In 1971, Egyptian American epidemiologist Abdel Omran (1925–99) published ‘The Epidemiologic Transition: A Theory of the Epidemiology of Population Change’.1 This paper has become a citation classic, and has been celebrated by two full reprints plus commentaries in 2001 and 2005. It is easy to understand why it became so popular: it provided a powerful concept which helped to understand one of the most important phenomena in population health: the decline in mortality underlying a spectacular increase in life expectancy, first in Western Europe and North America and more recently also in other parts of the world. Omran pointed out that we live longer because—to put it simply—we have exchanged infectious diseases, which take their toll at a young age, for chronic diseases such as cardiovascular disease and cancer, from which we mainly die at an older age. A fuller summary of the rather long paper is provided in Box 1. Although the theory has clearly been very useful, it does have important limitations, not only in terms of its accuracy as a characterization of what happened in the past, but also in terms of understanding the present and predicting the future.
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