Epidemiological Transition

Derwent Stainthorpe Whittlesey (1890-1956)

There were three major philosophies promoted separately during the past years by medical geographers and epidemiologists. The first is the sequent occupance theory, which was proposed in 1929 by Derwent Whittlesey (1890-1956). The second is the epidemiological transition theory promoted by Abdul R. Omran in 1971. The third is politely referred to as The McKeown Theory (created ca. 1955) for population growth and disease, a philosophy which over the decades has become something very much akin to the post-modernist movements in geography taking place during the late 1980s and 1990s.

Following its introduction, Whittlesey’s Sequent Occupancy theory detailing how and why certain changes in society take place as a result of economic development became highly popular. But soon the popularity of this theory dwindled until it was revived during the 1950s by Midwestern professor Alfred Meyer . Meyer’s efforts soon after resulted in negative feedback, with its loudest critics claiming it was a fatalist theory, a by-product of a philosophy no longer in need of academic coverage or review. (The exact reasons for this criticism were never really clear to me as a contemporary academician in geography, but it was certainly understood by several of my peers within the university setting, who cautioned my about reintroducing this philosophy as a part of studies of disease history and medical geography. I suspect this is somehow linked to the eugenics movement initiated by numerous scientists in the early 1900s and strongly promoted by American physicians and experts like Bernarr Macfadden and William Kellogg (the Kellogg of that famous cereal and sanitarium), but later taken over by Germany just before the second World War. Determinist philosophy is what underlies their sensitivity to the issue today they keep telling me.)

Omran and two Navajo.

Original photograph is in the Archives & Special Collections, Augustus C. Long Health Sciences Library, Columbia University Medical Center, New York, New York. The archival caption for this photo reads: “At Window Rock, the headquarters of the Navaho Reservation with Mrs Annie Waunika, the Chairman of Health Committee of the Tribal Council and Mr. Selth Bejay, the late delegate to the Tribal Council for the Many Farms area.” Source: Abdel R. Omran, “Use of the “Epidemiological Approach” in Evaluation of Tuberculosis Case-Finding by Tuberculin Testing of Young Children in an Area with Underdeveloped Resources.” Doctor of Public Health thesis, Columbia University, 1959. From the article by GEORGE WEISZ AND JESSE OLSZYNKO-GRYN , entitled “The Theory of Epidemiologic Transition: the Origins of a Citation Classic”, JOURNAL OF THE HISTORY OF MEDICINE AND ALLIED SCIENCES, Volume 65, Number 3 , p. 287-326, accessed on March 24, 2012 at http://www.mcgill.ca/files/ssom/OmranFiinal.pdf.

The second philosophy that I saw pertaining to my research on epidemics and disease is the epidemiological transition theory promoted by Abdul (Abdel) R. Omran in 1971. Unlike Sequent Occupance this theory is now very popular due to the major changes we have seen take place in developing countries around the world as they become more economically active and the world itself became more in touch due to the web and the global economy. Authors in support of this philosophy agree that there are some patterns that recur in populations over time. As these populations increase in size and density, the older diseases tend to fade away as different types of diseases and medical conditions begin to take hold of populations. As these populations undergo changes in domestic, social and work-related living patterns due to this transition, people become less susceptible to the most basic infectious diseases, live longer, and more susceptible to diseases like cancer, obesity, heart disease, and non-insulin dependent diabetes.

The third concept related to this study was over the year assigned the common title “The McKeown Theory“, much of the content of which began to be voiced by Thomas McKeown as early as 1955.

For anyone who can remember the influences of technology upon medicine during the 1980s and 1990s, many will also remember the controversial comments that often were voiced about whether or not medicine actually did much to improve the average human lifespan. From the 1950s to 1970s, there were numerous innovations made in medicine as well, but few had a major influence upon lifespans except when it came to quality of life and socioeconomic status related issues. The diseases people died from in underdeveloped social or country-defined settings were often results of the basic needs of life, things like adequate food, clean living conditions, stable family structures, the ability to perform a basic skill to which an occupation can be linked. McKeown states that these necessities and the improvements in the lifestyle one endured in his/her setting were responsible for increase height, improved memory and skills related accomplishments, reduced illness and sickness linked to poorly preventive living practices.

