A History of Health for Our Time

Humanists, ever more desperate for enrollment and grants, have increasingly embraced the health humanities as an avenue to salvation.  

As more and more students pursue vocational or pre-professional degrees in the health sciences, courses in the literature of pain and illness, medical ethics, and the history of medicine and public health offer a way to appeal to those prospective nurses, health administrators, and doctors who seek a well-rounded background not only in the sciences but in the human and moral dimension of health, illness, and disease.

The health humanities is a field of research, education, and practice that, in the words of The Routledge Companion to Health Humanities, offers “an inclusive, democratizing, activist, applied, critical, and culturally diverse approach to delivering health and well-being….”  It:

  • Interrogates the “relationships between ill health and social equality.” 
  • “Develops humanist theory in relation to health and social care practice.”
  • Accentuates the value of interpretive as opposed to purely quantitative methods in health research.
  • “Foregrounds cultural difference as a resource for positive change in society.”
  • Critically examines “the humanity of an increasingly globalized health-care system.”
  • “Showcases less familiar, prominent, or celebrated” therapies and practices.
  • Demonstrates “the value and health benefits of the arts and humanities.”

In short, the health humanities offer critical perspectives on the health care policy, practice, and medical technologies.  The field compares and contrasts various cultural traditions and their perspectives on health and illness, foregrounds the perspectives of patients, and shows how the applied arts, expressive therapies, and humanistic perspectives (such as narrative medicine or music and arts therapy) can contribute to improvements in physical and mental well-being.  

A successor to the somewhat earlier medical humanities, the health humanities represent something more than a “shift in nomenclature.”  Proponents seek to foreground those groups that tended to be marginalized in the medical humanities and in the practice of medicine itself. Highly attentive to diversity, intersectionality, and inequality, this field attaches a special emphasis on instilling cross-cultural sensitivity, empathy, and compassion in the training of healthcare professionals.

Yet for all the field’s growing visibility, it remains hard to convince many prospective health science majors that courses in the health humanities are as relevant or meaningful as classes in the sociology of health or health informatics or health policy or health economics, let alone biology, chemistry, and physics.

A new book by a classical historian, however, offers a fresh and highly persuasive strategy for engaging students in the bio-medical sciences from a more humanistic perspective.  Kyle Harper’s Plagues Upon the Earth: Diseases and the Course of Human History, which hasn’t received a fraction of the attention it deserves, is much more than a traditional work of medical history.  

To be sure, the book contains a host of familiar stories, but invariably from a novel perspective.  Alongside the most notorious “celebrity” diseases – bubonic plague, chicken pox, cholera, diphtheria, influenza, malaria, measles, mumps, polio, rubella, scarlet fever, smallpox, tuberculosis, typhoid fever, typhus, whooping cough, and yellow fever – are neglected and emerging tropic diseases.  

You will read about the Black Death, Irish Potato Famine, and The Great Bengal Famine, but also a host of other blights and epidemics the world over and why some areas suffered grievously while others were spared.  The heroes of Eurocentric medical science are there – Ehrlich, Fleming, Koch, Jenner, Lister, Pasteur, Sabin, Salk, and many more – but so too are key figures in the history of medicine from China, India, the Islamic Middle East, and sub-Saharan Africa, like Ibn Khaldūn. 

So how is this book distinctive?  In its span and scope which has produced a work that is anything but Eurocentric.  Its data and methodology.  Its lucidity.  Its challenge to traditional historical narratives.  Its attention to the disparate impact of disease and its socio-economic, political, and military consequences. Its attention to the human costs of slavery, contract labor, and colonialism, and of early urbanization, the birth of jails and hospitals, and the military revolution that increased the frequency and scale of armed conflict.  Above all, its emphasis on the transhistorical interplay of demography, ecology, economics, environment, and evolution. 

As the author describes the central theme of his book:  “Human history shapes disease ecology and pathogen evolution, disease ecology and pathogen evolution in turn shape the course of human history.  Our germs are a product of our history, and our history has been decisively patterned by the battle with infectious disease.”

Here are a few of the work’s most notable contributions.

