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Health and the Rise of Civilization
Civilized nations popularly assume that “primitive” societies are poor, ill, and malnourished and that progress through civilization automatically implies improved health. In this provocative book, Mark Nathan Cohen challenges this belief. Using findings from epidemiology, anthropology, and archaeology, Cohen provides fascinating evidence about the actual effects of civilization on health, suggesting that some aspects of “progress” create as many health problems as they prevent or cure.
“[This book] is certain to become a classic―a prominent and respected source on this subject for years into the future…. If you want to read something that will make you think, reflect, and reconsider, Cohen’s Health and the Rise of Civilization is for you.”―S. Boyd Eaton, Los Angeles Times Book Review
“A major accomplishment. Cohen is a broad and original thinker who states his views in direct and accessible prose…. This is a book that should be read by everyone interested in disease, civilization, and the human condition.”―David Courtwright, Journal of the History of Medicine
“Cohen has done his homework extraordinarily well, and the coverage of the biomedical, nutritional, demographic, and ethnographic literature about foragers and low energy agriculturalists is excellent…. The book deserves a wide readership and a central place in our professional libraries. As a scholarly summary it is without parallel.”―Henry Harpending, American Ethnologist
“Deserves to be read by anthropologists concerned with health, medical personnel responsible for communities, and any medical anthropologists…. Indeed, it could provide great profit and entertainment to the general reader.”―George T. Nurse, Current Anthropology
“[This book] is certain to become a classic―a prominent and respected source on this subject for years into the future…. If you want to read something that will make you think, reflect, and reconsider, Cohen’s Health and the Rise of Civilization is for you.”―S. Boyd Eaton, Los Angeles Times Book Review
“A major accomplishment. Cohen is a broad and original thinker who states his views in direct and accessible prose…. This is a book that should be read by everyone interested in disease, civilization, and the human condition.”―David Courtwright, Journal of the History of Medicine
“Cohen has done his homework extraordinarily well, and the coverage of the biomedical, nutritional, demographic, and ethnographic literature about foragers and low energy agriculturalists is excellent…. The book deserves a wide readership and a central place in our professional libraries. As a scholarly summary it is without parallel.”―Henry Harpending, American Ethnologist
“Deserves to be read by anthropologists concerned with health, medical personnel responsible for communities, and any medical anthropologists…. Indeed, it could provide great profit and entertainment to the general reader.”―George T. Nurse, Current Anthropology
296 pages, Paperback
First published September 10, 1989
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March 23, 2015
The emergence of agriculture and civilization represented an astonishing advance for humankind. Or did it? A growing number of people are raising questions about this cherished belief. Mark Nathan Cohen, an anthropology professor, wrote Health & the Rise of Civilization to shine a light on the history of human health. His book is fascinating.
Hunter-gatherers did not enjoy perfect health, but they were vulnerable to far fewer maladies than people in agricultural societies. In hunter society, dying from accidents was common. Intestinal parasites were common, and hunters were vulnerable to zoonotic diseases, which could use humans and other animals as hosts, but couldn’t be transmitted from human to human. Diseases that could be transmitted from human to human were rare. Cancer, heart disease, and other degenerative diseases were very rare, as was starvation.
There are scientists who study the health of dead folks via their bones or mummified remains. Their research reveals that big game hunters were the best nourished group in human history. Animal foods are the best source of complete proteins, and they are rich in other nutrients. When big game declined, we shifted to intensified foraging, and hunted for small game. The people of this new phase were shorter and experienced more infections.
With the shift to farming, the quality of our health plunged. Infection rates doubled at some Illinois sites. Tuberculosis became common. Intestinal parasites increased. Reduced nutrition led to shorter people. Life expectancy did not increase.
Wild hunter-gatherers were nomadic. They frequently packed up and moved, leaving their excrement behind. Wild grazing animals were also nomadic. When they needed more vegetation, they moved on, leaving their excrement behind. The nomadic life had two advantages — animals were free to move in pursuit of better nutrition, and by moving they left behind the risks of acquiring the diseases of filth and confinement.
