Many of the diseases that afflict us did not arrive from outside human society — they arose in tandem with what humans were doing. This lecture covers sections 15.1 and 15.2 of chapter 15, “Disease, Health, and Healing,” in The Human Story for Introduction to Anthropology, tracing disease co-evolution, the epidemiological transitions, and the cultural dimensions of illness and healing. It sits in the Cross-Cultural Understanding hub, with the disease-and-environment material connecting to Environmental Engagements. Sections 15.3 and 15.4 — healing systems, biomedicine, and power — are treated at Medical Pluralism.
Key Concepts
- Disease tracks the way people live. Tapeworm came with collaborative hunting; giardia, roundworm, and hookworm with permanent settlement; rabies, brucellosis, and anthrax with domesticated animals; malaria with clearing land for irrigation (436).
- An epidemiological transition is a change through time in a population’s primary diseases and causes of death, tied to a major shift in how people live. The chapter models three: dense urban settlement and industrialization; public health systems, vaccines, and pharmaceuticals; and today’s combination of chronic disease with emerging infections and antibiotic resistance (436–437).
- Most of the great famines have occurred under agriculture, not under hunting and gathering, and monocropping is a problem of displacement: maize was domesticated in what is now Mexico, where hundreds of varieties are eaten with beans — remove it from that context and people develop pellagra while eating enough calories.
- Rising life expectancy is mostly not about old age. If one person dies before age one and another lives to seventy, life expectancy is thirty-five. Vaccination and hygiene for children under two are what moved the number.
- Indigenous Americans lacked more than immunity — they lacked the protocol. European towns had learned to shut down, burn the bridges, and expel the infected; the practice in the Americas was to care for the sick and stay close. Roughly 90% of the Indigenous population would eventually perish, though not all from disease: some were killed and some were worked to death.
- Illness, disease, and sickness are distinct analytical categories: disease is a physiological change that can be classified and treated, illness is the subjective experience of suffering, sickness is the social expectations and roles attached to a condition (440). Stigma and health complete the set.
- We host more nonhuman cells than human cells, some essential to digestion and immune development (438) — we are more social than we are individual.
- Medical anthropologist Janice Morse found iTaukei and Indo-Fijian women and men scaling childbirth pain differently in Fiji (442), and medical anthropologist Lance Gravlee found that racial classification, not measured skin pigment, tracked with blood pressure in Puerto Rico.
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Diseases Co-Evolve With Human Societies
We often think of disease as something that happens to us from the outside. But many diseases are part of a cycle with human culture and society (436). Hunter-gatherers were spread out, without dense settlement, without animals living alongside them, without irrigation — so transmission was limited and something like malaria was not much of a problem.
Then the pattern begins, and each stage adds its own diseases. Tapeworm arrives with collaborative hunting. Giardia, roundworm, and hookworm arrive with permanent settlements. Rabies, brucellosis, and anthrax arrive with domesticated animals. Malaria arrives with clearing land for irrigation, as we saw in the Agricultural Transition. Even clothing and bedding created new habitat for parasitic insects — which is how we know roughly when humans invented clothing, since body lice diverged into a separate species from head lice, a story told at Humans and Other Humans.
This is not an argument that agriculture was a mistake. It is an argument that the things we do have consequences we did not choose, and that those consequences show up in our bodies. Sickle cell trait is the shape of that bargain: an evolutionary response to malaria, and a debilitating condition for those born heterozygous or homozygous.
Sharon DeWitte and the Black Death
The chapter opens with bioarchaeologist Sharon DeWitte, who works with the Museum of London’s collection of medieval skeletons — particularly from East Smithfield, a Black Death burial ground. The plague spread across Europe and adjacent continents between 1347 and 1350, killing 30–50% of people, and was followed by massive religious, economic, and political change.
DeWitte uses ancient DNA to trace the evolution of plague strains, but the finding that matters most for anthropology is social: hunger, malnutrition, and economic inequality shaped who died. A pandemic does not fall evenly on a population. It follows the contours of the society it lands in.
The Monocropping Problem
When people concentrate on one crop and become dependent on it, a failed harvest becomes starvation. Most of the great famines have occurred under systems of agriculture, not under hunting and gathering.
But monocropping is a problem of displacement rather than of the crops themselves. Maize was domesticated in what is now Mexico, where there are still hundreds of varieties, eaten with beans and other locally domesticated foods, and it makes a nutritious diet when grown and combined correctly. The same is true of potatoes in the Andes — hundreds of varieties, prepared many ways. Take the crop out of that context, grow one variety, and stop combining it, and people end up with full bellies and no vitamins. That is what happened to my ancestors in northern Italy, where corn was cheap and easy and eaten without the things it needs to be eaten with.