By the 2000s, this resulted in a significant amount of debate in the public health literature, leading many to exclude this philosophy from certain teachings. In spite of these professional disputes, McKeown’s concepts have an application to societal changes and health over time in many of the early population settings. As a result, McKeown’s interpretation of health in realtion to population development does provide useful insights into the transition of ingenous people from their original lifestyle to that expected of them by earlu Euro-American settlers and political powers. McKeown’s theory could and should be related to the above two population health concepts. As recent writer James Colgrove stated in an article on on this part of the history of public health:

“Thomas McKeown put forth the view that the growth in population in the industrialized world from the late 1700s to the present was due not to life-saving advancements in the field of medicine or public health, but instead to improvements in overall standards of living, especially diet and nutritional status, resulting from better economic conditions. His historical analysis called into question the effectiveness of some of the most basic and widely applied techniques in the public health armamentarium, including sanitary reforms, vaccination, and quarantine. The “McKeown thesis” sparked the inquiries and shaped the research hypotheses of many scholars and became the subject of an extended controversy.” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447153/)

Each of these concepts can be related to Mahican history and health. In recent years, a number of books have been published relating epidemiological transition theory to the history and present health status of certain Native American groups or communities. Not so much has been published about the sequent occupance theory as it relates to Native American change. This writing is an attempt to merge both of these concepts together by relating them to the Mahican Indians and the Missions as an example of a sequent occupance-generated epidemiological transition event in local history.

Sequent Occupance

Derwent Whittlesey first defined the theory of Sequent Occupance in a short article by the same title published in Annals of the Association of American Geographers, volume 19, in 1929. This theory states that certain transitions in living and land use patterns take place over time as local social settings change and grow and the area becomes more heavily populated. There is temporal pattern that relates to the sequent occupance theory, in which regions undergo certain types of changes in a specific order as local commerce and trade development, along with the other essentials necessary for a society, such as the establishment of governing bodies, the development of industries, the improvements in technology for a given place over time, etc. One flaw with this philosophy is that it essentially states that certain lifestyles occur in a specific sequence, such as simple farming followed by agricultural and industrial commerce patterns. In Whittlesey’s descriptions of this philosophy, the following sequence is often mentioned: native american style wilderness living settings, followed by the development of buildings and the establishment of personal trade relationships such as by pioneers residing in log cabins and on occasion engaging in mercantile businesses, followed by the early industrialization of this setting in which small-scale industries are developed as replacements for the pioneer businesses, followed by the establishment of much larger industries in which major factories are developed and housing settings begin to appear and behave in a more technologically savvy manner.

During the 1950s, this philosophy was once again popularized by Midwestern geographer Alfred Meyer. In his study of the historical geography of the Calumet Indians residing near Kankakee Marshlands, he noted the following sequence of population history events:

The Potawatomi Indian–Fur Trading Stage (up to 1830)
The Pioneer Settler–Subsistence Agriculture Stage (1830-1850)
The Corn Belt Farmer–Commercial Agriculture Stage (1850-1900)
The Agricultural and Industrial Specialization–Conurbanization Stage (1900-1953).

Figure from my Thesis (Cholera on the Oregon Trail) For more on this see this section of my page on Regions and Health – The Pacific Northwest

In the above rendering of sequent occupance, a simple example of this type of transition in the Hudson Valley region exists for the Colonial years and post-colonial years prior to 1850, as follows:

the establishment of traditional Iroquois and Algonkin community living patterns and wildcrafting behaviors (1600-1670)
the development of colonial homes, first by squatters of Dutch Land Claims and other families and groups residing in close proximity to Native American establishments, followed by the establishment of larger home settings, typically involving rock-based construction habits (1670-1720)
the development of large households and mercantile businesses, with major landform changes made such as the elimination of old marshlands and the development of more effective public transportation routes; the establishment of some small scale single dwelling or estate industries like flour, cornmeal, poultry, meat, and fish industries (1720-1790)
the development of major industries, of early form and function and typically livestock or natural product based, such as the development of early lumber, tanning and woolery industries, the establishment of large-scale sheep and cattle farms, the production of larger crop fields and businesses related to the circulation of these products, and the development of buildings that offered special services to a community such as a school, drugstore, bank, auction house, newspaper publisher, etc. (1790-1850)

