Health, Risk, and Adversity

Catherine Panter-Brick, Agustín Fuentes, Catherine Panter-Brick, Agustín Fuentes

• Publisher: Berghahn Books
• Year: 2008
• Print ISBN: 9781845452810
• eBook ISBN: 9781845458713
• Edition: 1
• Topic: Social Sciences
• Subtopic: Medical Theory, Practice & Reference
• Index: Social Sciences

Research on health involves evaluating the disparities that are systematically associated with the experience of risk, including genetic and physiological variation, environmental exposure to poor nutrition and disease, and social marginalization. This volume provides a unique perspective - a comparative approach to the analysis of health disparities and human adaptability - and specifically focuses on the pathways that lead to unequal health outcomes. From an explicitly anthropological perspective situated in the practice and theory of biosocial studies, this book combines theoretical rigor with more applied and practice-oriented approaches and critically examines infectious and chronic diseases, reproduction, and nutrition.

PART I

Health Risks and Disease in Transition

Understanding Health

Past and Present

Charlotte Roberts

It is hard for people to know if things are getting better or worse.…there is the myth of progress, which claims that technological innovation makes our lives less grueling, healthier, more productive, and happier…[and] there is the myth of the good old days…

—G. J. Armelagos (1998:59)

The Complementarity of Studying the Living and the Dead

As a person who does not research health in living populations, I find that this book not only provides fascinating and incredibly useful insights into living populations—that is, how we might approach evaluating how and why people get sick—but also shows how relevant medical and biological anthropology are to our understanding of the origin and evolution of disease over long periods of time. Palaeopathology, biological anthropology, and medical anthropology complement each other nicely; while palaeopathology can provide a window on disease evolution over long periods of time and highlight the main reasons for the appearance of specific diseases (Roberts and Manchester 2005; Larsen 1997), biological/medical anthropology focused on living populations can provide a better context for the many factors responsible for disease occurrence in populations today (McElroy and Townsend 1996; Sargent and Johnson 1996). Approaches to understanding health that are broad, holistic, and interdisciplinary, that emphasize the health implications of interactions between humans and their physical and biological environments, are something for which we should strive in palaeopathology, biological anthropology, and medical anthropology. The anthropology of modern populations, like palaeopathology, considers people in many environmental and cultural settings ranging from isolated and marginalized locations to urban community settings. However, one common difference is that in palaeopathology there can be a tendency for the study of disease for its own sake with no consideration of the factors causing the condition observed, and a concentration on individual skeletons rather than populations, often with an emphasis on just one geographical location (e.g., Anderson 1997). In medical and biological anthropology of modern populations, this approach is usually avoided.

It is surprising how many of the approaches seen within the three sections of this volume (Health Risks and Diseases in Transition; Generational and Developmental Change; Gene Evolution, Environment, and Health), have been followed in palaeopathology. However, palaeopathologists still have much to learn from biological and medical anthropologists about the impact of the many variables determining health status in the living. Researchers in past human health tend to come from diverse backgrounds (anthropology, archaeology, medicine, dentistry, nursing, anatomy, public health), but, more often than not, they lack an appreciation of the real impact of health problems on people living in the past because their dataset consists of observations from skeletal remains, often with no consideration of the association of signs and symptoms with the disease changes they observe. Furthermore, until recently, methods of analysis have been limited, and it has not been possible even to attempt to answer some questions about past health with the analytical methods available (although times are changing—see Brown 2000 for a commentary on ancient DNA analysis). However, there has always been some attempt, more often in North America, to consider past health both in the context of the origin and evolution of disease, and the socioeconomic and political factors relevant to a disease's appearance and maintenance (see, e.g., Walker and Hollimon 1989; Merrett and Pfeiffer 2000). While advocating this approach, it must be acknowledged that it is often not that easy to apply when studying a sample of skeletons from an archaeological site that are often fragmentary (making diagnosis of disease very difficult), and with no knowledge of whether that sample is representative of the health of the original living population from the region (see Waldron 1994, and Wood et al. 1992, for a detailed discussion of the problems of inferring health from skeletons). Additionally, for most, there are limited analytical methods (usually restricted to diagnosis of disease that affects only bones and teeth) and sociocultural contextual data may be incomplete, making a biocultural approach to palaeopathology difficult. However, we make the best of what we have (Roberts and Cox 2003), make recommendations for future work, and hope things will improve. There are similar problems with collecting and interpreting data in the fields of medical and biological anthropology, although anthropologists who focus on living populations are better placed to investigate health risks under adverse environments.

