Published by EH.NET (May 2003)


Richard H. Steckel and Jerome C. Rose, editors, The Backbone of History: Health and Nutrition in the Western Hemisphere. New York: Cambridge University Press, 2002. xx + 633 pp. $75 (cloth), ISBN: 0-521-80167-2.

Reviewed for EH.NET by William J. Collins, Department of Economics, Vanderbilt University.

The Backbone of History is a coherent collection of papers that distill data from skeletal remains to make comparisons of living standards across vast stretches of time and space. Early versions of the papers appeared at a conference sponsored by the National Science Foundation in 1996 at Ohio State University, but the co-editors laid the groundwork for the project’s data compilation more than ten years ago. The scope and scale of the project are ambitious: over 12,000 skeletons from more than 200 sites spanning 7,000 years are in the project’s database, more than fifty contributors are listed as co-authors, and the book sheds light on some high-stakes historical issues, including the health implications of the transition to settled agriculture and long-run group disparities in health status. The volume’s contributions to knowledge are wide-ranging and significant. Moreover, the papers and their underlying dataset will spur future research on Western Hemisphere populations. In combination with a similar project currently collecting European evidence, the work’s impact may be magnified even further.

The authors of this volume, borrowing a line from Seamus Heaney, glean the unsaid off the palpable. But just how much history can be gleaned from bones and teeth that are hundreds, and in some cases thousands, of years old? Readers who have had relatively little exposure to research in paleopathology may be surprised by just how much information the remains convey. In this regard, Alan H. Goodman and Debra L. Martin provide a helpful orientation in their chapter on “Reconstructing Health Profiles from Skeletal Remains” (Chapter 2). Of course, there are limitations and potential pitfalls to making strong inferences based on this evidence, and wherever possible supplemental evidence on health and living standards should be brought to bear, but I am inclined to agree with the co-editors that the skeletons “furnish the best and, in many cases, the only picture available of human health over the millennia” (p. 3).

An outstanding feature of the project, and the aspect that binds this volume into a coherent body of work, is a shared methodological approach to interpreting the records of skeletal remains. In particular, the area- or topic-specific chapters (5 through 18) are based on a common format for scoring remains and forming a composite index of health. The methodological common ground is cleared in Chapters 2 to 4. Chapter 3, “A Health Index from Skeletal Remains” (by Richard Steckel, Paul Sciulli, and Jerome Rose), is absolutely fundamental to the rest of the volume since the frequent cross population comparisons are based on the authors’ proposed health index. The index combines available information on stature, enamel hypoplasias, dental health, infections, and degenerative joint disease.

Some qualifications should be mentioned here. First, Steckel, Sciulli, and Rose are appropriately cautious about making strong inferences regarding relative living standards on the basis of the index. They label the index “Mark I,” and they point out that this is a starting point, not a definitive measure, for forming health comparisons based on skeletal remains. To the extent that the index is subject to significant revision, the subsequent quantitative ranking of populations is also subject to substantial revision. Second, there are aspects of life (and death) that do not leave impressions on bones; for example, acute diseases that kill swiftly may not leave evidence embedded in the skeleton. Third, for readers accustomed to fretting about selectivity biases in samples and standard errors in measurement, there is not much comfort in the figures. In general, the authors of these chapters are well aware of the limitations of the material and the samples with which they are working, including the multiple layers of uncertainty underneath the index values, and so this last point is intended as a strong caution to readers, especially those who consider bypassing the methodology section.

In the final paper of the book’s methodology section (“Paleodemography of the Americas,” Chapter 4), Robert McCaa derives estimates that imply significant variation in fertility levels over time and across populations in the available samples. An apparent switch from a “low-pressure” to a “high-pressure” demographic regime about 1,500 years ago, even among non-horticulturalists, is especially interesting in that it suggests that agriculture might have been a response to, rather than a cause of, demographic regime change.

A second outstanding feature of the volume is that each site- and topic-specific chapter supplies some historical context before delving into the examination of skeletal remains. This helps non-specialists appreciate what questions are at stake in the analysis, provides a sense of what biases, if any, may accompany the sample, and situates the investigation in the existing literature on the population under study.

Space does not allow for a thorough review of each of the fourteen site- and topic-specific chapters. I will give a brief rundown and highlight a few important points. Approximately 80 percent of the skeletal sample consists of Native Americans, but the first group of papers focuses on European and African Americans in North America within the last 200 years. Shelley Saunders, Ann Herring, Larry Sawchuk, Gerry Boyce, Rob Hoppa, and Susan Klepp write on “The Health of the Middle Class: The St. Thomas’ Anglican Church Cemetery Project” (Chapter 5). Rosanne Higgins, Michael Haines, Lorena Walsh, and Joyce Sirianni report on “The Poor in the Mid-Nineteenth Century Northeastern United States: Evidence from the Monroe County Almshouse, Rochester, New York” (Chapter 6). Paul Sledzik and Lars Sandberg examine “The Effects of Nineteenth-Century Military Service on Health” (Chapter 7). Ted Rathbun and Richard Steckel examine “The Health of Slaves and Free Blacks in the East” (Chapter 8), whereas “The Quality of African-American Life in the Old Southwest near the Turn of the Twentieth Century” is surveyed by James Davidson, Jerome Rose, Myron Gutmann, Michael Haines, Keith Condon, and Cindy Condon (Chapter 9). The comparisons across free blacks, slaves, middle-class whites, and poor whites are intriguing, in large part because the relative health ranking of the groups is so unstable, depending on which component of the health index is under scrutiny.