The pattern continues. We now grow corn for syrup, for nearly all our livestock, and for genetically engineered salmon. And the severe monocropping famines are recent — mostly the last three to five hundred years, consequences of moving crops through colonial and commercial networks, not of the Neolithic.
The Epidemiological Transitions
An epidemiological transition is a change through time in the primary diseases and causes of death within a population, linked to a major transition in how people live. The chapter models three (436–437).
With urbanization around 5,000 years ago came the First Epidemiological Transition: agriculture combined with the first dense settlements and poor sanitation. Influenza, measles, typhoid, smallpox, and tuberculosis all emerge here. These became endemic — maintained over time within particular regions — and they were the big childhood killers for the next five millennia. Diseased teeth belong on the same list: before dentistry, a bad tooth could mean not eating, sepsis, and death.
The second transition came with public health systems, vaccines, and pharmaceuticals. But the success generated its own problems. We got very excited about antibiotics, and overuse — combined with aseptic environments — selects for the hardiest pathogens, which is where infections like MRSA come from. It sets off an evolutionary arms race. People say we cannot see evolution happening; this is exactly that, running against us.
The third transition, ongoing, combines persistent chronic disease with emerging infection and antibiotic resistance, amplified by globalization. The chapter also introduces syndemics — cases where causes of disease interact rather than adding up independently. COVID-19 interacting with widespread existing diabetes produced many additional deaths beyond what either would have caused alone.
Life Expectancy Was Never Mainly About Old Age
This is the most misread number in the history of health. If one person dies before their first birthday and another lives to seventy, life expectancy for that pair is thirty-five. Keep the infant alive and the figure jumps, without anyone living a day longer at the far end.
So when life expectancy rises, it mostly is not because we got better at extending old age. It is because vaccination and better hygiene for children under two suppressed the diseases that were killing them. The First Transition diseases were overwhelmingly childhood killers, and it was simply expected that a parent would lose a child or two.
Vaccination and What Is Currently Being Lost
Most of those diseases are now preventable or controllable with vaccines. That was one of the great public health achievements. But the achievement is reversible, and it is currently reversing.
Measles was declared eliminated in the United States in 2000. In 2026 the country recorded more than 2,300 confirmed cases by late July — surpassing the full-year 2025 total and reaching the highest annual count since 1991, with 93% of cases outbreak-associated and kindergarten MMR coverage at 92.5%, below the 95% threshold for herd immunity. Elimination status is under formal review.
Tuberculosis remains the infectious disease that kills the most people worldwide. It reclaimed that position from COVID-19, and WHO estimates 10.7 million people fell ill and 1.23 million died in 2024. TB can be cured for relatively little money, but global funding for prevention, diagnosis, and treatment reached only $5.9 billion in 2024 against a $22 billion annual target.
These were the big childhood killers, and they had been for 5,000 years. It is a strange moment when the things that killed us 5,000 years ago are coming back.
Colonial Disease Exchange: Immunity Was Not the Whole Story
Starting about 500 years ago, diseases transmitted between continents — overwhelmingly one way, from Europe to the Americas. These emerged from the Eurasian agricultural complex, which combined domesticated animals with domesticated plants. The Americas had extensive plant domestication but few large domesticated animals — no horses or cattle for plowing — so that disease pool had not developed there.
The usual explanation stops at immunity. The lecture’s better point is that Europeans also had a protocol. Centuries of plague had taught them what to do when smallpox comes to town: shut the village down, burn the bridges, keep everyone separated, throw the infected person out and burn their house. Brutal, and learned the hard way. Indigenous Americans had no reason to know any of it, and their own tradition ran the other direction — when someone falls ill, you go to them, care for them, watch them closely. The virtue became the vector.
Roughly 90% of the Indigenous population would eventually perish. Not all of it from disease: some were killed, and some were worked to death. The only disease that possibly traveled the other way is syphilis, and whether it originated in the Americas remains debated.
Modern Disease Pressures
Industrialization brought cancers and toxic exposures — lead among them, in gasoline and in plates and dinnerware for anyone who grew up in the 1970s. It is hard to say precisely what has caused the cancers we see; some of it is simply that more people live long enough to get them, and some of it appears to come from industrial production and the chemicals we use to make and clean things.
Climate change and habitat destruction push people to clear forests and come into closer contact with wild animal populations — probably how HIV reached humans, and most scientists think COVID-19 took a similar route. Ebola and SARS came before it. COVID is now endemic; it will simply be with us. As forests change and animal populations move, more of these jumps should be expected.
And there are the diseases of global labor markets and neoliberalism: depression, diabetes, cardiovascular disease, hypertension. Not absent from earlier societies, but intensified by contemporary stress levels, diets, and the demand to work constantly and move constantly. Many diseases we think of as “natural” are cycling with human activity.
