In a contemporary global environment plagued by a pandemic and its associated social and mental health ramifications, ‘health’ as a concept needs to be problematized to address the diverse needs of the global community. Within the holistic field of anthropology, two subfields, medical anthropology and bioarchaeology, provide lessons and a framework to understand health and disease. The medical anthropological approach champions health as a socially contextualized experience while bioarchaeology (the investigation of human remains from archaeological contexts) allows a diachronic perspective on how experiences of health and illness change. Anthropological approaches emphasize that health exists as a continuum rather than a binary and demonstrate how interpretations of individuals’ health statuses must be made through historical, cultural, and sociopolitical lenses relevant to the moment that they occupy. In both subfields, and anthropology generally, the biocultural approach reveals the subjective nature of health, demonstrating the importance of considering social determinants when evaluating health experiences and related interventions. Ultimately, we argue that anthropology is ideally positioned to develop a framework for understanding health during a global disabling event, such as the current pandemic, where the diversity of fluid health experiences must be understood to address worldwide public health concerns and inequities appropriately.
Medical anthropologists problematize universalizing definitions of health by making a theoretical distinction between the terms ‘illness’ and ‘disease,’ to gain an understanding of an individual’s biocultural experiences of unwellness. ‘Disease’ is defined as a construct used in Euro-Western biomedicine to refer to pathological entities or a malfunction of an organ or of a physiological process. In contrast, ‘illness’ is used to describe the subjective experiences an individual has of being unwell, as patterned by their larger social contexts (Helman, 1981; Kleinman, 1978, 2013; Kleinman et al., 1978; Wiley, 2022). By understanding that there are a range of illness experiences associated with any one kind of ‘disease,’ anthropology can investigate the social impact associated with events, such as the current COVID-19 pandemic and can study chronic diseases without assuming research participants will necessarily occupy a ‘patient’ social role or define themselves as unhealthy. Furthermore, one’s ability to access healthcare as well as one’s relationship to and past experiences with a healthcare system can impact one’s subjective experiences of health. For example, the ability to access particular treatments changes whether an infection, such as HIV, is deadly or manageable (Farmer 2004). By considering health as a synergistic product of both individual biology and social positionality (a biocultural perspective), anthropology provides important insights into the diverse range of factors that must be considered when defining health.
Bioarchaeological investigations of past health rely upon the skeletal and mummified remains of past humans. For example, in one case, analysis of an individual’s skeletal remains revealed extreme gracility and vertebral deformation (absence of the 11th and 12th thoracic vertebral bodies, collapse and forward flexion of spinal column), suggesting to bioarchaeologists that the 15-year-old individual had late-stage tuberculosis and likely experienced significantly reduced mobility, which would have impacted their ability to participate in their Neolithic society (Formicola et al., 1987). In another context, bioarchaeologists found evidence of Hutchinson’s incisors (abnormal, triangular shaped, notched front teeth) and mulberry molars (back teeth with surplus cusps), which in living individuals are usually part of Hutchinson’s Triad, a pathognomic indicator of congenital syphilis (Cooper et al., 2019). Both individuals may have experienced varying levels of disease-related impairment that impacted their daily lives; however, their experiences likely differed greatly. The latter lived in the 19th century, was institutionalized and isolated, hidden from society. The former individual (~4000 B.C.) was able to survive beyond the initial onset of their disease, likely due to being cared for by their family or community (Formicola et al., 1987; Tilley, 2015, 2017). Additionally, this individual was buried in the same manner as others in their society, suggesting their continued inclusion, rather than exclusion, in their community despite experiencing a disease (Formicola et al., 1987). These cases highlight that while the biomedical expression of disease may leave physical markers on the body, health cannot be fully understood without taking into consideration social contexts such as the response of the individual’s community to their disease expression (Tilley, 2015).
Bioarchaeological interpretations of health and disease are complicated further by the osteological paradox. In order to manifest on the skeleton, and thus appear in the archaeological record, most diseases need time to progress without killing the host (DeWitte & Stojanowski, 2015; Kelmelis et al., 2017; Wood et al., 1992). This means that many individuals whose skeletons are unmarked by lesions may appear ‘healthy’ to a modern observer, when in reality they may lack lesions due to having been quickly killed by a disease. Conversely, a skeleton riddled with osteological lesions might uncritically be dubbed ‘unhealthy,’ while the individual may have lived longer than others who succumbed to a disease prior to an osteological manifestation (Wood et al., 1992). A skeleton is more than a momentary ‘snapshot’ of an individual’s health. Thus, when interpreting health, anthropologists must consider the impact of complicating frameworks and employ additional factors to assess health over time, such as social status, medical intervention, artifacts, and the written record where possible.
To return to the present moment, since health status is affected by an individual’s context, anthropology’s holistic orientation can help us better understand the synergistic interactions of various factors, both biological and social, that impact health disparities (Farmer, 2004; Singer et al., 2021). Consider, for example, how public health policies played out during the early pandemic period. Policies like lockdown orders have sometimes exacerbated types of harm by not considering social factors. For example, many individuals faced increased domestic violence (Singer et al., 2021), and socioeconomically and racially marginalized people have been more likely to be burdened by unfavorable home conditions such as cramped living spaces and poor Internet access that impeded their ability to work from home (Warren & Bordoloi, 2020). Approaching public health anthropologically can emphasize the social determinants of health to reveal and avoid the unequitable effects of such broadscale interventions.
In the context of a worldwide infectious disease event, where the reactions and impacts are diverse, anthropology provides a foundation for understanding health as a fluid and contextualized experience. Anthropology’s holistic approach allows us to interpret health through overlapping and intersecting biological and cultural lenses. Evidence from the bioarchaeological record demonstrates that health experiences exist on a continuum relative to cultural and historical contexts. We feel that Jadad and O’Grady (2008, p. 1364) said it best when they concluded that:
“any attempt to define health is futile; that health, like beauty, is in the eye of the beholder; and that a definition cannot capture its complexity. We might need to accept that all we can do is to frame the concept of health through the services that society can afford, and modulate our hopes and expectations with the limited resources available, and common sense.”
Works Cited
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Tilley, Lorna. “Showing That They Cared: An Introduction to Thinking, Theory and Practice in the Bioarchaeology of Care.” In L. Tilley & A. A. Schrenk (Eds.), New Developments in the Bioarchaeology of Care, Lorna Tilley and Alecia A. Schrenk, editors. Springer International Publishing, 2017, pp. 11-43.
Warren, Meg A., and Samit D. Bordoloi. “When COVID-19 Exacerbates Inequities: The Path Forward for Generating Wellbeing.” International Journal of Wellbeing, vol. 10, no. 3, 2020, pp. 1–6.
Wiley, Adrianna. A Thorn by Any Other Name: Exploring University Students’ Constructs of Mental Health and the Creation of Positive Identity. 2022. University of Guelph, MA dissertation.
Wood, James W., et al. (1992). “The Osteological Paradox: Problems of Inferring Prehistoric Health from Skeletal Samples [and Comments and Reply].” Current Anthropology, vol. 33, no. 4, 1992, pp. 343–70.
Cover image source: “Group of medical professionals at the ICU ready for coronavirus patients,” Rawpixel
