Child Well-Being: Anthropological Perspectives 18

Edward G. J. Stevenson and Carol M. Worthman

18.1 Introduction

Anthropology commonly is regarded as the study of human origins or exotic cultures, but in fact, its remit embraces all aspects of humanity. It is distinguished from other social sciences, conceptually, by its attention to both culture and biology and their interaction on the timescales of evolution, history, and the individual lifespan, and methodologically, by a tradition of ethnographic ﬁeldwork conducted among diverse populations. Anthropological study of children occupies a special place in the discipline, as it engages with issues from the evolution of the life course to how culture is acquired during the earliest years. A lapse in attention to children and childhood by mainstream anthropology in recent decades has been balanced by a current surge of interest in the place of children in society and appreciation of the value of anthropological studies for understanding child well-being (Bluebond- Langner and Korbin 2007; Lancy 2008). Unfortunately, major recent reviews of threats to child welfare and how to ameliorate them (Grantham-McGregor et al. 2007; Engle et al. 2007; Walker et al. 2007, 2011) have largely overlooked anthropological contributions – and particularly the importance of culture as a determinant of both socioeconomic conditions and local deﬁnitions of well- being. In this chapter, we discuss anthropological perspectives that advance

E.G.J. Stevenson (*) Department of Anthropology, University College London, London, UK e-mail: [email protected] C.M. Worthman Laboratory for Comparative Human Biology, Department of Anthropology, Emory University, Atlanta, GA, USA e-mail: [email protected]

A. Ben-Arieh et al. (eds.), Handbook of Child Well-Being, 485 DOI 10.1007/978-90-481-9063-8_20, # Springer Science+Business Media Dordrecht 2014 486 E.G.J. Stevenson and C.M. Worthman understanding of child well-being by engaging the places and possibilities that various societies provide for children. The chapter is structured as follows: First, we summarize how culture constitutes a basic and unique feature of human childhood and child care and is therefore a necessary concept for modeling child development and well-being. Then, we describe models that anthropologists have used to explain variation in child development and well-being. Next, we consider the ways these models add to our understanding of how ongoing transitions in vital rates, education, nutrition and disease, and politics, economics, and ecology are affecting child well-being worldwide. Finally, we describe policy implications and suggest future research directions. Our broad aims are to demonstrate the value of anthropological approaches for understanding and promoting child well-being and to illustrate the kinds of research needed to test hypotheses derived from anthropological models.

18.2 Shared and Variable Features of Human Childhood

Underpinning the anthropological approach to child well-being is a set of observations about children in relation to other species. One observation is that humans are distinctive vis-a`-vis their nearest living relatives, the chimpan- zees and gorillas, in how long they remain dependent on caregivers. Whereas other primates begin to locomote early and receive only milk from their mothers, humans are unable to walk until they are nearly a year old and rely on adults for provision of food until maturity (Pereira and Fairbanks 2002). Another basic observation is that the circumstances of child-rearing among humans are tremendously diverse, ranging across almost all the world’s terrestrial ecosystems and including social contexts from small, mobile, and relatively egalitarianforaginggroupstodenseurban neighborhoods characterized by great inequality. Together, these two features – prolonged dependence and environmental variation – have important consequences for human development and well- being. During the prolonged juvenile phase, both the nervous system and the immune system – which are characterized by immense complexity and mediate critical social and ecological relations – rely on or are sensitive to environmental cues that are expectable features of experience. For example, children acquire cultural concepts through exposure to the language-using community in which they grow up (Ochs and Schieffelin 1986), and they acquire immunocompetence via early exposures to pathogens and irritants (reviewed in McDade 2005). Behavioral patterns, including diet, are often shared at the level of the local group; and risks and opportunities for healthy development also vary signiﬁcantly at this level. Accounting for environmental variation therefore is crucial for deriving more valid, generalizable models of child development and well-being. 18 Child Well-Being: Anthropological Perspectives 487

Table 18.1 Four major dimensions of child well-being studied by anthropologists Health Relationships Nutrition and growth (Eveleth and Tanner Attachment/anxiety (Hrdy 2005; LeVine and 1990; Martorell et al. 2010) Norman 2001) Food/water security (Dettwyler 1993; Hadley Social relations (Hinde 1987; Whiting and and Wutich 2009; Stevenson et al. 2012) Edwards 1988) Morbidity (Bentley et al. 1991) Sexual mores (Mead 1928; Herdt 1989) Mortality (Hill and Hurtado 1996; Kaplan Freedom of choice and action (Lancy 2008; et al. 1995) Panter-Brick 2002)

Stress/suffering Competence Early stressors (Landauer and Whiting 1981; Knowledge/learning (Blurton Jones and Konner Kuzawa 1998) 1976; Boyd and Richerson 1985; Richerson et al. 2010) Biocultural mediators (Worthman et al. 2010) Psychomotor development (Chisholm 1983; Adolph et al. 2010) Subjective well-being (Izquierdo 2005; Play (Norbeck 1974; Schwartzman 1976; Bock Godoy et al. 2009; Kohrt et al. 2011) and Johnson 2004)