The next two parts of the book deal with Native Americans, and to a lesser extent with European Americans, in Central and South America. Rebecca Storey, Lourdes Marquez Morfin, and Vernon Smith report on “Social Disruption and the Maya Civilization of Mesoamerica” (Chapter 10). Lourdes Marquez Morfin, Robert McCaa, Rebecca Story, and Andres Del Angel measure “Health and Nutrition in Pre-Hispanic Mesoamerica” (Chapter 11). “Patterns of Health and Nutrition in Prehistoric and Historic Ecuador” (Chapter 12) by Douglas Ubelaker and Linda Newson, and “Economy, Nutrition, and Disease in Prehistoric Coastal Brazil” (Chapter 13) by Walter Alves Neves and Veronica Wesolowski, provide evidence on South American populations. The Central American sites are all pre-Columbian and are all below the sample average in terms of the overall health index. The native populations in South America are more diverse in their outcomes: some appear to be well above the sample average, and others are well below. The extremely high score of “Coastal Brazil” (and some others), however, seems to reflect a quirk of the indexing procedure, which does not attempt to impute values for missing data. All of the South American sites score poorly on the stature measure (when it is available), but Coastal Brazil does not have an estimate for stature, and so its average health score (calculated only using the criteria that are observed) is not pulled down in the same way that other South American population averages are by their low stature measures.

Five papers on Native Americans in North America comprise the next section of the volume. The geographic coverage for North America is extensive, the samples are relatively large, and the data provide rich and varied depictions of life before and after contact with Europeans and Africans (and their diseases). C.S. Larsen, A.W. Crosby, et al. contribute “A Biohistory of Health and Behavior on the Georgia Bight” (Chapter 14). Paul Sciulli and James Oberly report on “Native Americans in Eastern North America” (Chapter 15). Chapter 16 is entitled “Cultural Longevity and Biological Stress in the American Southwest” and written by Ann Stodder, Debra Martin, Alan Goodman, and Daniel Reff. Phillip Walker and Russell Thornton examine “Health, Nutrition, and Demographic Change in Native California” (Chapter 17). Finally, S. Ryan Johansson and Douglas Owsley describe “Welfare History on the Great Plains: Mortality and Skeletal Health, 1650-1900” (Chapter 18).

Chapters 19 and 20 are both written by Steckel and Rose, and both provide useful “big picture” views of the project. Chapter 19 is critical. In it, the authors attempt to discern broad patterns in the health measures, both across groups and over long stretches of time. Historically, Native North Americans in the East, on average, appear to have been relatively healthy compared to other occupants of the Western Hemisphere, including the European Americans. Native Central Americans score at the bottom of the distribution, on average, a few index points below African Americans. If one looks at stature alone, rather than the composite index, African Americans score surprising well — higher than any other group in the sample. Importantly, there appears to have been a decline in Native American health status in the centuries preceding the arrival of Columbus. In the Western Hemisphere, the transition to settled agriculture and the consequent rise of dense, populous settlements, which until fairly recently was celebrated as the basis for subsequent economic and social progress, appears to have been associated with significant declines in the average human’s health. Of course, such a finding does not contradict the eventual benefits of economic development, but it does reinforce a significant caveat to our interpretation of the transition away from hunting and gathering.

Chapter 20 is the editors’ conclusion, a valuable aspect of which is the subsection on “research needs,” essentially a call for refinement of the existing analysis and the collection of more data. Chapter 21 (“The Body as Evidence; The Body of Evidence”), written by George Armelagos and Peter Brown, and Chapter 22 (“Overspecialization and Remedies”) by Philip Curtin, are short, insightful reviews the volume’s evidence, methods, and promise.

I believe that this volume achieves just what the editors and contributors intended. After assembling a large, consistently coded dataset, a valuable contribution by itself, the authors illustrate how the skeletal remains can shed light on the comparative health of populations over very long periods of time. Each chapter is engaging, organized, and likely to spur renewed debate about the specific population under study as well as about the Western Hemisphere’s economic history. I recommend the book highly to anyone interested in Native American history and to anyone interested in long-run demographic trends and turning points.

William J. Collins is the author “Race, Roosevelt, and Wartime Production: Fair Employment in World War II Labor Markets,” American Economic Review, March 2001, and “Exploring the Racial Gap in Infant Mortality Rates, 1920-1970,” NBER Working Paper 8836. Additional details on his work can be found at