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

3 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 Sept 2021

Bibliographical note

The authors would like to thank all the members of the “After the Plague” project, including Ruoyun Hui, Toomas Kivisild, Christiana Scheib, Sarah-Jane Harknett, and Bram Mulder, for discussion of these issues. The authors thank Ileana Micarelli, Mary Anne Tafuri and Lorna Tilley for the kind invitation to take part in the EAA session this was originally presented in, and Lorna Tilley for detailed comments on the manuscript. All deficiencies remain their own.

Funding Information:
This work was supported by the Wellcome Trust (Award no. 2000368/Z/15/Z).


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


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