Session 3
Population Health from the paleolithic on
TURN IN GREAT LEVELLER RESPONSE

SCF State of the World's Mothers 2004
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.
A fifth of 20-yr old women
In the US gave birth in their teens

Studies looking at various health outcomes and societal factors (data)
Considering mechanisms (biology) through which structural factors work
Looking for contrary evidence

list 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
Nomadic
Hunter-
Gatherers
Human History and Pre-History
Tribes Big-Man
Societies
Sedentary
Foragers
Chiefdoms
Civilizations
Primitive
Kingdoms
Feudal
Societies
Nation states

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.

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 Economics
WHY DID SOCIETIES ADOPT AGRICULTURE?

Emerged 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 ."

Anthropological 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

villages: 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

classification 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

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

hierarchies 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
DIVISIONS ruler / ruled rich / poor literate / illiterate townspeople / peasants

infectious 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

fertility
– 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)

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

Average 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

80
Japan
70
USA
60
Russia
Life Expectancy Trends: Paleolithic On
50
40
30
Sub-Saharan
Africa
Paleolithic
Rome
20
Present (1990) (1900) 1000 10000 100,000
Y e a r s b e f o r e p r e s e n t ( l o g s c a l e )

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

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

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

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.)
180
175
170
165
160
155
USA UK Sweden Norway Netherlands France Austria/Hungary
1750
1800
1850
1900
1950

Great Plains Tribes in 19th Century
Indians European-Americans migrated 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 accumulation densely settled, sedentary greater inequality
Individualistic, little need for community-based social insurance because the rich could use the market for their needs, placing the poor at further risk epidemics took huge toll in cities and rich escaped, not bringing food to poor in cities similar ethnic heritage (sense of community) varied diet
"Tallest in the World" Steckel & Prince, 2001

QUESTIONS?