Farmers, on the other hand, spent their lives in one place, in denser populations, and their excrement remained on location. This delighted fecal-oral diseases. Farmers often confined numerous domesticated animals, which converted plant material into excrement that also accumulated on the farm. Thus, the farm was transformed into a treasure chest of pathogens, worms, and intestinal parasites. Domesticated animals suffered from diseases that were rare or unknown in wild animals.
The farm was home to a mixture of species: cattle, goats, sheep, pigs, horses, dogs, waterfowl, and poultry. By keeping multiple species in close proximity, we encouraged the transfer of diseases from one species to another. Humans acquired livestock diseases like measles, smallpox, influenza, diphtheria, and the common cold.
Living in permanent homes with stored food led to frequent visits from hungry rodents and insects, who sometimes carried pathogens. Living indoors made it easier for contagious illness to spread from person to person.
Malaria and yellow fever were originally treetop diseases of non-human primates, but they spread to humans as farmers cleared forests. Malaria is rare among nomadic people, but common in farming societies. It is especially serious where farmers grow rice in flooded paddies (mosquito incubators). Some believe that malaria has killed more people than any other disease.
Growing civilizations typically created extensive trading networks. Trade and travel spread many diseases to new regions where the inhabitants had no immunity. These include bubonic plague, smallpox, and tuberculosis. Speedy new steam ships and locomotives enabled cholera to spread explosively in the last 200 years, killing millions.
Hunters enjoyed a diverse and nutritious diet, and farmers didn’t. The farm diet majored in cereals and tubers that were rich in calories but contained fewer nutrients. This diet often lead to illnesses from mineral and vitamin deficiencies — pellagra, anemia, thyroid problems. Tooth decay was almost unknown among hunters, but cavities are a common problem for people who consume gummy cereal foods and sugar.
The spread of disease closely followed the spread of civilization, and the growth of population centers. Measles originated in cattle. It couldn’t survive in human communities of less than 500,000 people, because there were not enough babies to provide an adequate supply of new hosts. Thus, measles is a new disease for humans. I was surprised to learn that there was little contagious disease prior to the shift to agriculture.
Modern people tend to be physically inactive, and consume generous portions of calorie-intense processed foods that are very low in fiber — an excellent recipe for obesity. The twentieth century witnessed the emergence of degenerative diseases that had previously been rare — cancer, heart disease, diabetes, etc. It seems that most of the amazing technology of modern medicine is used to counteract the unintended consequences of the rise of civilization. With seven billion people, vast numbers of confined livestock and poultry, a high-speed global transportation system, and a growing number of drug-resistant pathogens, the conditions are perfect for the creation and spread of catastrophic pandemics.
The idea of “progress” first appeared around 1800, and it proudly celebrated recent improvements over the horrid life of the 14th to 18th centuries. Cohen said that the people of this dark era “may have been among the nutritionally most impoverished, the most disease-ridden, and the shortest-lived populations in human history.” Members of the progress faith incorrectly projected this horror farther back, to include healthy, well-nourished prehistoric hunters.
Cohen concluded that our beliefs in the benefits of civilization are in need of revision, because civilization did not make life better for most people.
Hunter-gatherers did not enjoy perfect health, but they were vulnerable to far fewer maladies than people in agricultural societies. In hunter society, dying from accidents was common. Intestinal parasites were common, and hunters were vulnerable to zoonotic diseases, which could use humans and other animals as hosts, but couldn’t be transmitted from human to human. Diseases that could be transmitted from human to human were rare. Cancer, heart disease, and other degenerative diseases were very rare, as was starvation.
There are scientists who study the health of dead folks via their bones or mummified remains. Their research reveals that big game hunters were the best nourished group in human history. Animal foods are the best source of complete proteins, and they are rich in other nutrients. When big game declined, we shifted to intensified foraging, and hunted for small game. The people of this new phase were shorter and experienced more infections.
