Between 1554 and 2021, the number of and mortality from epidemics in Amsterdam decreased sharply. The decrease in epidemic outbreaks, such as those of plague, smallpox and cholera, paralleled the decrease in chronic mortality from endemic ailments and diseases, such as tuberculosis, malaria and dysentery. There are several theories about the reason for these declines, which are not necessarily mutually exclusive: better nutrition, greater prosperity, increasing altruism, and a growing understanding of cause and effect with targeted medical and public health measures. In the powder keg of chronic poverty and poor public health, a social crisis, such as war, migration, and natural disaster, usually was the spark that led to epidemic outbreaks. The nature and extent of poverty and ill health have changed and improved over the centuries, but the threat of man-made crises is unfortunately unabated.