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Throughout history and prehistory trade and economic growth have always entailed serious population health challenges. The post-war orthodoxies of demographic and epidemiological transition theory and the Washington consensus have each encouraged the view that industrialization necessarily changes all this and that modern forms of rapid economic growth will reliably deliver enhanced population health. A more careful review of the historical demographic and anthropometric evidence demonstrates that this is empirically false, and a fallacious oversimplification. All documented developed nations endured the ‘four Ds’ of disruption, deprivation, disease and death during their historic industrializations. The well-documented British historical case is reviewed in detail to examine the principal factors involved. This shows that political and ideological divisions and conflict—and their subsequent resolution in favour of the health interests of the working-class majorities—were key factors in determining whether industrialization exerted a positive or negative net effect on population health.