With the shift to farming, the quality of our health plunged. Infection rates doubled at some Illinois sites. Tuberculosis became common. Intestinal parasites increased. Reduced nutrition led to shorter people. Life expectancy did not increase.
Wild hunter-gatherers were nomadic. They frequently packed up and moved, leaving their excrement behind. Wild grazing animals were also nomadic. When they needed more vegetation, they moved on, leaving their excrement behind. The nomadic life had two advantages — animals were free to move in pursuit of better nutrition, and by moving they left behind the risks of acquiring the diseases of filth and confinement.
Farmers, on the other hand, spent their lives in one place, in denser populations, and their excrement remained on location. This delighted fecal-oral diseases. Farmers often confined numerous domesticated animals, which converted plant material into excrement that also accumulated on the farm. Thus, the farm was transformed into a treasure chest of pathogens, worms, and intestinal parasites. Domesticated animals suffered from diseases that were rare or unknown in wild animals.
The farm was home to a mixture of species: cattle, goats, sheep, pigs, horses, dogs, waterfowl, and poultry. By keeping multiple species in close proximity, we encouraged the transfer of diseases from one species to another. Humans acquired livestock diseases like measles, smallpox, influenza, diphtheria, and the common cold.
Living in permanent homes with stored food led to frequent visits from hungry rodents and insects, who sometimes carried pathogens. Living indoors made it easier for contagious illness to spread from person to person.
Malaria and yellow fever were originally treetop diseases of non-human primates, but they spread to humans as farmers cleared forests. Malaria is rare among nomadic people, but common in farming societies. It is especially serious where farmers grow rice in flooded paddies (mosquito incubators). Some believe that malaria has killed more people than any other disease.
Growing civilizations typically created extensive trading networks. Trade and travel spread many diseases to new regions where the inhabitants had no immunity. These include bubonic plague, smallpox, and tuberculosis. Speedy new steam ships and locomotives enabled cholera to spread explosively in the last 200 years, killing millions.
Hunters enjoyed a diverse and nutritious diet, and farmers didn’t. The farm diet majored in cereals and tubers that were rich in calories but contained fewer nutrients. This diet often lead to illnesses from mineral and vitamin deficiencies — pellagra, anemia, thyroid problems. Tooth decay was almost unknown among hunters, but cavities are a common problem for people who consume gummy cereal foods and sugar.
The spread of disease closely followed the spread of civilization, and the growth of population centers. Measles originated in cattle. It couldn’t survive in human communities of less than 500,000 people, because there were not enough babies to provide an adequate supply of new hosts. Thus, measles is a new disease for humans. I was surprised to learn that there was little contagious disease prior to the shift to agriculture.
Modern people tend to be physically inactive, and consume generous portions of calorie-intense processed foods that are very low in fiber — an excellent recipe for obesity. The twentieth century witnessed the emergence of degenerative diseases that had previously been rare — cancer, heart disease, diabetes, etc. It seems that most of the amazing technology of modern medicine is used to counteract the unintended consequences of the rise of civilization. With seven billion people, vast numbers of confined livestock and poultry, a high-speed global transportation system, and a growing number of drug-resistant pathogens, the conditions are perfect for the creation and spread of catastrophic pandemics.
The idea of “progress” first appeared around 1800, and it proudly celebrated recent improvements over the horrid life of the 14th to 18th centuries. Cohen said that the people of this dark era “may have been among the nutritionally most impoverished, the most disease-ridden, and the shortest-lived populations in human history.” Members of the progress faith incorrectly projected this horror farther back, to include healthy, well-nourished prehistoric hunters.
Cohen concluded that our beliefs in the benefits of civilization are in need of revision, because civilization did not make life better for most people.
December 24, 2020
This is a book that's filled with fascinating and overwhelmingly convincing information. At 142 pages, it took me longer to read than I thought it would, mostly because I am a sucker for completion and was often interrupted in my reading by the frequently interesting endnotes. The info got repetitive after awhile, however, which left me skimming a decent portion of the end of the book.