Diseases and Transitions

Health and disease are measures of the effectiveness with which human groups, combining health and cultural responses, adapt to their environments (Lieban 1973:1031).

The theme of this section, “Health Risks and Disease in Transition,” has been tackled in palaeopathology by some scholars for some time now (see, e.g., Swedlund and Armelagos 1990). Our ancestors experienced a change in their ecological relationships with the advent of hunting and gathering, pastoralism and nomadism, settled agriculture, and urbanism and industrialization, all with their attendant health problems; the developing complexity of life is viewed as broadly detrimental to health (see, e.g., Cohen and Armelagos 1984; Cohen 1989; Roberts and Cox 2003; and Steckel and Rose 2002). However, Froment (2001) has highlighted the problems of inferring health from skeletal remains, as illustrated in more detail by Wood et al. (1992). For example, even thought skeletal remains of hunter-gatherers may appear “more healthy” than those of settled agriculturists, there is a possibility that they may have died from diseases that did not affect the skeleton, or they could have died before disease had chance to make its mark on bone. Froment further indicates that nonsedentary groups will be more at risk from exposure to specific epidemiological risks such as closer contact with wild animals and more violent deaths through hunting and other accidents. Nevertheless, it is suggested that the contexts of hunter-gatherer groups in the past and present are “radically different” (Froment 2001:259). Clearly, there are different health risks for people around the world that are influenced by a variety of environments and economies, and these risks will have changed through time.

Armelagos (1998) describes three major epidemiological transitions: the transition to agriculture, the post-World War II development of antibiotics to treat infectious disease, and the reemergence of new diseases as a consequence of changes in our environment (including the mutation of pathogens to resist pharmaceutical remedies). However, transitions and change can be very gradual and slow, with people experiencing different “worlds” at the same time (something that is true for living populations). Clearly, though, the dominance of the degenerative diseases in patterns of morbidity and mortality today, certainly in developed parts of the world, is being affected by emerging and reemerging infections.

The topic of health risks and diseases in transition has been interpreted broadly in this book, but the focus is on the risks of human populations to disease as their living environment changes through (mainly short) periods of time. Much has been written on this theme, which includes the impact of the movement of people to new environments (whether it be for trade, tourism, or to potentially gain a better life—see, e.g., Mascie-Taylor and Lasker 1988; Roberts et al. 1992; Wilson 1995) and the consequences of socioeconomic change on disease loads in human populations (see, e.g., Cohen 1989; Morse 1995). For example, one of the many factors in the rise of tuberculosis today is increased mobility of human populations; Davies (1995) claims that immigration is one of the single most important causes in increases of TB in most developed countries. Likewise, malaria has seen a global resurgence as a consequence of many factors, not least the impact of particular agricultural systems on the ability for mosquitoes to survive and reproduce (Brown 1997). Of course, humans have a great ability to adapt to changing circumstances. If adaptation means survival, then the human body needs to develop coping mechanisms whether these are cultural or biological, including genetic (through natural selection over a long time) and physiological (over the person's lifetime) mechanisms. Clearly, this phenomenon has occurred in the past and continues to occur today.

The chapters in this section are wide ranging in their treatment; they consider:

• cross species transmission of disease, particularly primate-borne zoonoses in Asia, and the consequences for human populations (Jones-Engel and Engel);

• the possible global impact of avian influenza, its relevance to the 1918 influenza pandemic and the potential of cross-species transmission from bird to human (Herring)—an issue that is very topical; and

• the impact of evolutionary (cold exposure) and adaptive (changing economy) responses of indigenous Siberians on cardiovascular disease rates (Leonard, Snodgrass, and Sorensen).

The chapters cover diseases both of an infectious and of a chronic degenerative nature. The latter is illustrative of people living in both developed and (increasingly, more recently) developing countries as a result of greater exposure to a “lifestyle,” in its broadest sense, that is conducive to chronic degenerative diseases (as indicated by research by Eaton and Boyd 1999 and by the chapter by Leonard et al.); the former tends to be more common in developing countries due to a set of particular circumstances, not least of which is a poor living environment and problems with access to health education and care, such as antibiotic therapy (although, increasingly, infectious diseases are being seen in the developed world). Both are indicative of our changing world and highlight where we have made mistakes, what risk factors we should look out for in the future, what we might do to address those mistakes, and whether the measures taken will be effective. It is a sad fact that it is usually when the developed world encounters a health problem that serious action to combat it is taken.

