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    Semana 7 Stanford Et Al. (2009) CAP 16

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    Naaomy Duque

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    ay te eee Anchrapelagy, Seneavey 14 CHAPTER OUTLINE Anthropology Biocultural and Evolutionary Approaches to Disease Birth, Growth, and Aging 36 wrctine on ite sure hy 70000 yas gin the Souter pt oft snow FAA sma poop bos hve ben lig sre mefnorng esting he cere conan in Pir egn ooking rcs sre tos tho aan leaning partes They re aregio get hey They snow at ead eo ge fr foe The ronan eveing met proce ye prs and hein {bettie bt ty avon he oun betwen hoe to maa Ait of ere bay dono ns oregg nth cnc The sierra and war and apart nusberres an nes raping Form Seca essere seen has be oo ore al ne chars nd gine eel dar il rae a goose {Ye boyr an manage cits on They senda hur oo Mog from soto mn rere oo a be on coving couple rr ste oes Thay soe ara an pen 20 mines ry ae 9 tpnmip on tlre reg ats loner ne ren Een toi he ra they ae lappy wth the acu foe ey fcug her mey rge heaven ty op byasveam fr aretand enone y one hey ling Linen on be unre cy ne ey ty coryat aide scan Unies Sar A ere gop ene a te caeera to ether ich They he ete mara bes des cong tt sch er They ae ad ere chr cen hey int hee ioe cing he seraon yt nhac Sony ones weber pet se een ‘iter soo cn ford orh ove fn teache former than 1209 Batons Bete citron pus rough he . aera ine mos of thom ore tegrated ele wrest breads ead they crore ods gh nat tad spr cen nugget res cle Te 2 etree lot ilk estat en for sed soa ae ul vere rele Aer hey st dost clr Sins ffs her eas oro them woud yt hy rely fod fa cera res bane yo Snare hey rum to ther charsan formov nacion we [NT MEST GLANCE; Clutbaa IX DEvEzofeD CouNTRES in the edly tear ‘ennary are much healthier than this counterparts who lived 20,000 yeas ago ies They are bigger and more physically mature fof the age and. unlike the Paleolithic dheescors, ch 466 biomedical anthropology The ‘bl lage arora co fered wth eso eth des, epidemiotogy The gant Sey ofthe eeirene tn ae of ‘deen popu art V + New Frontiers In jological Anthropology ‘bone, ora toothache will tur into fatal baci infection, They are blssflly fee of parasites. ‘On the other hand, a child from 20,000 years ago might have grown up more slowly than s contemporary child, but upon reaching adulthood he would Rave had a strong, lean bods, with much more muscle than fa. He would not have {Spunva ifetime consuming more calories than he expended. he were lucky enough fo avoid infectious disease, injury, and famine, in his middle and old age he would have bees less likely to suffer from heat disease, high blood pressure, diabetes, and ven some kinds of cancer than would én adul living today. {eatch and illness ave fondamental parts ofthe human experience. The ini- vidual experience of illness is produced by maay factors. liness is a product of ‘ur genet and culture, our enviconment and evolution the economic and educa- tlonal systems we liv under, and the things we et. When we compare how peo: ple live now to how they lived 20,000 years ago, i is apparent chat i is dificult fo define «healthful envionment Is tthe quantity of ie (years lived) or the qual {fy that matters most? Are we healthier living as ur ancestors did, even though swe cannot re-create those past environments, or should we rejoice in the abun- {Ssnee and comfort that a steady food supply end modern technology provide ws? ‘Biomedical anthropology isthe subfield of biological anthropology concerned ‘with issues of health and illness. Biomedical anthropologists bring the traditional Interest of biological antaropology—evolution, human variation, genetics—to the ‘uy of medially related phenomena. Like medicine, biomedical anthropology is 1 Diclogical science, which rlis on empiricism and hypothesis esting and, when jousbe, experimental esearch ta further the understanding of human disease and Hines Biomedical anthropology is also like cultural medal anthropology in is ‘comparative outlook and its attempt to understand illness inthe context of specific cultural vironments. Tn this chaptes, we will look at many aspects of human health from both bio cultural and evolutionary peespectves. We will se how health relates to grow, evelopment, and aging. We will then consider infectious disease and the prob lems associated with evolving biological solutions to infectious agents that can also evolve, Finaly, we will examine the iteration berween diet and disease and fhe enormous changes in diet our species has gone through since the advent of fader agriculture. But before going on to those topics, lt us briefly consider ome basic concepts from an allied discipline, epidemiology, which provides the {quantitative foundations for population-level health esearch, Epidemiology: Basic Tools for Biomedical Anthropology Biomedical anthropology is particularly concerned with understanding the expression of disease atthe popula solve: Another th ence ih s popsltns level outiook is epidemiology. Epidemiology is the ‘quantiative study of the occurzence and cause of dis- {ase in populations. Compared with anthropologists epidemiologists ace *number-crunchers," looking for broad-seale statistical associations between ill health and the factors that produce it in specific populations (Figure 16.1) Io the same way that understanding the Cellis essential for developing a proper understanding of SInatomicalstrutuce, familiarity wich some ofthe basic Statistica tools of epidemiology is essential for the an~ thropologiets understanding of she distribution of dis- ex wt rina palin athe poputon ee case in buman populations. Chapter 16 + Biomed Antiropology 467 RATES: MORTALITY, INCIDENCE, AND PREVALENCE ‘The most basic epidemiological statistic isthe rat of disease per 1,000 individuals, or even per I milion individuals for rare conditions, We define rare as Rate = EventsPopulation at rsk ‘The event isthe disease or condition you are interested in, I is important to specify the population at risk. Fo instance, we should calculate the ovarian ca ‘cer rate for adult women, not for the population as 2 whole. ‘Mortality rates are measures of the probability of dying within a population over a given period of time. The crude death rare is defined as CCeude death rate = (Al deaths during calendar yearPopulation at midyat) 1,000 Deaths per 1,000 ‘We have to be wary in imerpreting crude death rates. or example, in 1997 the death race in Pennsylvania was 10.6/1,000, whereas in Ural it was only 561,000. Does this mean that we would ail be better off living in Utah rather than Pennsylvania? Nor necessarily. The birth rate in Utah for that year was 21.2/1,000, whereas in