Cohen is basically positing -- based on studies of contemporary hunter-gatherer tribes (such as the San in Africa) as well as archaeological/paleological records of bones at ancient hunter-gatherer sites -- that "primitive" hunter-gatherer life was neither as impoverished as many pro-civilization advocates would like to believe nor as peaceful and bucolic as many late 20th-century anthropologists would like to fantasize. The majority of the information that Cohen presents (mainly by citing dozens or hundreds of archaeological and anthropological studies) focuses more on the former claim than the latter.
Anyone short on time can read the great final chapter which sums up the conclusions of the entire book: Hunter-gatherers were generally more nourished, less sick, and living longer than any of their agricultural descendants. They endured periods of "stress" related to diminished food supply but due to their mobility very seldom experienced any famines as severe as those that would come in more "civilized" times. They suffered from parasitic infections due to contaminated water and food, but almost never anything as significant or crippling as the nutritive deficiencies and epidemic viruses that would come later.
It would take civilization until the 19th or 20th century to produce a citizenry as healthy as the "primitives" they replaced thousands of years before. Indeed, the idea that hunter-gatherers were impoverished is an opinion that can only be validated by comparing them to modern-day humans, because they were actually more affluent than any humans in history prior to the 19th century.
Cohen's main point seems to be that the idea that we "progressed" and evolved out of hunter-gathering due to technological breakthrough gets the cause and effect mixed up. Really, because hunter-gathering was producing diminished returns after populations began to grow and food sources became scarce, agriculture was something they turned to out of necessity, even though it meant a less nutritious diet overall.
It may be a subtle difference, but it's significant. Technology is not the cause of our evolutionary progress, but rather the result of very trying circumstances. And it did not improve our lives as much as we often like to think, since it brought with us food instability and epidemic disease. Only since the breakthrough of modern medicine (itself a response to horrible living conditions in the 14th-18th centuries) have we improved our lifestyle in relation to our ancient ancestors.
Not Bad Reviews
@pointblaek
Cohen is basically positing -- based on studies of contemporary hunter-gatherer tribes (such as the San in Africa) as well as archaeological/paleological records of bones at ancient hunter-gatherer sites -- that "primitive" hunter-gatherer life was neither as impoverished as many pro-civilization advocates would like to believe nor as peaceful and bucolic as many late 20th-century anthropologists would like to fantasize. The majority of the information that Cohen presents (mainly by citing dozens or hundreds of archaeological and anthropological studies) focuses more on the former claim than the latter.
Anyone short on time can read the great final chapter which sums up the conclusions of the entire book: Hunter-gatherers were generally more nourished, less sick, and living longer than any of their agricultural descendants. They endured periods of "stress" related to diminished food supply but due to their mobility very seldom experienced any famines as severe as those that would come in more "civilized" times. They suffered from parasitic infections due to contaminated water and food, but almost never anything as significant or crippling as the nutritive deficiencies and epidemic viruses that would come later.
It would take civilization until the 19th or 20th century to produce a citizenry as healthy as the "primitives" they replaced thousands of years before. Indeed, the idea that hunter-gatherers were impoverished is an opinion that can only be validated by comparing them to modern-day humans, because they were actually more affluent than any humans in history prior to the 19th century.
Cohen's main point seems to be that the idea that we "progressed" and evolved out of hunter-gathering due to technological breakthrough gets the cause and effect mixed up. Really, because hunter-gathering was producing diminished returns after populations began to grow and food sources became scarce, agriculture was something they turned to out of necessity, even though it meant a less nutritious diet overall.
It may be a subtle difference, but it's significant. Technology is not the cause of our evolutionary progress, but rather the result of very trying circumstances. And it did not improve our lives as much as we often like to think, since it brought with us food instability and epidemic disease. Only since the breakthrough of modern medicine (itself a response to horrible living conditions in the 14th-18th centuries) have we improved our lifestyle in relation to our ancient ancestors.