Each chapter in this section illustrates the complex evolutionary and adaptive relationship that humans have with their changing environments, clearly emphasizing that the changes humans create in their “environment” can have grave implications for their health and well-being. Herring (Chapter 3) clearly illustrates the impact of factory farming and developed trade networks on avian influenza transmission. All chapters also remind us that the epidemiology of disease is highly complex, and that to “conquer” these diseases multiple factors need to be taken into account with people from different disciplines needing to work together to achieve that aim (as illustrated well in Jones-Engel and Engel in Chapter 2). While the medical profession and public alike thought some diseases such as TB had all but disappeared in the 1980s (e.g., Smith 1988), some “conquered” diseases are reemerging and totally new pathogens have also evolved. The journal Emerging Infectious Diseases first appeared in 1995, which perhaps illustrates the increasing awareness of the problem of infections. For example, we have seen tuberculosis and SARS (severe acute respiratory syndrome) spread from human to human via droplet infection through travel, trade, and contact around the world, the impact of developments in the food industry and increased eating out in restaurants on the frequency of food poisoning (e.g., in the UK), and the effect of increased, and inefficient, use of antibiotics to treat infection, leading to antibiotic resistance in some pathogens (e.g., MRSA or methicillin resistant Staphylococcus aureus in UK hospitals; see Barrett and O'Hara (2005) on the 25^th anniversary of the Journal of Hospital Infections).

Cross-species Transmission of Disease

In these chapters a number of observations emerge and themes develop. Firstly, Jones-Engel and Engel emphasize the need to look more closely at the links between humans and nonhumans in the occurrence of disease in human populations. In particular, we must focus on nonhuman primates and especially the enzootic simian retroviruses, which have been shown to cross the species barrier (enzootic meaning “affecting animals in a limited region”—in this case Asia). Immunologically, physiologically, genetically and behaviorally, human and nonhuman primates are very similar, and thus nonhuman primates are more likely to infect humans than are nonprimate species. Clearly, in some parts of the world contact between nonhuman primates and humans is more likely, but it is suggested that the risk of this contact on disease transmission to humans has not been fully appreciated. In the context of Asia and nonhuman primates, monkey temples attract tourists, there are animal markets, people have nonhuman primates as pets, they hunt them for food, they are kept in zoos, they are used for harvesting purposes (sometimes) and to prevent crop raiding, and of course we see them as performing animals. Not only, then, can tourists come into contact with them, but the people that work with them are very vulnerable. The potential for human and nonhuman primates to come into contact and contract infections through body fluids via inhalation, ingestion, and skin contact is clear. However, Jones-Engel and Engel stress that pathogens have a variety of characteristics that influence their transmission, that humans and nonhuman primates also have characteristics that impact pathogen transmission, and that natural and human-made environmental factors influence whether pathogens are transmitted.

In archaeology and paleopathology, this focus on human-animal interaction in disease transmission has not been prominent; this is surprising considering the long list of potential infective organisms that Jones-Engel and Engel list. The study of zoonoses in archaeological animal remains, or diseases that are passed from animals to humans, has been very limited and there is a general lack of interest in this field in the archaeozoological community, with a few exceptions (e.g., Brothwell 1991). This is despite recognition that zoonoses must have had an impact on humans in the past (e.g., TB, anthrax, brucellosis), and specific factors, such as working with animals, would have predisposed people to contracting diseases from their animals. Some research has identified TB in animal remains (e.g., Bathurst and Barta 2004), but this type of work is limited to date. Of course, as Jones-Eng...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• List of Figures
• List of Tables
• List of Boxes
• Foreword: Framing Health, Risk, and Adversity
• Introduction: Health, Risk, and Adversity: A Contextual View from Anthropology
• Part I: Health Risks and Disease in Transition: Understanding Health: Past and Present
• Part II: Generational and Developmental Change: Thinking about Health through Time and Across Generations
• Part III: Gene Evolution, Environment, and Health: Explaining Health Inequalities
• Conclusion: Adversity, Risk, and Health: A View from Public Health
• Contributors
• Glossary
• Index