Relating this to early local settlement patterns in the Fishkill Landing area for example, we can define the transition of this area from Stage 1 to Stage 2 with the establishment of the Madame Brett Homestead (ca. 1680), followed by the settlement of lands and homes in and around this area by approved squatters (who usually paid their “taxes” in bales of hay and bushels of crops) (ca. 1700). This in turn was followed by the establishment of secure homesteads and small mercantile shops (ca. 1730/40), and finally the establishment of a semi-urban setting in which specialty services like breweries, inns, a meeting hall and the like become established (from Fishkill Landing to Fishkill Village, ca. 1760).

Along with the changes in life style associated with Sequent Occupance we also find changes in health and disease risk taking place as a consequence of these economic transitions. This was in part due to the changes in lifestyle and living safety features associated with local economic development, as well as different occupational types and settings that emerge due to increasing population sizes and people’s’ needs. During the earliest stages in this development pattern (Stages 1 and 2), the types of illnesses that would have been endured are different from those that became common once communities were established. In the beginning, social interactions were few and far between relatively speaking and families resided and existed in small groups if not in solitude. The most basic infectious diseases capable of passage via direct and indirect human-to-human transmission were rarely spread except between family members and close associates. The disease types that tend to display related mostly to life practices such as events related to tending to personal wants and need with regard to land use, as well as maladies related to inheritance and personal body weaknesses (gout, obesity, diabetes).

Whereas in Stage 1, natural events such as climatic changes and biological needs such as foods and certain nutrients tended to result in fatalities, we find that as stage 2 evolved, many of these earlier health issues get resolved, in exchange for increasing the ability of other diseases to be spread within more interactive communities, domestic settings, and occupational locations. Accidents related to work and living habits still predominate and due to social interaction between different families and groups, who were previously unrelated in any social way, begin to occur as other disease patterns begin to erupt, such as a local sore throat, fever or mumps epidemic. Stage 2 in sequent occupance also consists of communities with loose aggregates of people, or in terms of Hudson Valley history, the establishment of hamlets and a few places for socialization such as a church, marketplace or town hall.

Stage 3 is the development of more efficient household settings, higher population densities, easier to travel land routes, and a few regular commercial trade activities. The ability to travel has significantly improved, and along with this comes the ability for foreign disease transmission to commence and infect a large enough number of people so as to become endemic or epidemic in nature. During this period of time in local New York city and Hudson Valley history, it became possible for yellow fever to make its way into the region and begin to establish itself for the season due to mosquito breeding patterns and local environmental settings. The increased concentration of people led to sanitation based diseases ensuing, such as the development of recurring dysentery epidemics due to infected water supplies. This also allows for livestock-generated microbial diseases to begin to occur, such as the intestinal worms and several forms of influenza and diarrhea epidemics. Due to population clustering, human-to-human contact diseases like the pox, measles, mumps, and rubella become more likely to ensue in epidemic form.

Stage 4 disease patterns demonstrate further progress in epidemic and endemic disease development, with the addition of still more foreign-born infectious diseases like diphtheria, amoebic dysentery, and Asiatic cholera. Due to crowding behaviors, at home and in the social settings, infectious diseases are easily transmitted so as to develop well diffused epidemic patterns. Improvements in transportation patterns occur along with improved commercial patterns, and so infectious diseases spread by people and human-generated commercial products (foreign food sources, contaminated linens and clothing goods, etc.) develop more effective dispersal methods. Since technology has improved, and occupations have changed due to these improvements, occupational disease patterns become more developed, such as diseases brought on by chemical and particulate exposure (esp. for the tannin industry, mining, and perhaps the grains and brewing industries).