Pennsylvania it was only 11.8/1,000. What i this telling us? ‘Age isan important variable in determining a person's chance of dying ina given period of time. We can infer from these data that Utah has a much younger popslation than Pennsylvania. The different age structures of the two states “undoubredly explain much of the difference in crude death rate between them, ‘Two of the most important epidemiological statistics ae incidence rate and prevalence rate. They ace defined as follows Incidence rate = (Number of new eases of a disease/Total population(Petiod of time (usually a year) Prevalence rate = Total number ofcases of disease ata given time/Total population Incidence rates the occurence of new cases ofa disease, The hisher the incidence rate the more new eases are developing over a perio of time, A change in incidence rate indicates a change inthe balance of ecological factors that influence the expres- sion ofa disease, which could result from some naturally occurring factor ofthe development of an effective intervention program. Incidence rates of diagnosed ‘cases of AIDS peaked in the United States in the early 1990s, with more than 406,000 new cases in 1993 (starting from only a handiul of eases in 1981), and then leveled off to 2 steady 40,000 new cases per year starting in 1997 (Stine, 12003). This decline in incidence rate undoubtedly was caused by changes in behav for brought about by AIDS edveation programs. Ia vaccine for AIDS were developed, the incidence rate would plume. ‘The prevalence rate isa function of both incidence and duration. Changes in the prevalence rate ofa disease do not necesearily tell us anything about the incidence rate, For example, with the introduction of new drugs to treat AIDS, people who develop the condition are now surviving longer than ever Fifty percent (ofthe people inthe United States who were diagnosed with AIDS in 1995 were tll alive in 2002 (Stine, 2003) Because the drugs only conto the sympeoms of AIDS snd do nor cure the prevalence rate may actually increaze as a result of these new treatments with inereased ducation of illness, while she incidence rate remains the same. In contrast, a disease that kis quiekly-—or, looking on the bright side, is Auickly cured-could have an incidence race higher than its prevalence rate, EPIDEMIOLOGICAL TRANSITIONS. In 1971, Abdel Omran coined the term epidemiological transition to describe changes inthe pattems of disease and mortality in developed countries. Ia less developed societies, most deaths are caused by infectious diseases. In developed In 2003, the incidence rate of lung cancer in ‘men was 78.5/100,000 ‘ond in women 51,31100,000. Ninety percent of people dlagnosed with lung ‘cancer smoked at some point in thelr lives. Prevalence ate The rumberof (Seung ener of dae ace ‘he poplin (or dhe poplin n no. 468 Part + New Frontiers in Biological Anthropology countries that have passed through the epidemiological transition ofthe twentieth ‘Century, the most common cases of death are chronic diseases of old age. Infections disease rates dropped dramatialy in developed countries thanks to beter nutrition fd hygiene, a better understanding of how infectious agents cause illness, and ‘widespread use of antibiotics and vaccinations “Table 16.1 list the tp ten causes of death in che United States in 1900 and 2000, The death rae from accidents holds almost che same position in both lists, although the death rate from accidents in 2000 was about half he 1900 rate. The {hece big causes of death in 2000—heart disease, cancer, and stroke—are all primarily diseases of old age, accounting for 60% of all deaths. In 1900, they Eccoumted for only 16% of deaths. In 1900, people were a risk feom a variety of infeetios diseases. In 2000, the infectious cseases that made the top ten list— ‘pneumonia, influenza, and septicemia—were all eseass to which olde, chronically {people are particulary vuinerable ‘The concept of an epidemiological transition, which i based on an evoli- sionary and comparative view of diseases in populations, fits in well with much biomedical anthropological research, Anthropologist George Armelagos (1997) land colleagues have argued that Omran’ epidemiological transition isin fact the Second epidemiological transition. The first occurred with the introduction of 1900 1 Prcurenis m bh 2 Tuberc 194 " 2 Dirt inemarse 8 | “ Heart dase a7 8 | 5 ney dese cy 5 ‘ Aces % 4 1 Sle a 4 e Dienserteryinany 72 4 + cover « 4 1 Hoar eae 28 0 2 Concer 2 a 2 Serle a 1 4 Chron espiacory dene 4 5 5 econ 6 4 . Dieses elias 2s 3 z Infuezs ad pneumonias 24 3 8 Anheeer aease 8 2 ° doy desnse 4 a » Sepscria iu f Souac RD Grr WAP Hal al eric a of Une So 0-100 tron BE ‘Geicro TomhUs Nand Cea or eth ence Nese at See Rr 5550 {Chapter 16 + Biomedal Antropalogy 469 MULEANS NONTHLY SHEP] FIGURE 162 Search ver: oh vaccinia arson tous a “Ly Siete sha chles were he [veceee anne re niaetrar revs saat] ‘sours ottunus peeasoee, agriculrue, which in tua ed tothe development of large urban populations. These lnsger populations became the seting forthe spread of infectious diseases, many of which sll plagued lage cites in 1900 (Figure 162), cultural and Evolu: to Disease Epidemiology provides the quantitative foundation for biomedical anthropotogy’s mission to understand the evolutionary and cultural factors underlying human disease, Although these factors are interrelated, within biomedical anthropology the biocultural and evolutionary approaches provide insights into che population. level expression of disease from somewhat different perspectives, nary Approaches ‘THE BIOCULTURAL APPROACH The biocultural approach recognizes that when we are looking at something as complex as human ilinss, both biological and cultural variables offer important insights. The biocultural view recognizes that human behavior i shaped by bot’ our evolutionary and cur cultural histories and that, just as human biology docs, ‘our behavior influences the expression of disease at both the individual and population levels (Wiley, 1932, 2004 ‘An example ofan illness that can be understood only in ight of both biology and culture is anorexia nervosa, a kind of selt-starvation in which a person fil to mainrain a minimal sormal body weight, is incase afraid of pining weight, and «exhibits disturbances in che perception of his o her body shape or size (Figure 16.3) (American Poychiatrie Astociation, 1994), The anorexic person fights weight gain by not eating, purging (vomiting) afer eating, or exercising excessively. The preva- lence rate for norexa is about 0.5 to 1.0%; about 90% of sufferer are female Anorexia isa serious iinss with both long. and short-term increases in morality. Forexample at 6-12 year’ follow-up after