Nine month pregnant woman mid-pose with a sword

Pregnant warrior by dizznbonn.

Academic journals often solicit book reviews from faculty. Faculty get a publication and a free book out of it, so it's especially worth it for those of us clawing our way up the tenure track. Last year I reviewed Wenda Trevathan's Ancient Bodies, Modern Lives: How Evolution has Shaped Women's Health, and the issue finally came out yesterday (if you cannot access the issue for free and want to read my review, it is legal to email the author of the article for a copy. Hint, hint).

Overall, I loved the book, and think it's great for anyone with an interest in women's health or evolutionary medicine. So yes, I think you should buy it.

But Trevathan was provocative in a few places. In particular, Trevathan uses the terms health-rich and health-poor to describe populations, when the more common terms are often industrial and traditional, or western and non-western. Recently, I have even seen some populations referred to as post-industrial, since what many people are doing in places like the US are now different from industry and manufacturing.

There are some good reasons to try and make these distinctions between human populations. People who live as foragers, as agriculturalists, people who live in rural areas and in cities all get their food differently (hunting it, growing it, or buying it) and this has a profound impact on lifestyle. Many people think that understanding the different lifestyles and health of people who live differently will help us understand some of the big questions of human evolution. What selection pressures led to humans putting on fat as easily as we do? How is it that we can survive on just about any diet? How much physical activity was normal for early humans?

Making these distinctions also help those of us in countries like the United States figure out why we are seeing an increase in some health problems, like diabetes, obesity, cardiovascular disease and cancer. Making comparisons between those of us whose work consists of typing at a computer, harvesting barley or slowly stalking a giraffe help us understand modern diseases better than saying that Americans eat too much. There is something about the transition to sedentary jobs, to energy dense foods, something about the huge changes in the composition of our diets and how we live from day to day that needs to be better understood. And then we need to figure out what changes we could realistically implement in our society to change our health.

But are these the right distinctions to make? Trevathan is referring in part to access to health care when she uses terms health-rich and health-poor. But are Americans health-rich? We do a good job with childhood illness, with vaccinations, and with treatable or preventable illness, and with sanitation and clean water. We certainly have a lot that we take for granted.

But we have a high rate of premature babies, low birth weight babies, birth complications and maternal and infant mortality compared to other developed nations, not to mention the other health concerns I described above. So among the health-rich nations, if we were to use Trevathan's terms, we are health-poor when it comes to maternal and metabolic health.

I also can't help but think of how heterogeneous, or variable, health and health access is within the United States. Many low income women get little to no prenatal care. Race is a major determinant not only of access to health care, but health problems, homicide, addiction and other issues, based on discrimination and internalized racism.

It doesn’t make sense to put all the blame on Trevathan’s terms. Post-industrial/industrial/traditional have their own sets of problems, as do western/non-western. Trevathan is simply trying to find a better terms for the same old categories. So how do we define these different populations? And can we find better words for them?

Part of the point of anthropology is to try and understand the causes and consequences of human variation. One of the problems here is that we are trying to bin all human kind into only two or three categories. Where do we draw the line, and how do we draw it? Because wherever it gets drawn we'll have to be comfortable with the variation we are ignoring in order to do it. If we bin people into any of these groupings, are we just making the best of a bad situation, relying too much on old dichotomies, or doing our field a disservice?

What kind of terms do you think we should use? What would be the more appropriate way for us to understand how different populations end up with different health profiles? And when we use these terms, what are the implications for how we do research and outreach?