There is also a temporal component to epidemiological transition that has to be considered. By temporal, I am referring to when the different stages are be happening. For the first two stages–Indigens and Pioneer–this is not so much an issue. Health and disease-wise, living either way, even today, in spite of the electricity and TV even the lowest income members of a low income population now have, time does not have much impact on the major public health related disease problems that exist in these groups, such as underimmunization, malnutrition or poor nutrition, the onset and support of certain psychosocial and sociocultural illnesses, the presence of specific acutely infectious and chronically degenerative diseases. This means that the disease patterns of the first two steps may not have changed that much, except to say certain diseases are now more likely to happen than 500 years ago due to disease migration. Whereas in 1850 amoebic dysentery is not expected in American poor living conditions because it was then a foreign disease brought in by migration, today this particular dysentery has evolved into a disease presence in North America and one that can be popular in certain low income community settings. Likewise the intestinal tapeworm of African origin was at first not a low income-agricultural community risk until decades after its initial introduction into Europe, which took place sometime during the 14th century. In 1400, severely dangerous infectious diseases like measles and small pox were not a threat to American Indian survival, except at the immediate direct contact level. During the Indigen stage of development, contact between carriers and previously unifected were rare due to spatial distribution, an epidemiological condition that continued into and through much of the pioneer stage, but then converted into a deadly epidemic form once the carriers and previously uninfected members of a community became able to meet within the new social, community setting typical of an early industrialized community setting. Population density and spatial distribution were now the primary defining factor due to the competition for space. The initiation of pioneer settlement patterns is what made this fact of social history a reality to indigenous cultures; likewise certain sexually transmitted diseases became a similar reality for European cultures once the barriers between these two worlds sociologically and interpersonally vanished.

At the third stage is this epidemiological-sequent occupance process–the onset of the industrial era. This is when the interactions between people and their workspace are the key factors determining if and when a significant number of medical conditions and diseases may have to be faced. To better understand this stage in the process, one has to asnwer the questions: How does work cause disease? How do the products of work relate to disease? By 1840, woolen and paper manufacturing were very important to the American culture, as were a number glass and metal industries, the chemically and microbially rich tanning industry, the first small scale photography industries, and the first large scale livestock-generated food industries with slaughterhouses. These settings are obvious different from the more pioneer like settings that they replaced. Due to the new technology each of these fields had at hand, they bore difference risks than one or two decades earlier.

One of the more obtuse proofs that this stage is reached appears in the Poughkeepsie Journal in a most unusual manner–plans for street development. There were a number of road-related problems that recurred in local history. Good streets were required in order that commerce can precede in a more economically effective fashion. During this period of time, plank roads were the common practice in the development of roadways. These turned roads that were sometimes barely travellable into roads with a better likelihood of not experiencing water and precipitation related problem. This also led to the establishment of turnpikes, although the planning of turnpikes came about a few years prior to plank roads production. Between 1830 and 1850, this industrialization process was fully implemented for the region. What would soon follow was the growth of the primary urban hub for the region–Poughkeepsie–into a major big town/small city city for the first time. Evidence for this commercial success included the establishment of multiple newspapers for the town or city, one of which relied primarily upon the newest invention for communications during this time–the telegraph system invented by local entrepreneur Samuel F. B. Morse.

As a part of the industrialization process now ensuing, factories were raised in large numbers and types almost overnight. This had a significant effect upon the local living, working, and commercial settings. The city ordinances that became common during this time pertained to public health issues, like sweeping the streets, how and where to dispose of garbage, how to keep the chimney clean, how to control food sales, stores and rationing at the local storefronts now being used. Also during this time, the risk of chemical exposure was more prevalent. For example, there were a number of chemical stores that developed during this time that sold a very special line of products, such as lime and guano. The mercury and heavy metals sold by these facilities related to photographic film production. The sale of concentrated tannins and iron and the need for very hot, long-burning fires all resulted in very different working conditions than the simple barn or stable setting for a farrier, homestyle yarn producer and tapestry weaver, or blacksmith’s shop. With the establishment of moderate to large scale farming during this traditional early to mid-1800s setting in the US, the diseases become quite different. A similar set up existing today, in certain parts of Europe, Russia, Africa, and Brazil would no doubt be much different technologically and chemically. The chemical causes for certain disease types would remain unchanged. What changed were the types and severity of diseases that develop in these modern Stage 3 settings, and the progress this work setting undergoes in enabling Stage 4 levels of industrialization to evolve more quickly–high scale industries lacking most of the pre-WWI features of a society at the occupation level. (There are still pioneer type domestic conditions, the diseases of which are accompanied and overwhelmed by diseases promoted even more by the increasingly dense living space and very unsafe work spaces.)

