • Infant death
  • Infectious disease
  • Medieval health
  • Plague
  • Tuberculosis


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