1. It is a truly global history of the infectious, microbial, vector-born, and gastro-intestinal and respiratory diseases and various parasites and pathogens (fungi, helminths, protozoa, bacteria, and viruses) and how they have shaped human history from the Pleistocene era to the present.

2. It takes advantage of the latest findings in evolutionary biology, genetics, genomics, microbiology, palaeopathology, phylogenetics, and primatology to challenge established disease chronologies.

3. It contributes to the scholarship that shows how most human diseases historically originated from wild animals and how domesticates (cows, pigs, sheep, horses, and others) served as evolutionary bridges.

4. It uses the study of archaeological DNA to radically revise disease chronologies, showing, for example, that many diseases we think of as timeless in fact emerged relatively recently.

5. It offers remarkably lucid and intelligible discussions of such difficult subjects as horizontal gene transfer, zoonotic bridges, and other technical topics

6. It is disease, germ, and virus centric, and  is as interested in the impact of disease on plants and animals as upon humans.

7. It challenges the assumption that the history of health and disease prevention is an unambiguous story of progress.

8. It reveals how the impact of and responses to disease are influenced by a particular society’s age structure, population density, geographical distribution, household organization, class organization, technology and modes of production, and political system.

9. It emphasizes disease as a causal agent of historical change with a profound impact on migration patterns, military affairs, religious beliefs, social interactions, state functioning, and warfare. 

The book is filled with fascinating tidbits of information, such as the fact that our chimpanzee cousins “endure only a fraction of the viral diversity that we do,” yet their numbers have long been far smaller.

Although the book is structured chronologically, it is anything but antiquarian.  Its historical narrative shows how “progress,” beginning with farming and animal domestication and later manifest in economic productivity, social arrangements, class differentiation, long-distance trade, and regional and global interconnectedness often contributed to the entry of new pathogens into the human disease pool.  It also demonstrates decisively that the issues it addresses are transhistorical.

Harper is, of course, not the first to try to write a jumbo history of disease and history, and his book begs comparison with William H. O’Neill’s 1975 classic Plagues and Peoples, which stressed the role of global interactions in spreading disease, and Alfred Crosby’s studies of the biological and ecological consequences of the European Age of Discovery. But Harper’s study benefits enormously from recent genetic and archaeological and paleo-archaeological research, and contributes a great deal of nuance to those earlier histories, demonstrating, for example, the role of colonial violence and labor exploitation in indigenous depopulation of the New World.

Harper’s history is also quite unlike Siddhartha Mukherjee’s eloquent, riveting, lucid, even poetic, Pulitzer prize-winning The Emperor of All Maladies: A Biography of Cancer, which, for all its many strengths, is old-fashioned medical history: a chronicle of “epic battles” to “cure, control, and conquer” cancer that focuses largely on the ingenuity, perseverance, and determination, but also the “hubris, paternalism, and misperception,” of generations of surgeons, bedside physicians, and laboratory scientists. 

Works of scholarship as rich and sweeping as Harper’s take many years to research and write, and the book’s spade work began long before the current pandemic.  Although COVID is indeed mentioned, it does not occupy center stage, underscoring one of Harper’s most compelling themes:  That while modernization has, in certain respects, significantly enhanced societies’ ability to cope with infectious diseases, it also creates new opportunities for those diseases to evolve and circulate.  

As Harper’s book concludes: “For scholars who study the past or present of infectious disease, the pandemic was a perfectly inevitable disaster […] its contours predictable, its details essentially random.”

The humanities can indeed contribute substantially to the study of medicine by providing the big picture that those who study a particular era, a society, or a disease are all too likely to miss.  Not every reviewer shares my enthusiasm for Harper’s book.  In the future, others will write about the non-infectious causes of death, including cancer, cardiovascular and degenerative diseases and various chronic disabilities and disorders that account for a growing proportion of deaths in our time, and about the chemical pollutants, additives, and genetic manipulations that impact our health.  But for now, let’s be grateful for what Harper has done. 

By integrating history, demography, economics, evolutionary biology, and genomics into a seamless narrative, he does something that I, for one, have never seen before done so eloquently or persuasively:  He demonstrates that any thorough understanding of health requires the kind of sweeping perspective that the humanities offers.

Steven Mintz is professor of history at the University of Texas at Austin.

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