Published by EH.Net (July 2023)

Steckel, Richard H.; Larsen, Clark Spencer; Roberts, Charlotte A.; Baten, Jörg (eds.). The Backbone of Europe: Health, Diet, Work, and Violence over Two Millennia. Cambridge: Cambridge University Press, 2018. 476 pp. £83.99 (hardcover), ISBN 978-1108421959.

Reviewed for EH.Net by Kaspar Staub, Institute of Evolutionary Medicine, University of Zurich, Switzerland.


This book makes a strong impression, in more ways than one. The weight of the hardcover edition, about 1.1 kilograms, hints at the effort, commitment, and perseverance that must have been put in by all those involved, especially the main driving forces, to complete this nearly two-decade project and finally bring the results between two book covers. For this, the responsible scientists deserve a lot of respect. The book reviewed here is part of the larger Global History of Health Project ( and focuses on Europe. In terms of dataset, health indicators, context, and methods, it substantially extends an earlier subproject on the Western Hemisphere, which was the subject of a book published in 2002 (Steckel and Rose 2002).

As befits the 20-year Herculean effort that went into this project, its scale and purpose are large. Based on the largest skeletal dataset ever assembled, it aims to assess how human health and well-being have changed in Europe over the last two millennia. To achieve this ambitious aim, a large transatlantic network of collaborators has been established, using the same protocol to record health indicators from the skeletal remains of more than 15,000 individuals buried at 103 sites across Europe (representing 16 modern European countries) from the 3rd to the end of the 19th century.

When working with skeletal remains as historical sources, which are still one of the few ways to look back 2,000 years, sample size, context specificity, and generalizability or bias are often limiting factors. Therefore, the approach of the book to bring together as many skeletal remains as possible is certainly the right one. Thus, in addition to the book, the compiled large open access dataset (over 15,000 rows and over 180 variables) is a major output of the project. According to the editors, it is the largest database ever collected and analyzed in bioarchaeology. Making the numerous individual datasets comparable was certainly another major challenge, and the path via software that the researchers have taken here is certainly exemplary. It is great that the codebook for data collection and the coding process are very well documented, both in the book itself (chapters 14 and 15) and on the dataset website (

The book was edited by four renowned senior scholars in the field, whose experience and overview of the field are reflected in key chapters. A foreword and preface are followed by 15 chapters written by a total of 19 different contributors. The introduction by the four editors provides all the information necessary to understand and contextualize the project, the book, and the chapters that follow. As a side note, the precise data documentation here and later in the book is perhaps a little bit lacking in clarity as to how the dataset reduction process from the mentioned initial ca. 190,000 individuals identified at the start of the project to the ca. 15,000 at the end worked. Even when the understandable balancing ideas behind the reduction are described, it remains unclear, for example, whether there were large and important bone collections that were not accessible or had to be excluded for some reason.

Chapter 2 provides an overview of the archaeological and historical context, as well as information about the natural and socio-cultural environment, and highlights the potential of stable isotope analysis. Chapter 3 attempts an overall health assessment using the soc. health index, which combines seven skeletal variables or components that are recognized to represent a person’s health in early and later life. Chapter 4 focuses on oral health, Chapter 5 on proliferative periosteal reactions, Chapter 6 on growth disruption, Chapter 7 on anemia and related nutritional deficiencies, Chapter 8 on estimated stature, Chapter 9 on degenerative joint disease, and Chapter 10 on violence and trauma (a particularly interesting chapter from the reviewer’s perspective). Chapter 11 applies the developmental origins of health and disease approach to the dataset, and Chapter 12 assesses the all-important link between climate and health. The chapters are structured differently, are fully documented, and could therefore stand alone. However, as far as the reviewer has noticed, cross-links between the chapters are mostly missing. Thus, the reader is left alone with the sometimes contradictory results of the individual thematic chapters until the concluding Chapter 13, in which the four  editors compare the different dimensions.

In this recommended concluding chapter, the editors state that “collectively, these chapters explore longstanding bioarcheologically relevant topics using the most comprehensive and diverse skeletal sample yet available.” They go on to highlight some surprising findings (e.g., the unexpectedly favorable health situation in the early modern period) and otherwise provide guidance with interpretation, as the various indicators do not always point in the same direction. As a result, their overall conclusion is nuanced: The history of welfare in Europe over the past two millennia has been multifaceted in time, and many different components must be weighed against each other.

While reading, the reviewer wondered once or twice whether the full potential of this amazing dataset had already been exploited, and whether one or two more things could have been done here or there. For example, would modern quantitative methods of pattern recognition have made it possible to compute more complex synthesis models? Would such more complex methods have made it also possible to even better integrate uncertainties and deal even better with blind spots or missing data (e.g., the Mediterranean region covers only 5% of the dataset, and 28% of the dataset has missing age and sex information) to get towards the bottom of the complexity and perhaps resolve some of the contradictions? Would it have been beneficial to work with geographers to geovisualize or even model the spatial results in a more comprehensive way? Could the importance of major epidemics perhaps have been emphasized in a separate chapter to better acknowledge their impact (as repeatedly pointed out in individual chapters)? And, of course, one wonders how things might have gone after 1900, the book’s temporal end, during the 20th century, with its enormous changes in welfare and health in Europe.

But all this is subjective and does not detract from the book, it just shows how inspiring the whole project is. And that’s the way it is with these 20-year Herculean tasks: There is always more that could be done, but in this case more than enough has been done already and at some point one has to draw an (interim?) finish line. All of the above and certainly more could-haves are now left to other scientists, as this great dataset and its excellent documentation are helpfully available in open access.


Steckel, Richard H., and Jerome Carl Rose. The Backbone of History: Health and Nutrition in the Western Hemisphere. Cambridge: Cambridge University Press, 2002.


Kaspar Staub is a historian and epidemiologist with almost 20 years of research experience in the field of Historical Anthropometry and Health History. Since 2014 he has led the Anthropometrics and Historical Epidemiology research group at the Institute of Evolutionary Medicine at the University of Zurich.

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