Illness vs. Disease vs. Sickness
These terms seem like synonyms, but anthropology and the other social sciences separate them (440):
- Disease is a physiological change in the body that impairs functioning and can be classified, detected, and targeted for treatment.
- Illness is the subjective experience of suffering, anxiety, fear, and pain — which elicits and needs comfort and care, and which is shaped partly by how much social support a person has.
- Sickness is the social expectations and roles connected to disease and illness, including how the affected person relates to others.
- Stigma is being pushed down or out of society through association with devalued social identities — including those attached to particular diseases.
- Health is a state of well-being marked by the relative absence of disease, illness, sickness, stigma, and suffering — to which it is worth adding positive relationships, since not being sick does not by itself make a person healthy.
The point is not to memorize the terms but to hold the aspects apart. If your culture trains you to look down when elders speak, and a clinician treats eye contact as a diagnostic indicator for autism, you might be misdiagnosed. The parallel is sex and gender: biological characteristics on one side, social expectations on the other, overlapping but not identical.
Sickness is also visible in how societies respond collectively. Isolation, masking, and distancing during COVID-19 were social responses, widely mocked afterward — though for a newly emergent disease they were not far-fetched, and some argue the practices are worth keeping for something as ordinary as flu. Different societies hold different expectations for how people should go through illness.
Diagnosis — labeling a condition by interpreting physiological markers, behavioral patterns, or reported symptoms — can help. A label can trigger support and release someone from expectations they cannot meet. It can also do the opposite. Mental illness is better recognized now and still heavily stigmatized. Leprosy is the older case: poorly understood, intensely stigmatized, and answered with leper colonies.
Lance Gravlee: Racism Gets Under the Skin
Medical anthropologist Lance Gravlee tested a question about race and health in Guayama, Puerto Rico. His team measured skin reflectance directly and compared it against self-identified ethnic classification. Higher blood pressure tracked with the social classification — categories like negro — and not with measured skin pigment.
Working with geneticists, Gravlee’s team also found that personal experiences of racism are associated with telomere shortening, which is linked to more rapid biological aging and earlier death. The “weathering” of racialized bodies is compounded where racism intersects with gender, poverty, and other inequalities.
This is the sharpest available answer to anyone who suspects the social dimension is the soft part of medical anthropology. Race is not a biological category, but racism has biological consequences. For the fuller treatment, see Race and Racism.
The Human Microbiome
The human microbiome refers to all the interacting microorganisms living in and on our bodies — some of them, like the bacteria in our guts, necessary for digestion and central to immune development (438). We have more nonhuman cells in and on us than human cells. We are hosts for more of them than they are of us. Some are essential; others are just along for the ride. We are more social than we are individual.
The chapter frames this through evolutionary medicine, which uses evolutionary principles to explain disease and develop treatment. Sickle-cell anemia is its standard trade-off; bipedalism is another, enormously advantageous and the source of childbirth complications. The hygiene hypothesis links industrialized environments to immune dysfunction by way of reduced microbiome diversity — which is why some interventions now aim at restoring diversity rather than eliminating microbes.
40,000 Years of Healing
For as long as humans have had disease, humans have been interested in healing. Evidence goes back at least 40,000 years, and Neandertals show signs of caring for injured individuals — fossil evidence includes a survivor with healed injuries, which requires sustained care by others (440).
Humans, like other primates, have a high need for social cooperation. Living close together helps transmit disease; it also means we are concerned with what is happening to each other. We have empathy — the capacity to relate to the emotional state of others — which is not sympathy. Sympathy is feeling for someone; empathy is putting yourself in their position and wondering what it is like to be them. And it is really only among human beings that we recognize what a disease is, attempt a diagnosis, accumulate knowledge about treatment, and pass it to the next generation. Every human society does this, which is why people keep other people alive and patched together even when they are not immediately useful to the group.
The chapter supplies two concrete cases. At El Sidrón in Spain, occupied around 50,000 years ago, an individual with several large abscesses had poplar and mold in the calculus on their teeth — poplar bark contains salicylic acid, related to the active ingredient in aspirin, and the mold was Penicillium. And in central Italy around 13,000 years ago, someone performed dental work using bitumen, a natural tar otherwise used to waterproof containers, as filling material.
There is also an intriguing proposal in the text: that the human loss of body hair contributed to our success partly by making symptoms visible, and so making caregiving more effective.
Pain Is Cultural: Janice Morse’s Fiji Study
Pain is a subjective symptom that varies cross-culturally and within communities, shaped by age, gender, and social position. Medical anthropologist Janice Morse studied childbirth pain among first-time mothers in Fiji, comparing Indigenous Fijians (iTaukei) and Indo-Fijians (442).
iTaukei women expected the pain and were prepared for it — not that it was wanted, but it was understood as a valuable experience on the way to motherhood, something closer to a ritual to be gone through. Indo-Fijian women, less familiar with what childbirth would involve, experienced the same pain as a shock. Same physiological process, different cultural frameworks for undergoing it.