I can apply the above to any of a number of diseases and their personal and social interpretations, but for now I will use just one–epilepsy, a biological medical problem with a considerable amount of personal and culturally-bound influences when it comes to longevity and health state. In the first series of transitions–1700-1750-1790-1850, we find Indian descriptions of this problem to be traditional–and the fate of the child determined througth spiritual and natural causes–the child dies from seizures or makes it through some testing period to become a shaman, assuming he/she makes it through the “initiation process”. In the 1800-1850-1890-1950 occupance-transition pattern, the first two forms of society do not change in their interpretation of this disease. Likewise the early industrialization state of living still allows for enough traditional social lifestyle to exist for this same interpretation to prevail in the reservation setting as well. As demonstrated by a study of Navajo interpretation of epilepsy around 1950, we find that a partial assimilation of these people had also allowed for a change in the psychology of this disease to take place. The Navajos studied for one westernized reservation setting during the mid-1960s had the belief that the seizure was a problem due to the invasion of a spirit of a past family member, leading the father to not even acknowledge or help a child through what might have two generations earlier been termed a shamanic process. This resulted in Federal program assimilation of the child and the loss of sociocultural meaning regarding this illness–this child grew up in an impoverished setting, on and off federal programs, and had social expectations for life and progress, as set by the federal agencies and parents, that were quite different than the expectations of a family that went through the same experience only 50 years earlier. I can add to this the same situation and experience ins Inuit culture, for a condition called Pibloktoq (also seizure related, but both symptomatically and culturally defined as a mixed-allopathy-Inuit medical condition–often researched and written about as a “culturally-bound syndrome”), in which during the same decade might provide the child with a very different fate–the Inuit still becomes a shaman while the Navajo child suffers the life of a westernized form of poverty taken on by a reservation based less traditional family-social setting [citations on this later]. In the modern Stage 4 setting, traditional values may allow for a little more tradition to return to such a sociologically defined medical condition and the overall long term fate for the child involved.

Another excellent example of this epidemiological transition process as a work-health relationship is demonstrated by the “skywalkers,” the native american workers whose relative lack of fear of heights made them a most important population hired for the high-elevation work requirements typical of a welder producing bridges and tall buildings for an urban landscape (see http://group.aomonline.org/cms/Meetings/Seattle/PDF/12362.pdf.) In this case, a genetic, behavioral, and emotional feature of the American Indian, the lack of fear of heights, ability to balance and remain emotionally and biologically stable while walking at incredible heights above open space, enabled them to perform a task that many individuals were unwilling to engage in–walking the I-beams in urban settings in order to get the basic skeletal structure of a tall building fully constructed.

The epidemiological transition-sequent occupance history of this same worker and his family, had he been employed during different periods in American history, might be as follows (read as 1700-1750-1790-1850, 1800-1850-1890-1950, etc.):

Stage 1: Indigenous lifestyle.

1700–traditional.
1800–traditional or reservation-based.
1900-reservation based or assimilated; the countryside or urban poor.

Stage 2: Pioneer Lifestyle.

1750–self-supporting small business (game meat, hides, blacksmithing).
1850–traditional foodways and occupation, probably reservation based.
1950–reservation based or assimilated; the countryside or urban poor.

Stage 3; Early Industrial Era.

1790–farming or natural resource industry (livestock, crops, fish netting, lumber).
1890–assimilation processes lead to factory work, mechanical skillsets heavily employed; adaptability becomes a significant factor.
1990–assimilation processes lead to factory work, mechanical skillsets heavily employed (could add more based on socioeconomic status, but won’t).

