Introduction to Bruce P. Lanphear’s Insights
While browsing Bruce P. Lanphear’s blog titled “Pests, Pollution and Poverty: Exposing Hidden Threats to Human Health” (
Questioning Mainstream Causes of Death
When we inquire about the leading causes of death, search engines typically provide a list of clinical diagnoses: heart diseases, cancer, cerebrovascular accidents, diabetes, etc. This list implies that life is a neutral biological experiment ending when a part fails. But what if these aren’t actual causes, but mere conclusions?
Lanphear’s Powerful Metaphor
Lanphear employs a potent metaphor, reminiscent of Susan Sontag’s work. What if cancer isn’t the villain, but rather the final chapter of a longer story initiated by pesticides or factory gases? Or, could a heart attack merely be the final punctuation mark in a long sentence written in polluted air or through a diet of ultra-processed foods? Millions die annually from causes that, while not mysterious or random, are simply uncomfortable to discuss. These are the collateral damages of our lifestyle.
The Limitations of Official Mortality Statistics
Lanphear questions why official statistics fail to capture this complexity. To understand, we must examine the International Classification of Diseases (ICD), promoted by the World Health Organization.
The ICD-10, in its tenth revision (currently used worldwide), has two fundamental limitations. Firstly, due to its regulatory structure, it mandates assigning a single basic cause to each death. Despite advancements in medical and epidemiological knowledge, statistical reporting remains unicausal. Secondly, it’s structured under a biomedical ontology, assuming diseases and deaths originate from detectable, classifiable individual organic dysfunctions. Consequently, it fails to capture social determinants, environmental factors, contextual factors, or synergistic interactions between diseases.
Though the ICD has evolved over more than a century, it remains closely tied to the German statistical tradition (17th-18th centuries), which aimed to systematically describe the state rather than understand social processes in their complexity. The goal was to better govern by knowing the state’s characteristics (population, territory, economy, military force).
Today, the ICD-10 serves an administrative logic: standardize disease and death information; facilitate homogeneous registration across public health apparatus; produce comparable, auditable, and governable data. Essentially, it serves states and international organizations for planning, epidemiological surveillance, and resource allocation.
Where Do Life Stories Fit In?
Lanphear’s article raises the question: where do life stories fit into these official statistics? It’s evident that official statistics are first-person accounts, as “I” represents the state governing through information. However, we should strive to create third-person accounts considering the social, environmental, and political logic that views cancer not as a spontaneous enemy but as a product of tolerated or promoted carcinogenic environments. Similarly, heart attacks should be seen as accumulations of economic, political, and environmental damage over a lifetime.
Technical vs. Holistic Understanding of Death
Official statistics focus on technical, biomedical aspects of death, while discussing an individual’s life conclusion opens our view to their biography, social structure, history of exposures, and accumulated injustice. This distinction is epistemological and symbolic, revealing a strong tension in medical practice regarding life and death. Clinical diagnosis bases on analyzing an individual’s life trajectory, aiming to situate the disease within that context. Conversely, death diagnosis simplifies this trajectory into categorizing causes translated into codes, losing the individual’s singularity or reducing them to demographic data and a basic cause of death.
The Protocolization of Death Certification
In modern societies, death certification has been protocolized for administrative, legal, and statistical purposes. This symbolic closure of the physician-patient relationship becomes an impersonal, official, and/or hierarchical delegated administrative chore for many professionals. Certifying death is perceived as a cold, bureaucratic act that doesn’t honor their primary vocational calling.
Unlike diagnosis or treatment, death certification is viewed as an uncomfortable, secondary, and merely documental activity. This perception stems from a symbolic conflict between their ethical formation and the technical nature of the chore, partly explaining resistance to completing the format properly. However, it doesn’t justify apathy, evasion of responsibility, or normalization of indifference.
Reducing Life to Its Biomedical Dimension
When dominant policy allows death to be summarized as an isolated biological cause, it de facto reduces life to its immediate corporeal dimension, denying social conditions leading to that death and fragmenting the understanding of human beings. This reduction impoverishes medicine, public health, and social memory.
If we continue viewing death solely as a biomedical event, we perpetuate the denial of social, environmental, and political processes that incubate it. We need to break this inertia: construct new narratives, design new statistics, and imagine new ways of caring. It’s not just about certifying death correctly but honoring the life that preceded it, healing wounded memories, and demanding fairer conditions for those still alive. Each final diagnosis tells a story that could have been different. Preventing death honors, but transforming causes of death changes.
*The author is a Tenured Professor in the Department of Public Health, Faculty of Medicine, UNAM and a Emeritus Professor in the Department of Health Measurement and Evaluation, University of Washington.
The opinions expressed in this article do not represent the position of the institutions where the author works.
[email protected]; [email protected]; @DrRafaelLozano