Morse’s most striking result is about gender rather than group. Gender interacted differently with group norms in the two communities: iTaukei men scaled their wives’ childbirth pain as especially excruciating — as one of the most painful things there is, worse than anything they expected to face themselves, like a kidney stone, which does really suck — while Indo-Fijian men rated it as no different from other sources of pain. Same table, same study, opposite readings by the men of the two groups. It is a question worth putting to a class before showing them the figure.
Some societies build rituals around pain deliberately, where going through the pain is part of what the ritual accomplishes. Dimitris Xygalatas‘ study of the kavadi attam pilgrimage in Mauritius found that participants who were more ill or more socially isolated, and who endured more pain, showed significant physical and psychological improvement afterward. Whether any of this describes contemporary tattooing is a fair question — and the answer turns out to be partly yes, as the tattoos on the 5,300-year-old iceman discussed at Medical Pluralism sit on common arthritic points.
Idioms of Distress
How people communicate suffering varies too. Humans signal distress through spoken and body language using cultural metaphors called idioms of distress. “Stress causing an ulcer” is a familiar one — it conveys emotional difficulty without the stigma of naming it directly.
Medical anthropologist Lesley Jo Weaver studied how women in northern India express “tension,” a term carrying both physical and emotional symptoms, when seeking help with family or urban life difficulties. Because idioms of distress are local and varied, they complicate any diagnosis that relies on patient-reported symptoms.
In Haiti, people expressed distress in terms of the head hurting or the heart hurting (443–444). Clinicians heard symptom reports and prescribed for headache and indigestion. But these were not symptomatic descriptions; they were idioms of emotional distress, and what people needed were resources to address their situations — though sometimes you do also need the right drugs. After the Haiti earthquake, misreading local idioms led to inappropriate treatment. Researchers working in Haiti’s Central Plateau — Hunter Keys, Bonnie Kaiser, Brandon Kohrt, and colleagues, in Social Science & Medicine (2012) — asked people to draw how they experienced distress, and the drawings located it in the heart and the head. Work like that can improve diagnostic tools for conditions like depression where clinician and patient do not share an understanding of how distress is embodied.
Frequently Asked Questions
What is the difference between illness, disease, and sickness?
Disease is a physiological change in the body that can be classified, detected, and treated. Illness is the subjective experience of suffering. Sickness is the social dimension — the expectations and roles attached to a condition (440). The three overlap but come apart, which is where misdiagnosis and misrecognition happen. Stigma and health complete the chapter’s set of terms.
What is an epidemiological transition, and how many have there been?
It is a change through time in a population’s primary diseases and causes of death, tied to a major shift in how people live. The chapter models three: dense urban settlement and industrialization; public health systems, vaccines, and pharmaceuticals; and the current combination of chronic disease with emerging infections and antibiotic resistance (436–437).
Why did life expectancy increase?
Mostly through vaccination and better hygiene for children under two, not through extending old age. If one person dies before age one and another lives to seventy, life expectancy is thirty-five — keeping the infant alive is what moves the average.
Why did smallpox kill so many more people in the Americas?
Lack of prior exposure is only part of it. European towns had learned a protocol — shut down, burn the bridges, expel the infected — from centuries of plague. The practice in the Americas was to care for the sick and stay close, which spread the disease. Roughly 90% of the Indigenous population eventually perished, though not all from disease; some were killed and some worked to death.
What evidence is there that ancient humans cared for the sick?
Fossils include a Neandertal who survived serious injuries, which requires sustained care by others. At El Sidrón in Spain, around 50,000 years ago, an individual with severe dental abscesses carried poplar — containing salicylic acid, related to aspirin — and Penicillium mold on their teeth. In central Italy around 13,000 years ago, someone filled a tooth with bitumen (440).
Is pain experienced the same way everywhere?
No. Janice Morse’s Fiji study found iTaukei and Indo-Fijian women scaling childbirth pain differently, with the gender pattern differing between the two groups as well (442). Dimitris Xygalatas’ work in Mauritius found measurable health benefits for ritual participants who endured more pain.
Course Navigation
- Previous class: Marriage Systems
- This chapter, part two: Medical Pluralism — healing systems, biomedicine, and power (15.3–15.4)
- Next class after part two: Death Rituals
- Course home: Introduction to Anthropology with The Human Story
- Hub: Cross-Cultural Understanding
- Related: Race and Racism · Agricultural Transition · Humans and Other Humans