Stage 4: Late Industrial Era.

1850–early millworker, machines worker.
1950–assimilation processes lead to factory work, mechanical skillsets heavily employed; adaptability very important (i.e. high elevation work).
2050–major native american industries?

Attaching lifestyle and disease to each of the three above scenarios, there are limited changes in the transition from a poverty-like lifestyle with limited infectious disease exposure and high mortality rates due to infection, poor nutrition, natural endemic and epidemic disease patterns. Injury-related illness and occupational exposures begin to prevail with early industrialization, as well as some lifestyle change-induced problems (This is when the pima and inuit began to show their “obesity gene”.) Later industrialization periods make the same people more susceptible now to occupational disease, population density-human behavior diseases–in the late 1800s this only resulted in major employment and community-popuilation-related disease pattern changes, along with the prior lifestyle, poor nutrition, psychological induced changes; socioeconomic status, personal values and psychology, fatalism and self-perceived helplessness become more common public health terms for these states of survival by the end of the 20th century; self-determinism played a more major role in “cultural recovery” as a substitute for assimilation.

The point being made here is that sequent occupancy models have to be given just as much fluidity and openness to consideration as the epidemiological transition theory. The latter is very limited in its application is seemingly more and more very limited in its application. In the 1990s an applciation of the epidemiological transition theory to Pacific Northwest tribes was produced and published and became one of the most broadly applied examples of applications of this concept to history and anthropology, an intellectual route for this concept that apparently went no further. The former (sequent occupance) suffers when it too Americanized and applied as it originally was to the colonial-postcolonial period of United States history. Sequent Occupance has a much better application being made into a more health-lifestyle related way of interpreting time-space relationships than the overly intellectualized education-industry-economic development westernized fashion that was originally applied to this model between 1900 and 1970. Sequent Occupance works very well with understanding health-related areal-population changes. Too much focus on the industry/occupation type alone kind of takes away from this very important potential use of this theory.

So how do we relate all of this to the Mahican-Moravian settlement history?

The Mahican-Moravian settlement history presents us with two periods of sequent occupance, and perhaps is best represented either as some sort of transitional stage in this social evolutionary process, or as a the product of Stage 2 in the above described sequent occupancy patterns. Interestingly, in spite of the period of time in which Moravian-Mahican interactions took place, with many of these activities taking place in the most rural of community settings, there is strong supporting evidence for this interpretation of missionary health as a detailed example of how to apply sequent occupance to this history. In the Gnadenhutten records for example (formed after the missions removed from New York to Pennsylvania and finally to Ohio), we see animal disease transition take its toll on Native Americans for the first time, when porcine-generated diseases like trichinosis begin to infect the Christian Indians for the first time. Lacking in sufficient cattlehead, anthrax was not a consequence of this settlement pattern, but zoonotic (animal born) diseases like salmonella, listeria, brucellosis, campylobacteriosis, roundworm, tapeworm and ringworm were probably a problem on occasion.

Fortunately for the Mahicans, the population-dependent infectious diseases like Asiatic Cholera (ca. 1821) probably did not strike their settlement much, due to its isolation from most significantly sized population centers back east. When we look at the earliest years of cholera spread, we find transportation routes to be the main paths to new epidemic settings. Since the Moravian-Mahican settlements were pretty much isolated from New World trade and commerce routes, we don’t see the Asiatic cholera makes its way into these settings as it did for the local fort settings during the final years of the missions in Ohio. In contrast, dysentery, another diarrhea disorder, less fatal than cholera, could make its way into the missionary setting, as a consequence of increased population size and increases in unsanitary conditions at nearby debris disposal and latrine settings.

In terms of highly contagious human-to-human contact diseases, like measles, small pox, and even mumps and whooping cough , we see penetration into communities taking place even within the woodlands settings. Unlike the pre-missionary history of a Mahican settlement, occasional clusters of cases of these disease would appear in this setting, due to visitors and officials passing through this otherwise isolated community tucked away in the hinterlands. This rural setting may have also made it possible for some wildlife born zoonotic diseases to occasionally infect the Mahicans, not unlike before, such as deer tick-born illnesses and the occasional wild animal bred giardia events.