Not Bad Reviews
@pointblaek
April 12, 2019
A short and clear read about how just because modern systems are great to displace other systems, they are not necessarily the best way for us humans to organize. It displaces some myths about our improved health and nutrition and the poor lives of 'primitives'. I think it's a great book but because it is written in the 80s a lot of the information needs updating and some of the arguments in the Paleopathological and Skeletal evidence section have been debunked.
January 31, 2012
Cohen effectively and with great clarity and insight marshals a legion of scholarship to paint the complex interactions between human health and social changes over the past ~15,000 years. He delves deep into each question (largely in footnotes, preserving a relatively simple narrative for those less interested) and never oversimplifies or jumps to unwarranted conclusions from the data. While trends are complex and there are lots of (very interesting) exceptions, the trend he finds in this search shows that health, in terms of nutrition and infectious disease, has declined substantially from nomadic forager groups through modern civilization, with the exception of recent, fossil-fuel subsidized wealthy elites. While we are the great exceptions to the trend (the first population to avoid starvation entirely, to contain many serious epidemic diseases, and to supplement our nutrition with science and/or petrochemicals) we have paid great prices and the benefits are felt only by a relative few.
One of the most interesting things pointed out in the book is the "Germs" from Jared Diamond's opus. Civilizations have high population densities and foster lots of disease, which makes them a reservoir and source for those diseases, and at the same time makes them relatively immune to their effects due to exposure. So civilized peoples have some great advantages here in the struggles for land their use patterns seem to create nearly inevitably.
The class differences in civilized benefits are mentioned throughout but never explored in detail - I imagine that many of the complex trends he observes might become more clearly declensionist if elites are excluded. It would be interesting to see such a research project, though it might be impossible.
The data itself is rather dull, almost inevitably (who wants to read 30 pages of bone stuff?). But the conclusions are interesting, as is the impressionistic picture one gets of changing diets and the complex interactions between environment and health.
I think Cohen is a really excellent scholar and a good writer, and I've enjoyed reading both of his books quite a lot. Both have given me a very nicely expanded view of prehistorical societies and the complexity of their evolutions.
One of the most interesting things pointed out in the book is the "Germs" from Jared Diamond's opus. Civilizations have high population densities and foster lots of disease, which makes them a reservoir and source for those diseases, and at the same time makes them relatively immune to their effects due to exposure. So civilized peoples have some great advantages here in the struggles for land their use patterns seem to create nearly inevitably.
The class differences in civilized benefits are mentioned throughout but never explored in detail - I imagine that many of the complex trends he observes might become more clearly declensionist if elites are excluded. It would be interesting to see such a research project, though it might be impossible.
The data itself is rather dull, almost inevitably (who wants to read 30 pages of bone stuff?). But the conclusions are interesting, as is the impressionistic picture one gets of changing diets and the complex interactions between environment and health.
I think Cohen is a really excellent scholar and a good writer, and I've enjoyed reading both of his books quite a lot. Both have given me a very nicely expanded view of prehistorical societies and the complexity of their evolutions.
January 14, 2013
The book is a comparative study across different subjects (archeology, antropology, paleopathology) that shows why we have been forced to become civilized and what we have lost in terms of health.
The note section is about half of the book and for a full understanding is advised to read it fully.
The text is technical, consequently some sections could not be easy to be read from the general public.
The note section is about half of the book and for a full understanding is advised to read it fully.
The text is technical, consequently some sections could not be easy to be read from the general public.
June 30, 2020
I read this for my Medical Anthropology in Biocultural Perspective class, and truthfully it was very dry. Cohen seemed to be summarizing evolutionary and social trends much too broadly and covering too much thematic ground, so by the end I wasn't really sure what, if any, material I had actually learned, even though I was focused while reading. I probably wouldn't have finished it except that I had to.
February 25, 2010
Cohen sets out to answer the simple question "are people healthier now than they were in the past?" using scientific rigor, and the answers he uncovers will change how you perceive the condition of modern man.
Displaying 1 - 7 of 7 reviews