diagnosis, the mortality rates 9.6 times the expected rate (Nielsen, 2001), ‘An ideal of female attractiveness emphasizing thinness often is thought to provide a cultural stress lading tothe development of anorexia. Obviously, because hot all girs living in this envizonment become anorexie there are undoubtedly biological factors that also make some individuals more likely than others to have the illess. Anovexiais aso found in non-Western cultures, However, anorenie petiens in Hong Kong do not have the “fat phobia we associate with Western Anorexia but rather exhibit a generalized avoidance of eating (Katamnan 8 Lee, FIGURE 163 Aceeraged srw 470 Part + New Frontiers in Biological Anthropology Shogens Onan and ees 11997). This indicates that eventhough anorexia isnot limited ro Western cultures, the focus on fats shaped bythe Western cultural concerns with obesity, thinness, tnd weight loss. ‘Most young women maintain their body weigh without starving them- selves, habitually purging, or even dieting, In a L-year longitudinal study of the ating and dieting habit of 231 American adolescent gils, medical anthropol- gist Mimi Nichter and colleagues (1998) showed that most of the subjects ‘hsimained their weight by watching what they eat and trying to follow a healthful Tiestyle rather than taking more extreme measures, Anthropological studies ‘such as this are important because clinicians are not as interested in what the healthy population is doing, and they help to provide biocultural context for the expression of disease. ‘THE EVOLUTIONARY APPROACH Biological anthropologists have long looked at disease from an evolutionary perspective In the 1990s, Randolph Nesse and George C. Williams (1994) coined She term evolutionary medicine to describe a “Dacwisian approach” co under- anding disease, Nesse and Williams argued that the evolusonary perspective provides several insights into the expression of disease. + Defenses versus defects. Every disease produces certain signs and symptoms. A dlefect results from the dseare proces itself, whereas a defense is apart of the body's sttempt ta fight the disease. For example, a fairskinned person with [pneumonia may have a cough and darkening skin color. The darkening skin olor isa defect, caused by the face that che person's hemoglobin isnot carry~ ing sufficient oxygen, The cough isa defense—an adaptation—that evolved 25 2 mechanism fo eject infectious material from the theoat and lungs. + Infection and “arms races.” The environments filled with infections agents ot pathogens, suchas bacteria and viruses. As ous bodies evolve defenses co fight them, they 100 are evolving to combat our defenses. A familar example isthe tvolution of antibionc resetance in bacteria, Anibiocs were fst introduced in the 1930s. By 1944, some strains of staphylococcal bacteria were showing signs of resistance to pencil, and today 95% are pencilin resistant. As a resule we have fo use other antibodies to fight them. «+ Environmental mismatch, Human bodies did not evolve wo deal with most aspects cof modern life, inclading fatty ces, low reproductive ates, and nose. Thus cer fain diseases may be considered ro be the result, in whole or prt ofthe mismatch ‘between our bodies, adapted for life ina hunter-gatherer enviscnment, andl con- temporary environments. We will discuss examples ofthese diseases ater inthe chapres + Pleotropic gone effects. We have many genes or alleles that probably didnot lead to adaptations in past environments but were simply harmless. However, in modern environients these genes may be expressed in new ways. For example, tecause we now live longs, we have to deal with genes that cause diseases sch a5 Alcheimer disease and cancer, which ate rypcaly expressed only in old age. «+ Design compromises, A classic example of an evolutionary design compromise Jeading to human suffering is back pain. The S-shaped spine we evolved in order to walk upright clearly predisposes ts to developing back pain (Fgure 16.4). Ths Shape, combined with a sedentary lifestyle, causes $0 to 60% ofall people in industrialized society to suffer from lower back pain at some point in their lives (Anderson, 1999), Biomedical anthropology sits a the intersection of evolutionary nd biocultural approaches to health and illness, A central concept of biomedical anthropology is CChaptor 16 + Biomedieal Anthropology an adaptation. As we have discussed in previous chapters, an adaptation is a feature ‘or behavior that serves over the long term to enhance fitness in an evolutionary sense. But we can also look at adapration in the short term; this is known as ‘adaptability (see Chapter 5). A basic question biomedical anthropologists try t0 answer is, To what extent i adaptability itself an adaptation? The life history ‘tages that all people go through have been shaped by natural selection, but out biology must be flexible enough to cope withthe different environmental chal- lenges we wil face over a lifetime. Birth, Growth, and Aging Allanimals go through the processes of birth, growth, and aging. Normal growth land development are not medical problems per se, but the process of growth isa sensitive overall indicator of health status (Tanes, 1990). Therefore, seudies of srowth and development in children provide useful insights into the nutritional fenvicoamental health of populations. HUMAN CHILDBIRTH "Nothing should be more natural than giving birth, Afterall, he survival of the species depends on i. However, in industrialized socesies birth usally occurs in Forptals. Of che more shan 4 milion bist in the United Seates in 2000, more than 90% occurred in horpitale; in 2001, 24.49% of all births were Cesarean deliveries (MacDorman et al, 2002). in 1900, only $% of US. births occurred in a hospital (Werez Ge Wertz, 1989). At that rime, given the high risk of contracting an unveatable infection, hospitals were seen as poteatially dangerous places to aie birth Human females are not chat much larger than chimpanzee fermales, yet they ive birth to infants whose brains are nearly as large asthe brain of an adult chi panzee and whose heads are very large compared with th size of the mother’s pelvis (Teevathan, 1999). The easiest evolutionary solution to this problem would be for women to have evolved larger pelves, but too large a pelvis would reduce bipedal efficiency. Wenda Trevathan points ot that the shape as well as the size ofthe pelvis is a critical factor inthe delivery ofa child. Not only is there a tight fic between the size of the newborn's head and the mother’s pelves, bu the baby'= Ihead and body must rorate or rwist as they passthrough the birth canal, which is 4 process that introduces other dangers (such as the umbilical cord wrapping round the baby’s