The transition of the Mahican-Moravian settlement into a more pioneer like setting according to Meyer’s rendering of the sequent occupance theory was not complete at the time this settlement existed in the Shekomeko region of the Hudson Valley. There is evidence that some medical traditions were maintained in the Shekomeko village,with the support of the Moravian missionary leaders. A review of this location as part of the 1859 dedication of this site with a monument, once used to depict the burial site of one of the leaders who passed decades before, but now transplanted to a new tourist stop in order to remind us of the fate of these people, reminds us that not all Mahican traditions were lost through the Moravian led Christianization process. This site description tells us there were signs that a sweat lodge was still in use, with a garden nearby raised more in a traditional European fashion. Close by was the pig sty. The latrine was probably set up at some distance from this plot. According to Moravian correspondence, the dwellings that were built, including the church, remained more like traditional bark like homes than the more robust log cabins at first.

Epidemiological Transition

Epidemiological transition has been more commonly associated with Native American medical anthropological work than Sequent Occupance. When Abdul R. Omran first defined this theory in 1971, he listed the following three major stages of disease transition which took place in populations that underwent typical economic change and lifestyle transitions (ref: wikipedia):

The Age of Pestilence and Famine: Where mortality is high and fluctuating, precluding sustained population growth, with low and variable life expectancy, vascillating between 20 and 40 years.
The Age of Receding Pandemics: Where mortality progressively declines, with the rate of decline accelerating as epidemic peaks decrease in frequency. Average life expectancy increases steadily from about 30 to 50 years. Population growth is sustained and begins to be exponential.
The Age of Degenerative and Man-Made Diseases: Mortality continues to decline and eventually approaches stability at a relatively low level. Life expectancy rises and exceeds 50 years, with fertility becoming the crucial factor in population growth.

The time related features defined above pertain mostly to contemporary societies, for which changes take place due to relative economic development and stabilization. This relationship between life and death focuses mostly on age-related mortality features, a population fate changed as a result of the missionary process. With each mission, there is initially an increase in mortality rates generated due to exposure to carriers of infectious diseases, such as measles and small pox, but this initial stage in transition is followed by a decrease in mortality rates due also to changes in life style and work habits or occupational changes. With the advent of livestock breeding with pigs, we would not be surprised to learn about the possible generation of a swine-bred strain of influenza for example. Due to a lack of periods of starvation and increased food supplies, we might learn about certain forms of obesity setting in now that the survival gene is no longer a necessity in life.

The concept of an “obesity gene” is a fairly new theory posed in the contemporary medical literature, in which it is referred to as the “metabolic syndrome”. The actual “discovery” of this medical problem stems back to the Inuit missions, when the Hudson’s Bay company began providing for local Inuit populations in central northwestern Canada, near Alaska. Their access to the fort’s food stores, enabled them to become a little more dependent on such products as flour, milk, sugar, and livestock-derived lard, fats and grease. The major health related impact this had pertained to diabetes. By 1880, the Hudson’s Bay company physicians noted a sudden increase in Inuits with diabetes, documenting this in the medical journals. [citation?]

This first publication of an article detailing the onset of diabetes contrasted greatly with the other articles often appearing in medical journals about Native American health. A number of articles noted the excellent health many natives were in. The habit of running or travelling long distances between tribal settings provided some members of the Navajo tribes with what is today referred to as athlete’s heart syndrome, a bradycardia (very slow heart beat) that was often attached to improved longevity. Likewise, the forced life style, low income community setting, limited food sources, often all resulted in a fairly healthy diet so long as the desires for fried dough or fritters (a Scottish introduction to the tribes ca. 1790, in Hudson’s Bay area) and living too much of a sedentary lifestyle dependent on alcohol did not follow. Articles on these public health related issues on occasion also appeared in the medical literature occasionally during the early 1900s [add citations below].

