Health Services 482

Session 3Population Health from the

paleolithic on

TURN IN GREAT LEVELLER RESPONSE

SCF State of the World's Mothers 2004

A fifth of 20-yr old womenIn the US gave birth in their teens

In Phillips County,Arkansas, the birth rate among teenage girls in 2000 was 127 births per 1,000 women aged 15 to 19 - a rate higher than in 94 developing countries.

Methods of investigation:

Studies looking at various health outcomes and societal factors (data)

Considering mechanisms (biology) through which structural factors work

Looking for contrary evidence

Learning Objectiveslist the stages of human development with corresponding trends in population health

discuss the ways in which a human population is different than simply a collection of individuals

describe possible biologic mechanisms that underlie the association of hierarchy and health in humans and in non-human primates

Egalitarian Feudal Societies

NomadicHunter-Gatherers

Tribes Big-ManSocieties

Sedentary Foragers Chiefdoms

PrimitiveKingdoms

Civilizations

Nationstates

Human History and Pre-History

Societies from the Paleolithic to Present

Forager-Hunter society has been human’s most successful adaptation“Cultural man has been on earth for some 2,000,000 years; for over 99% of this period he has lived as a hunter-gatherer. Only in the last 10,000 years has man begun to domesticate plants and animals..... Homo sapiens assumed an essential modern form at least 50,000 years before he managed to do anything about improving his means of production.... To date, the hunting way of life has been the most successful and persistent adaptation man has ever achieved.”

– Lee, R. B. and DeVote I. (1968). Man The Hunter.

Poverty from the PALEOLITHIC to PRESENT

The world's most primitive people have few possessions, but they are not poor. Poverty is not a certain small amount of goods, nor is it just a relation between means and ends; above all it is a relation between people. Poverty is a social status. As such it is an invention of civilization. It has grown with civilization [as an invidious distinction between classes] – Marshall Sahlins Stone Age EconomicsWHY DID SOCIETIES ADOPT AGRICULTURE?

Agricultural SocietiesEmerged to cope with increasing population and decreasing food supplies from foraging

Inventions, technologies,and organization related to agriculture usually known to societies

These technologies only adopted when necessary and adoption goes hand in hand with social stratification Less work before present "English data on farm work in the Middle Ages show that at least in England the working days which the peasants had to perform for the landlords lasted from sunrise to noon only. A fair day's work seems to have been a half-day's work."

Agricultural SocietiesAnthropological studies suggest that primitive peoples usually consider both hunting-fishing, and food collection as pleasurable activities, while food production is resorted to only to the extent that other and more agreeable activities fail to provide sufficient food. The effort devoted to food production is often seen to be limited to the bare minimum of hours necessary to avoid starvation. (Boserup)

Expansive: settlement patterns changed from bands to tribes, chiefdoms, states

Destroyed hunter-gatherer societies:– Mostly through behavioral violence

•Bounties in USA: (£ 20 for male £ 10 for a female or child)

– More recently through ethnocide•Cultural: Residential Schools

– Brody’s The Other Side of Eden

Today: destruction using structural violence via globalization

Agricultural Societies

Agriculturevillages: of several hundred to few thousand, sharing common language, culture, linked in loose confederacies (tribes), or united more formally in rank societies or chiefdoms comprising many thousands•safety in numbers because stored food in towns

•craft specialization emerges, so proximity improves efficiency of specialized tasks

•farmed and stored foods become private property

•central government control more possible

civilization: communities of varying sizes, integrated into states

Importance of POWER and power relationships

Agricultureclassification of societies in reference to inequality–Egalitarian •usually only small societies•have persisted well into the 20th century

–Display of ranking •begun 10,000 years ago•some still during 20th century

–Socially stratified (class societies)•began with origins of civilization and the state about 5000 years ago•usually only the largest, which are most sharply stratified

Agriculture

fertility increases because – availability of weaning foods– child labor utilized in farming economies •child rearing did not require as much investment since they could be put to work earlier in life

– reduced strain on women carrying children•more difficult to be mobile mother

– increased mortality

30 fold population increase over 4000 years

Agriculturehierarchies emerged as larger and denser societies replaced smaller societies in pre-history

– internal stratification within individual societies

– inequality of power & exchange between societies

– began 5000 years ago

DIVISIONSruler / ruledrich / poorliterate / illiteratetownspeople / peasants

Agricultureinfectious diseases increase

–TB a disease of crowded urban poor and ghettoes and reservations–bubonic plague–influenza and cholera with international military operations–AIDS

contemporary forager-hunters display low rates of

-infantile and other diarrhea, anemia-epidemic diseases

only have chronic diseases and some zoonotic and soil borne diseases which don’t depend on people for survival and transmission