neck). In contrast to humans, bicth is easy inthe great apes. ‘Their peves are substacially larger relative to neonatal brain siz, and the shape of theie quadeupedal pelves allows a mote direct passage ofthe newborn through the birth canal (Figure 16.5 on page 472) In traditional culrares, woren usually give birth with assistance from a midwife [almost always a woman). Trevathan (1999) observes that although ‘women vary across cultures in thle reactions tothe onset of labor, in almost all cases, the ceaction is emotion-charged and sesults in the mother seeking assis tance from others. She hypothesizes that this behavior isa bioculeural adapra- tion. A human birch is much more likely to be succesful if someone is pretent to assist the mother in delivery. Part ofthe assistance isin actually supporting the newborn through multiple contractions as it passes through th birth canal, ‘bur much recent research has shown thatthe emotional support of mothers pro- vided by birth asiscants i also of critical importance (Klaus € Kennel, 1997) Such emotional support often is lacking in contemporary hospital deliveries, although there har been some effort in recent years to remedy ths situation (Figuce 16.6 on page 472), Soom (Sslomons Ncoceys 4 laments) the eoiton of Boesay rales mans hig susepuibe co bck ‘nr an pan The term “medicaliza tion" is used to describe the process whereby a condition, such a pregnancy, once not considered to be of clinical interest, becomes the target of medical ‘treatment. 472 Part + New Frontiers in Biological Anthropology suxology Thesenceofharan [owh and developmen FIGURE 165 Compared to ching, th hun newtor ae ae rom to spare asc pses though te Bir cana PATTERNS OF HUMAN GROWTH ‘The study of human growth and development is known as auxology. All animals go through stages of grovith that are under some degree of genetic control Floweven the processes of growth and development can be acutely sensitive to ‘environmental conditions. Thus patterns of growth that emerge under different ‘environmental conditions can provide us wit clear examples of biological plasticity (Mascie-Taylor 8 Bogin, 1995) (se Chapter 5) ‘Looking at himan growth, we can imagine an optimal environment in which an individual will reach his or her geneic potential. Howeves, mast environments fate not optimal. We can view growth responses to nonoptimal environments in twa differene ways (Schell, 1995]. The anthsopological model views the way [humans grow in high-stess environments {with a lack of food, heavy infectious disease load, and polucion) in che context of nongenti adaptation, or adaptability. ‘Growth patterns are responses to environmental conditions, which may actually ‘enhance survival, On the other hand, the medical approach assumes that any FIGURE 166 Women ging brn ado cute mal rece ap bem ‘She monn ormiwhesMdfeasied Beare ab cong heey ‘omer hosp sings (Chapter 16 + Biomedical Antropology 47 Aeetinyean) FIGURE 16.7. irene pres of he bay mature ferent, Gener refers tote body a whale: the major organ tens (nonreproducie murda bod volume. deviation from optimal growth patterns i evidence of ill health, The biomedical “anthropological approach incosporates both these perspectives ‘We char growth and development using several different measures including height, weight, nd head circumference. Cognitive skills, such as thore governing the development of language, also appear it a typical sequence 2s the child manures, ‘We can also assess age by looking at dentition or sexual reprodsetive capacity Different pars ofthe body marure at different rates (Figure 16.7). For example, « neatly adult brain sie is achieved very early, whereas physical and reproductive ‘maturation all come later in childhood and adolescence STAGES OF HUMAN GROWTH In the 19605, Adolph Schultz (1969) proposed a model of growth in primates that incorporated four stages shared by all primates (Figure 16.8 on page 474). In general as lifespan increases across primate species, each stage of growth increases in length as wel, ‘The Prenatal or Gestational Stage The frst stage of grow isthe prenatal or gestational stage, This begins with conception and ends with the bith of the new- born. As indicated in Figure 16.8 on page 474, gestational length increases across primates with increasing lifespan but is not simply a function af larger body size. Gibbons havea 30-week gestation, compared with the approximatsiy25-week ges tation of beboons, even though they are much smaller, Growth during the pee. natal period is extraordinarily rapid. Is humans, during the enbryonic stage fst § weeks after conception), the ferlized ovum (0,005 mg) increases in size 275,000 times. During the remainder of the pregnancy (the fetal period), growth continues ata rate of about 90 times the initial weight (the weight atthe end ofthe emabey- ‘nie stage) per week, to reach 2 normal birth weight of about 3,200 g ‘Although proteced by the mother both physically and by ber immune system, the developing embryo and fetus are highly susceptible to the effects of some substance in their environment. Substances that cause birth defects or abnormal development ofthe ferus are known as teratogens. The most common human teratogenis alcohol. Fetal alcohol syndrome (FAS) isa condition seen in children ‘that results from “excessive” crinking of aloahol by the mother during pregnancy. At this polar, iris nor exactly clear what the threshold for excesive drinking is or terstogens Subrance ha ie ies dtc or other sonora {he delosng embryo or us arg preaney a4 Part + New Frontiers in Blological Anthropology prea prnd ‘oie ced oie pried satpeiod fence | ‘reproductive period ni Gitbon — Chinpansse ‘4 FIGURE 16.8 The four sags fe expressed ne eee primates Now tat [eso igh ness wis erased le pan ae he ag poroeprodueive (fel) lesan otserved humans btn note pats whether binge drinking oa prolonged low level of drinking i worse forthe fetus {Thackray 8 Tile, 2001). Nonetheless cs clear that heavy maternal drinking can lea t the development of characeric fail slormalties end behavioral ‘problems in children. lis estimated thar between 0. and 5 in 1,000 children have {ome form of aleobol-zlated birth defece, ‘Although they are not teratogens, other substances in the envionment may tfc the developing feta. Polutants sucha ead ane polyclosnaed biphenyls ‘may cause low birth weight and other abnormalities. Excessive aoise inthe envi ronment has been conclusively linked ro reduced prenatal growth (Schell, 1991), Infancy, Juvenile Stage Adolescence, and Adulthood Schultz defined the three stages of growth following breh—infancy, juvenile stage, and adulthood —with ‘Chapee reference tothe appearance of permanent ret. Infancy lass from bith until the appearance