Relevance for Public Health
The germ theory had immediate implications for clinical medicine. Its relevance was extended to public health through the concept of the epidemiological triad, which stressed the need for attention to all 3 corners of a triangle: host, vector (and agent), and environment, for effective control of disease outbreaks. A focus on germs (ie, agents) alone was insufficient. John Snow's removal of the handle of the Broad Street pump during the London cholera epidemic of the 1850s showed the relevance of both vector and environment to infection control.
Although less frequently applied, the triad has also proved robust in its application to chronic disease. The concept of anthropogens, as proposed here, offers a broader base for managing chronic disease than the germ theory did for infectious diseases. It offers a single concept for 2 corners of the triad, environment and vector (and agent). Although agents can be inducers of metaflammation — either exogenous or endogenous (eg, EDCs, excessive cortisol levels) — these agents, plus the vectors through which they are delivered (eg, polluted air/water, socioeconomic stress) and environments in which they exist (eg, industrial output, inequality) are included under the single concept of disease-promoting anthropogens. Public health approaches in this model thus become generic, rather than fragmented (eg, dietary intakes rather than specific nutrients), and distal, rather than proximal (eg, industrialization/economic growth rather than fast-food marketing). Most important, such approaches need to involve disciplines often otherwise not considered in discussions of epidemic illness — such as macroeconomics, geography, ecology, and even business — in considering big-picture causality.