By the 1920s, the tendency for changes in epidemiological patterns to occur due to reservation life was documented for the first time as a public health problem impacting several reservation-bound Native American groups such as the Navajo and members of most of the formerly eastern tribal communities resettled on reservation land. This transition in health patterns occurred most significantly for the Pima Indians residing in New Mexico. This significant change in body shape and size led to new research projects on this Native American personal and public health change. By the 1950s, anthropologists had successfully documented this unhealthy by-product of assimilation and acculturation. In 1964, geneticist James V. Neel coined the term “Thrifty Genotype” to define this tendency for diabetes to afflict Native Americans. In 1984, the term “New World Syndrome” was coined for this change in body condition by anthropologists Weiss, Ferrell and Harris.

There is also a significant amount of evidence suggesting that this genetic condition may also be linked to the long age status (>90 years longevity) noted to occur within many tribal settings. The longevity trait of Natives may in fact be the same genetic sequence and biological events linked to early onset of hyperlipidemia, weight gain, diabetes, and ultimately early death. If we conceptualize this part of human biochemistry as some sort of see-saw effect taking place, we see evidence suggesting that the increased activity of enzymatic sequences responsible for weight gain, a protective mechanism linked to recurring periods of low foods stores and starvation, is also capable of causing hyperlipidemia and atherosclerosis as this storage mechanism continues to fire and produce fat stores for the next rainy day. In turn, this ability to survive without much food intake, and therefore reduced lipid production in the blood, also results in lower blood lipids overall, such as a reduction in high density lipoproteins and low density lipoproteins (HDL and LDL) (Kurbel and Zucic, 2008). This particular trait is linked to longevity in cultures worldwide, but especially in circumpolar indigenous settings.

The following figure (source: http://en.wikipedia.org/wiki/Epidemiological_transition) demonstrates a fairly simplified (perhaps too simplified) way of defining disease pattern changes in relation to social or sociocultural development and change. For this figure, the 3-stage process originally defined by Omran has been changed to a 5-stage process, for which the first two stages remain pretty much unchanged.

For Mahican-Moravian settings, we can link Stages 1 and 2 to the changes introduced by missionary activities. We see fluctuations in deaths due to varying infectious disease patterns. Furthermore, in the purest sense, we can even consider the option that Moravian settlements might have undergone only a partial change to Stage 2, a process which never really took hold due to a shortened lifespan of the missions brought on by the violent activities in Ohio during the 1820s, which essentially extinguished the Moravian Christian Indian missions permanently. The Christianized Mahicans never survived long enough as a community to demonstrate some of the long-term consequences of assimilation, such as a modification in health related states linked to the New World Syndrome or possible longevity trait. What we do see is an example of what impacts the earliest period of transition had on Indian life and cultures during the Colonial-post-colonial period of history in New York and the Hudson Valley.

References

Thomas McKeown and The McKeown Thesis

McKeown T, Brown RG. Medical evidence related to English population changes in the eighteenth century. Popul Stud. 1955;9:119–141.

McKeown T, Record RG. Reasons for the decline of mortality in England and Wales during the nineteenth century. Popul Stud. 1962;16:94–122.

McKeown T, Brown RG, Record RG. An interpretation of the modern rise of population in Europe. Popul Stud. 1972;26:345–382.

McKeown T, Record RG, Turner RD. An interpretation of the decline of mortality in England and Wales during the twentieth century. Popul Stud. 1975;29:391–422.

McKeown T. The Modern Rise of Population. New York, NY: Academic Press; 1976.

McKeown T. The Role of Medicine: Dream, Mirage, or Nemesis? London, England: Nuffield Provincial Hospitals Trust; 1976.

James Colgrove, MPH. The McKeown Thesis: A Historical Controversy and Its Enduring Influence. Am J Public Health. 2002 May; 92(5): 725–729. Access at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447153/

The McKeown Thesis. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60292-5/fulltext.

Sequent Occupance

For more on sequent occupancy, see http://www.valpo.edu/geomet/histphil/biograph/meyer/meyer.html, accessed on October 10, 2010.

Brian Altonen, MPH, MS