ofthe fst permanent tooth In humans, this footh usally ithe lower fis molas and t appears around 5 or 6 years of age. The juvenile stage bens at his pone and lass unl he eruption of he lst permanent od the hid prerolay, which can occur aywhere between 15 and 25 years of age, Adulthood folows the appearance ofthe las permanent oot “Tooth eruption peters provide usu landmazks for looking a stages of growth across ferent spares of primates, but they donot tll the whole try. Besides tcngh of sages, there is much variation inthe paterns of groweh and development in primate apcis. Barry Bogin (1999) sugges tha he fourstage mode! of po mate growth is too sple and does aor reflex puters of growth thet may” be Unigue to humans. fn paricalaz he argues chat ig humans the juve stage docs not take us al the way to adulthood. Intend we have an addtional cet stage, ‘edolesconce, when a growth spar that reflects species specific adaptation cure. ‘The length ofthe juvenile stage, most of which oecuts after bean ss has reached adule proportions, varies widely among mammal species. There ta cos (0 4 prolonged juvenile age because delays the onset of fll sexual maturity andthe bility to reproduce. But the juvenile stage is also necessary 26a raining period dri which youngee animals can learn their adult roles andthe socal behaviors necessary to susive and reprodce withia her own species. The evolutionay cos of delaying maturation ate offset by the benefit of socal ie. Among mammal che juvenile stages longest in hihly social animals, suchas wolves ad primates. Togin places the ed ofthe ave perody and the beginning of adolescence, at she onset of puberty, The word puberty literally refers to the appearance of bic hae bua a mater of growth refers more comprehensively eo the period dhring which there rapid growth and maturation ofthe body (Taney 1990), The age at which puberty occur is semendously variable bot within and berween ‘Populations and even within an individual, ferent pars of dhe body may mare diferent ates and ines, Pobery tends os ener inl than it doesn boys {a induselized societies, alent all ehilden go though pubery berween the get ‘of 10 and 14 years (Figure 16.8). During adolescence, maturation ofthe primary land secondary seal characteristics comin. In aiton, there isan adolescent sreuth spurt. According to Bogin (1993, 1999), the expanding database on primate Maturation patterns indicates tht the adolescent growth spurt—and therefore {Mlolecence=i mos pronounced in humans 2 206 18 180 1 Bu ty Eu wo = Fro ~ : thi oy |" 3° eee Zé Ea 4 ® * M ° “ oa eee Me em 2 Agelnyert FIGURE 16.7 The adsescen growth spr in hurr i ean a "bar! [ne hag cre snza spa” nebe ape vocey ce. 16 + Biometel Anthropology as 416 V+ New Frontiers in jological Anthropology ‘Why do we need adolescence? Humans ate theultimate social animal, Bogin argues thatthe complex social and cultural life of humans, mediated by language, requires an adolescence, which isan extended period of social learning and devel. ‘opment. In support of the view that adolescence isa period necessary for social learning, recent research on human brain growth has demonstrated that although approximate adult brain size is eached around 6 or 7 years of age, there is also an adolescent period of growth inthe gray matter (neurons) of some parts of the brain, ncloding the frontal and parietal lobes (Giedd etal, 1999, Sowell ctl, 1995). ‘These are both areas substantially devoted to higher brain functions (ch as dec sion making). Thus, the uniquely human adolesoent growth spurt includes the brain. ‘THE SECULARTREND IN GROWTH One of the mos stcking changes in paterns of growth identified by auxologists isthe secular trend in growth. By using data collected as long ago as the eighteenth ‘century, they demonstrated that in industrialized countries, children have been {growing larger and maturing moze rapidly with each passing decade, stating in the lave nineteenth cerry in Europe and Nosth Ameria (Figure 16.10). The secular trend started in Japan after Woeld War I, and itis just beng initiated now in parts ofthe developing world. In Europe and North America, since 1900, children at 5 to 7 years of age averaged an increase in stature of Ito 2cm per decade (Tannes, 41990}. In Japan between 1950 and 1970, the increase was 3 em per decade in ‘-yeasolds and 5 em per decade in 12-year-old, 3 secular cred in growth undoubtedly isa result of beter autrition (more ‘calories and protein inthe diet) and a reduction in the impact of diseases during infancy and childhood. We find evidence forthe over the shor term fom migration studies, which have showin thar changes inthe envizonment (from ales healthful toa more healthful environment) can lead to the development of a secular tend in growth. Migration studies look at a cohort of the childeen of migrants bora and raised in their new country and compare their growth with ether their parents’ growth ff the children have reached adulthood) ofthat ofa cohort of children in the ‘country from which they immigrated. Recent migration studies of Mayan reagees fom Guatemala tothe United States show evidence ofa secular tend in growth (Gogin, 1995). Mayan children raised in California and Florida were on average 5.5 em taller and 4,7 kg heavier than their counterparts in Guatemala, 1B, ca 8, one v9 a ve a va TB) ‘4, 1) "= Fro $ 1a ra “ 1 ve no no Tevioinsiavisieie 78 PUIaIMIsTEITIS ce “ae FIGURE 16.10. The scr werdingroweh a mesures in Soa 2) ne) boys ewan 1889 ana 968 (Chapter 16 + Biomedial Anthropology ATT Peet menarche fo yoo) 12 ‘eso 185016801900. _1929 1940 19601960] Yeor FIGURE 16.11 The cectnng age of marurche ovr the ps 80 yer a been ‘esi in ary European cong has ko ae ober more rece Incewioing cours ‘The secular trend in growth in industialized societies has been so pervasive that Jt tends to obscure variation within populations eaused by socioeconomic factors (Tannes, 1990), However, we can measure the effect of the economy on child srowth in some locales. Deborah Crooks (1999) looked atthe growth of children ‘a rural, eastern Kentucky county at the edge of the Appalachian Mountains where 33% ofthe children lve below the poverty level. Crooks found mild but persistent parterns of shor stature among the chilen, with 21.7% of them having 2 stature below the fifteenth percentile ofa broader USS. sample. Among gil “stunted growth" was about fice as common inthis county ax elsewhere in the United States (9.1% versus 3%) ‘Although the secular trend in growth appears to highlight a streightforward relationship between increased stature and industialization, the stature each individual achieves is the result ofthe complex interaction of genetics, economic staras, and nuteiion MENARCHE AND MENOPAUSE