Pre-History Population Health Measuresfertility

– number of births in females from female pelvic birth scars

mortality– number of juvenile deaths– life expectancy of these populations as 30 to 50 years from various studies on different groups

– infant mortality estimates of 150 to 250 per 1000 live births

“Agriculture has long been regarded as an improvement in the human condition: Once Homo sapiens made the transition from foraging to farming in the Neolithic, health and nutrition improved, longevity increased, and work load declined. Recent study of archaeological human remains worldwide by biological anthropologists has shown this characterization of the shift from hunting and gathering to agriculture to be incorrect. Contrary to earlier models, the adoption of agriculture involved an overall decline in oral and general health.” (Larsen, C. S. (1995). "Biological changes in human populations with agriculture." Annual Review of Anthropology)

Health Declined with agriculture

Population Health Measures in Recent History

skeletal height (stature) "stature adeptly measures inequality…. Average height in the past century is sensitive not only to the level of income but the distribution of income" Steckel 1995, New Yorker April 4, 2004

Stature a measure of consumption that captures supply of inputs to health as well as demands on those inputs

– Data available in settings (18th Cent America) where income data poor, and for groups such as slaves, natives for which income or wage concepts don't apply

AuxologyAverage height rises for a given per capita income with the degree of income equality

Among populations average height correlates with mortality measures– Within populations, genetics plays a part

•Pygmies in Africa (“small but healthy” produce less GH)

Models regressing average height on income/cap, Gini, age, ethnicity, gender, etc. Gini is biggest factor (Steckel 1995)

THE HEIGHT GAP: April 5, 2004 New Yorker

Sub-SaharanAfrica

Russia

Present (1990) (1900) 1000 10000 100,000

Years before present (log scale)

Japan

USA

Rome

Paleolithic

20

30

50

60

70

80

40

Life Expectancy Trends: Paleolithic On

Population Health Measures in History

life expectancy estimates lie in range of 20 to 50 years until the last century

•25 years is estimate for –Europe in 18th & early 19th century–urban Europe well into the 19th century–Japan had higher life expectancy than W. Europe 19th century

•Italy, Spain, Hungary it was below 30 for most of 19th century

•US no data on life expectancy before 1900 but suspect higher than Europe (less hierarchy then)– better than India prior to 1920

Life Expectancy Trends From Pre-History To Present

20305060708040Sub-SaharanAfrica

Russia

Present(1990)(1900)100010000100,000Years before present (log scale)

JapanUSA

Rome Paleolithic

Population Health Measures in History

infant morality (150 to 250 for pre-agricultural societies)•US 1900 had five major cities with IMRs of 300, and many exceeded 200

•Europe: IMR >200 until late 19th century

•1999 many countries have IMR’s >100– 189 countries: 4>150, 27 > 100

Stature trends in America & W. Europe

Height particularly sensitive to income at low income levels

Great Depression hardly affected secular trend in US stature (average stature) and similarly in Europe

Early 19th C. US and pre-famine Ireland had tall populations despite lower incomes– (nutritional status of Americans surviving to adulthood 200

years ago were comparable to $10,000 income/cap in 20th century countries)

– Inequality in wealth modest in US cf W. Europe• Americans were relatively healthy but poor 200 years ago

Population Health Measures in History

can measure trends by dating of skeletal remains– “The overall trend in human stature until fairly recently, if mixed, has been downward although it has been reversed for affluent people and nations in the last 100 years."

– "The seventeenth- and eighteenth-century Europeans against whom we proudly measure ourselves to demonstrate our progress, were actually some of the smallest people who ever lived."•Cohen 1998

Stature Trends Men from 1750 on (cm.)

155

160

165

170

175

180

USA UK Sweden Norway Netherlands France Austria/Hungary

17501800185019001950

Great Plains Tribes in 19th CenturyIndians

European-Americansmigrated many times a year

– Less exposure to noxious effluvia

egalitarian practices (sharing food and shelter, caring for sick & wounded)rich were generous, and as their wealth was readily moveable, placed limits on accumulationsimilar ethnic heritage (sense of community)varied diet

densely settled, sedentarygreater inequalityIndividualistic, little need for community-based social insurance because the rich could use the market for their needs, placing the poor at further riskepidemics took huge toll in cities and rich escaped, not bringing food to poor in cities"Tallest in the World" Steckel & Prince, 2001

Life Expectancy Trends From Pre-History To Present

20305060708040Sub-SaharanAfrica

Russia

Present(1990)(1900)100010000100,000Years before present (log scale)

JapanUSA

Rome Paleolithic

NEXT SESSIONhappiness, social

cohesion

QUESTIONS?