Another hallmark of the secular trend in growth is a decrease in the age of ‘menarche—a git’ frst menstrual period—seen throughout the industrialized ‘world. From the 18506 until the 1970s, the average age of menarche in European and North American populations dropped from around 16 0 17 years to 12t0 13 years (Figure 16.11) (Tanner, 1990; Coleman 8 Coleman, 2002). A recent comprehensive stady of US. gitls (sample sizeof 17,077) found thatthe age of ‘menarche was 12.9 years for White gels and 12,2 years for Black girls (Heeman- Giddens etal. 1997). This doesnot reflec a substantial drop in age of menarche since the 1960s Tn cultures undergoing rapid modernization, changes in the age of menarche hhave ben measured over shore periods of time. Amoag the Bundi of highland Papua New Guinea, age of menarche dropped from 18.0 years inthe mid-1960s to 15.8 years for urban Bundi gi inthe mid-1980s (Worthman, 1939). Over the long term, the rate of decrease in age of menarche in most ofthe population was inthe ange 0.3 100.6 years per decade. For urban Bund girs che rate is 129 years per decade, which may be a measure ofthe rapid pace of modernization inthis society "Menarche marks the beginning of the reproductive life of women, whereas ‘menopause marks ics end, Menopause is che irreversible cessation of frtity that menarche The one fag Ee mertnal prod imenepeane Ta pero 478 Part + New Frontiers in Biological Anthropology snescence Ageresced dcinein ‘logs or bohwsrsl ceo ie ‘occurs in all women before the rest of the body shows other signs of advanced Aging (Pecos, 20014). Returning to Figure 16.8, noe tat of ll he primate species illestrated, ony in humane doce a significant part ofthe lifespan extend beyond the female reproduerive years In fact, as far as we kaow, humans are unigue in hhaving menopause (with the excepto of a species of pilot whale). Menopause thas occurred inthe human species for as long as recorded history (es mentioned inthe Bible), and there it no reason to doubt that i has characterized older human females since the davin of Homo sapiens. Although highly variable, menopause usually ocurs around the age of SO years. "Menopause occurs when women run out of eggs for ovulation All the eas a human female will ever have are produced during the fifth month of gestation, ‘These eggs are in a azcested stage of meiosis and are known as oocytes. At birth 4 girl bas 2 million oocytes in her ovaries, but that number drops £0 400,000 at puberty, Over the course of her fete, a woman ovulates only about 400 macure age. The rest ofthe eggs are lost through programmed cell death or anresia. If bhuman females maintained the eat of atresia they have for most oftheir adult life, they would have enough cocytes to last unt they were 70 years old. However, the rate ofatesia increases searing at age 40, with menopause resulting by about the age of $0. There is no strong evidence thatthe secular tend in growth has influenced the age of menopause in any way (Peece, 2001b). ‘Ati glance, menopause looks to bea well-defined, programmed life histo- zy stage. Why does ir occur? Jocelyn Peecei (1995) suggests e combination of fac- {ors including adaptation, physiological eadeotf, and an artifact ofthe extended Jnaman life span, Some adaptive models focus on che potential fess benefits of having older women around o help thei daughters raise ther children, termed the grandmothering bypothesis (Hill & Hurtado, 1991). Kristen Hawkes (2003) ‘Proposes thar menopause isthe most prominent aspect ofa unigue human pattern ‘6f longevity and that this pater has been shaped largely bythe inclusive fitness benefits derived by postmenopausal grandmathers who contibute to the care of thee grandchildcen In support ofthis idea, a recent study af Finish and Canadian historical records indicavee that women who had long postzeproductive lives had greater lifetime reproductive success (Labdenpers etal, 2004), Pecei suggests that an alternative co the grandmothering hypothesis may be more plausible: the ‘mothering hypothesis. Ske argues thatthe postreproductive life span of women allows them to devote greater resources to the (slowly maturing) children they Already have and that thie factor alone could account forthe evoition of menopause. AGING (Compared with almos al cher animal species, hamans live a long time, at east ‘measured by maximum ife span potential (approximately 120 years) But he human body begins to age, of undergo senescence, stating at « much younger age. Many bodily processes actualy stare to decline in function starting at age 20, although the eclne becomes much steeper searing berween the ages of 40 and $0 (Figure 16.12). ‘The physical and mental changes asociated with aging are sumerous and well known, either dtetly or indirectly, to most of us (Sehul& Salthous, 1999). ‘Why do we age? We can answer from both the physiological and che evohi sionary standpoints (Figure 16.13). rom a physiological perspective, several by potheses ar models of aging have been offered (Nesse & Willams, 1984; Schulz be Salthouse, 1999), Some have focused on DNA, with the idea that over the lifetime, the accumulated damage to DNA, in the form of mutations caused by radiation and other forces, leads to poor cell funetion and ukimately cell death, Higher lev- tls of DNA repair enzymes are found in longe-lived species s0 there may be some ‘validity to this hypothesis, alshough in general che DNA molecule is quite stable. Sup- port for the DNA damage theory of aging comes from a rae (1 in 10 milion peo- ple) autosomal recessive disorder known as Werner syndrome (Kirkwood, 2002) Chapter 16 + BlomedialAntropology 479. Pecanioge physical non FIGURE 16.12. Theefocs of sng canbe sen in he dein nfancion of may plage star. [When hey are young, people with this condition suffer from a variety of ailments ‘that ae common in the elderly (such as cataracts and osteoporosis). Wemmet syn drome i caused by an abnormal form ofthe enzyme helicase, which unwinds DNA ‘during replication, repais, and gene expression. Tis disease provides evidence that accumolating DNA etrors can cause aging. ‘Another model of aging focuses on the damage that free radicals can do to the tissues ofthe body (Finkel 8¢ Holbrook, 2000). Free radicals are molecules that contain at least one unpaired electron. They can link to other malectles in tissues and thereby cause damage to those tissues. Oxygen fre radials, which FIGURE 16.13 Pyles and ecutonary eos Og 480 Pare + New Frontiers in Biological Anthropology | Research on rats and ‘monkeys shows that @ restricted diet with 30% fewer calories slows the | oping process and Inereases longevity. result from the process of oxidation (as the body converts oxygen into energy), fre thought tobe the main cup for eausng the bodily changes associated with ‘ging. Antioxidants, such as Vitamins C and E, may reduce the effects of free fadicl, although its no clear yet whether they slow the aging proces. Further trvidence forthe free radical theory of aging comes from diseases in which the prodietion ofthe body's own antioxidants i severely limited. These diseases seem fomimic or accelerate che aging process. For example an enzyme called superoxide Usmurase (SOD) isan antioxidant usually produced by our bodies, People who Go rnot make this enzyme (they are homozygous for an abnormal SOD gene) devel- ‘pa fall form of the degenerative nerve disease amyotrophic lateral sclerosis (ou Gehrigs disease), Both che DNA and fre radical models of aging emphasize thatthe damage caused by these processes accumulates over the lifetime, ‘In wild popalations, aging s nota major contaibutor ro mortality: Most animals die of something other than old age, as humans did before the modern age. Thus fing pee se could not have been an adaptation inthe past because i occurred s0 ‘ely in the natural world (Kirkwood, 2002). Two nonadapeive evolutionary mod tls of aging are che disposable soma hypothesis (Kiskwood 8 Austad, 2000) and the pleioeropic ene hypothesis (Wiliams, 1957; Ness 8 Wiliams, 1994). Boch take the position that old organisms ate not as evolutionarily important as young organ sms, The disposable soma theory posts hat ies more efficient for an organism to devote resources to reproduction father than to maintenance ofa body. After al, evens body in perfect shape can sil be Killed by an accident, predator, or disease. ‘Therefore, organisms are beter off devoting resources to geting their genes into the next generation rather than fighting the physiological ide of aging. “The pleiotropic gene theary has a simila loi, although it comes atthe prob- Jem frm diferear angle. Ple‘otropy refers othe fact that most genes have mul tiple phenotypic effets (see Chapter 3) For all organisms, the effecrs of natural dection ate more pronounced based on the phenotypic effees ofthe genes dur~ ing the carliest rather than later phases of reproductive life. The simple reason for ‘thi is that a much higher proportion of organisms ive long enough to reach the tarly reproductive phate than do the proportion who survive until the late repro- ‘tive phase. For example, imagine that 2 gee for calcium metabolism helps a younger animal heal more quickly from wounds and thus increase its fertity {Nese & Willams, 1994). A pleiotropic effect ofthat same gene in an older animal night be the development of ealcium deposits and heart disease; this “aged” effect. hn litte influence on the lifetime fess ofthe animal. Aging itself may be eaused by the cumulative actions of pleiotropic genes that were selected for their pheno- typic effects in younger bodies but have negative effects as che body ages. A key point ofthe pleiotropic mode of aging is that you cannot select against senescence Eecause the effects of natural selection are always more pronounced ealir eather than later in he lifespan. Infectious Disease and Biocultural Evolution ‘Our bodies provide the living and reproductive envizonment for a wide variety of viruses, bacteria, single-celled eukaryotic parasites, and more biologically complex parasites, such as worms, As we evolve defenses to combat these disease-causing ‘Organisms, they in turn are evolving ways to get around our defenses, Understand: ing the neture ofthis arm ace and che environments in which i is played out may be eitial to developing more effective treatments inthe future. Infectious dteares are those in which a biological agent, or pathogen, para- sitives or infects @ host. Human health is affected by avast acray of pathogens ‘These pathogens usually are classified taxonomically (such as bacteria or viruses), by thelr mode of transmission (rach at sexually transmitted, airborne, or water- ‘bore), ot by the organ systems they affect (such as respiratory infections, encephali- tis, or “food poisoning” forthe digestive trace). Pathogens vary tremendously in ‘Chapter 16 + Biomedical Antropolory 481 ‘their survival strategies. Some pathogens can survive only when they are in s host, ‘whereas others can persis for long periods of time outside a host, Some pathogens live exclusively within a single host species, whereas others can infect muleple species for may even depend on diferent species at different points in their life cyl, HUMAN BEHAVIOR AND THE SPREAD OF INFECTIOUS DISEASE Human behavir is one ofthe critical factors in the spread of infectious disease, “Actions we take every day influence our exposure to infectious agents and deter mine which of them may or may not be able to enter our bodies and cause an illness. Food preparation practices, sanitary habits, sex practices, whether one spends ime in proximity to large numbers of adults or children-~all these can influence a person's chances of contracting an infectious disease. Another critical factor that influences suscepiblity eo infectious disease is overall nutritional health and well-being. People weakened by food shortage starvation, or another disease (euch ax cancer) ace especially vulnerable to infectious illness (Figure 16.14). OF course, it works both ways. Some studies indicate that children in areas where the parasidc worm Ascaris is common show improved nutritional tus after receiving, ‘medication to teat the infection, even without changes in diet (Mascie-Taylos, 1993, Brown & Gilman, 1986), Just a individoal habits play an important role inthe spread of infectious disease, so can widespread cultural practices. Sharing a communion cup has been linked tothe spread of bacterial infection, as has the sharing of a water source for ritual washing before prayer in poor Muslim countries (Massie Taylor, 1993). CCltucal biases agninst homosexsality nd the open discussion of sexuality gave shape tothe entie AIDS epidemic, from its initial appearance in gay communities to delays by leaders in acknowledging the disease as a serious public health problem. A facinating example ofthe influence of cultural practices on the spread ‘5f an infectious disease involves « condition known as ker (ee Insights and Ad> ‘vances: Kuru, Cannibalism, and Prion Diseases on page 483) Agriculture Agricultural populations are not necessarily more vulnerable to infecrious disease than hunter-gatherer populations. However, by virtue of their larger population size, agriculeeral popalaions are likely to play host to all the diseases that affect hunter-gatherer populations and others chat canbe maintained ‘only i larger populations. This isthe basis ofthe first epidemiological transition iscusedeali. For example, when a child is exposed to measles, his or her immune system takes about 2 weeks to develop effective antibodies to fight the disease. ‘This means that in order to be maintained ina population, the measles virus needs to find a new host every 2 weeks in other words, there must be a pool of twenty-six new chileen available over the course of a year to host the measles virus. This is possible in a large agricultural population but almost impossible in a much smaller ‘hunter-gatherer population (Figure 16.15 on page 482) ‘Another difference between agricultural and nonagricultural populations is ‘hac the former tend tobe sedentary, whereas the later tend tobe nomadic. Large, sedentary agricultural populations thecefore are more susceptible to diseases that ace tansmirted by contact with human waste products, which include a variety of bacterial diseases and parasitic worm, In addition, many diseases ate carted by ‘rate, and agricultural population are far more dependent on «Limited number Of water sources than nonagriultural populations. Finally, agricultural popula- Sons often have domestic animals and also play host toa variety of comimensal animals, such a rt, all of which ae potential carvers of diseases that may affect humane Specific agricultural practices may change the environment and encoura spread of such infectious diseases a sickle cell end malaria. Slash-and-burn agri caluze lead to more open forests and stending pools of stagnant water Such pools FIGURE 16.14 A chid arg ‘fom rir ne of est oman eden nace cones 482 Pare + New Frontiers in Biological Anthropology FIGURE 16:15 Risks ofvfecious dos eres in) hih-ensy arctrlpopuasons Compared 0) lower, persed ter -aterer popu, ace an ideal breeding ground fo the mosquitoes that carry the protozoa that cause talara, Agriculture that makes extensive use of irigaton and water damming brings people into contace with large flatworms of the genus Schistoma. These flatworms cause a disease known as schictosomiace, which soften characterized by blood inthe urine. Scistoae species have an exteaoeinary lifecycle chat involves several dstincr stage lived both inside and oursde ts two hosts: humans and a particular snail species, Schistosomiasis can damage the bladder, kidney, ive, Splee, and intestines. The World Health Organization estimates tht 200 mllion people may be infected with the parasite and chat 200,000 die annually from is ffees (Figure 16.16) Mobility and Migration The human species is characterized by is mobility: One price of this mobility hae been the transmission of infectious agents from one population to another, leading to uncontrolled outbreaks of disease in the popu Fons that have never been exposed tothe newly introduced diseases, “The Black Death in Europe (1348-1350) i one example of ust such an out break (Figure 16,17 on page 484). The “Black Death” was bubonic plague, a disease caused bythe haterium Yersinia pests. The bacterium is transmitted bythe rat flea, ‘which lives om rats, When the leas run out of rodent host, they move to other ‘manuals, such as hurnans. The bacteria can quickly overwhelm the body, causing {wollen lymph nodes (or buboes, hence the name) and in more severe cases lead ‘infetion ofthe respiratory sytem and blood, Itcan kl very quickly. An outbreak bf bubonic plague was recorded in China inthe 1330s, and bythe late 1340s it had feached Europe. Ina single alan city, Florence, a contemporary report placed the number dying between March and October 1348 at 96,000, By the end ofthe «epidemic, ne third of Europeans (25-40 milion) had been killed, and the economic fd culeral life of Europe was forever changed. Similae devastation awaited the native peoples ofthe New World after 1492 with the arival of European explorers and colonists, Measles, smallpox, influenza, ‘whooping cough, and sexually transmuted diseases exacted a huge toll on naive pop ‘lations throughout North and South America, the sland Pacific, and Australia. Some ‘populations were completly wiped ou, and others had such severe and rapid pop Tasion depletion tha cei cultures were destroyed. In Nocth America, for example, many communities of native peoples lost upto 90% of thee population through the inrroduetion of European diseares Pritaket 2000), Infectious diseases often reached CGURE 16.16 “Two cre wid native communities before the explorers or colonizers di, giving the impression that seam North America was an open and pristine land waiting tobe fled 7D) mol tees ing res (ocr ctora paces con gto be rat fe ous dete hte eae far 3 dese tht vee afc meas ofthe Fore {ibe gan! Now Gunn (Caen 8 Zp 957 Gol, 80) Rare ep rive neuroma order tha a ‘ance rom amore nthe a ae {Soa parr or the gte ets ye {are abv change echo recon ys sara nthe ery swe emary.and by miss Bere were more ha 200 ew cea yr spearig tr popdaion Fons 2000 nde Oe Se oan le ede proxy 3000 poole rly aa han are Serfin fore pup or one {ome warAtus trex garters fh fi were women wh ren oming be rere ropa acaae Ky ened pean fn teat Soup ob 8 gree disease. Scene venation ef far INSIGHTS > ADVANCES Kuru, Cannibalism, and Prion Diseases (Chapter 16 + Biomed Anthropology sarcd in he te 19505, whieh wat about thesare emear nese tat andane ris tlznced_polymorpham was beng ‘worked eve Therefore not uring sone vector sige ar wt tls bong mained ses anced py ‘morphism of om une Thy were shown {5 be wrong however whan Cveton Caf Aiek and coenges (196) demonstrated ‘fecha coud uamlaryte cpa by necting them wih text rom ru ti. ‘Wie now know that ar i pron tere, one of iy of dene the ect the tenes of ere bra ening to both ‘muvee degrarion ad harsh ormalis (ye 2002 They ae eo Called tremble. spongforn en ephlopthy [TSE] sete ane prcily bran tase The enact ncn fee protein al nro Prion dese cin be erat A mute verso OFT asain sch [hl nsorm), and sponaneous mutations Inthe pion gee a alo» sor ext, However th sng ig about pron da cases hat tay ar aa commonest 1 person wih a aermal pron protin s ‘pote oh abnormal Gzeate-cing rin prot abnormal prion procin {anton eaafrmaton Othe mora protic he duets orang {the demlopnent of aTSE dene Une sible reou age hac rene wi Karu i he Fore people potably can be tced beck tos muon trot {he pion ee of pein ning someting atcheand ofthe ritaaent canary Bat ‘nox wpreadthrough he popuadon aa geneve deze woul hve nies, the fanemiion of karyin the Fore was ‘uted simon ental by sisal eal Is underesten arng fre ries sul I by resiver of be cand Such res ster simore nye drcied by women he canals was conared eo be the women domain Young sheen se fompanying heir mothers tnd ees tives alo consumed human fash (Ge youngest kru vii recorded ws 4 yar (3a) Ainegh ter groupe ing nee Fore ko praciced ual cenilon he

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