18.2.1 Problems and Goals in the Anthropology of Well-Being

In anthropology, research relevant to child well-being has been carried out both by cultural anthropologists, who have tended to focus on children’s linguistic, moral, and psychological development, and by biological anthropologists, who have tended to focus on mortality, physical growth and maturation, and stress. Although we cannot hope to represent the whole range of topics that anthropologists have addressed in relation to child well-being, Table 18.1 reflects the diversity of relevant concerns, under the headings of health, relationships, competence, and stress or suffering. Work by both cultural and biological anthropologists has acted as a check against the assumption that Western standards of human development (including developmental tempo and markers of competence) apply to all humanity (see Mead 1928; LeVine and White 1986; Henrich et al. 2010). Ethnography, the hallmark method of anthropology, which combines interview and observation of naturalistic behavior, often over long periods of time, can provide windows into child development in cultural context and accommodates rich description of multiple dimensions of well-being (LeVine 2007). Ethnography may expose unexpected relationships between environments of child-rearing and outcomes in terms of well-being. For example: • Among the Yoruba of Nigeria, parents provide only very small amounts of meat or fish to their children, for fear of spoiling their alafia, “a [concept of] well- being that includes physical health, peace of mind, material prosperity, [and] harmonious relationships” (Zeitlin 1996: 410). • Among the Gusii of Kenya, minimal verbal interaction between parents and children, and consistent withholding of praise, serves as part of a socialization strategy that promotes obedience and responsibility, without any apparent harm to children’s self-esteem (LeVine et al. 1994). 488 E.G.J. Stevenson and C.M. Worthman

• Among the Matsigenka of the Peruvian Amazon, physical health has improved over the past three decades, but the commonness of sorcery accusations (a marker of social cohesion and trust) has increased (Izquierdo 2005). One goal of anthropology is to explain such apparently paradoxical relationships between environments and outcomes by taking into account the cultural context – and especially local systems of meanings and expectations about what it is to be a person and to lead a good life (LeVine and White 1986; D’Andrade 1992; Shweder 1996; Markus and Kitayama 1998). This requires close attention to indigenous concepts, which may often be difficult to translate. A more ambitious and elusive goal of anthropology is to identify regularities in well-being across cultures and through time. This enterprise, contrastingly, requires broad definitions of well-being that apply to many cultures. For the purposes of this effort, we may assume that well-being everywhere partially corresponds with physical health and that it is dependent on a set of basic capacities in the individual (e.g., adequate nutritional status) and on social supports (e.g., nurturing relationships). These two complementary goals of anthropology are reflected in two, overlapping families of models that we describe below – one aimed at explaining well-being in cultural context, and the other at explaining variation in well-being across cultures. An assumption common to both approaches is that while much variation in child well- being may be determined by culture, other influences – such as differences in childcare arrangements within the same cultural community and processes such as globalization that affect many cultural groups – are also important. Integrating these multiple levels of influence, and accounting for their compound effects on child well-being, constitutes a major theoretical challenge. In the following sections, we examine anthropological models that seek to achieve this integration; we then look at how these models may help us understand the effects of historical changes on child well-being.

18.3 Anthropological Models of Child Development and Well-Being

It is well-established that in contemporary societies characterized by socioeconomic stratiﬁcation, poverty and low levels of parental education are among the clearest predictors of deﬁcits in children’s health and development (Grantham- McGregor et al. 2007; Marmot et al. 2008). Anthropologists recognize that in societies with alternative institutions and systems of subsistence, wealth and formal schooling may matter less. As such, they have sought to devise theories of human development that are applicable not only to contemporary industrial societies but also across a broad spectrum, from hunter-gatherer bands through modern states. These models fall into two classes: heuristic models to be applied within particular cultures and predictive models to be applied across time or across cultures.1

1The distinction between these orientations broadly corresponds to that between cultural psychology and cross-cultural psychology (Shweder et al. 1998). 18 Child Well-Being: Anthropological Perspectives 489

Table 18.2 Anthropological models of child development/well-being Heuristic Key independent models variables Dependent variables References Ecocultural Everyday activities, Child well-being Weisner 1998; 2002 routines Developmental Settings, customs, Child health and Super and Harkness 1986 niche caretaker psychology, development endogenous factors Cultural Evolutionary, Childcare arrangements LeVine et al. 1994 mediation economic-demographic, and cultural factors Predictive models Discordance Paleolithic material and Resource allocation Konner and Eaton 2010; biosocial environments across the life course, Kuzawa and Thayer 2011 versus chronic disease later environments Developmental Early life experience, Later function, McDade 2005; ecology maternal early life nutritional status Worthman 1999, 2009 experience, trade-offs in resource allocation Embodied Requirements for adult Parental investment Kaplan 1994; capital competence Kaplan and Gurven 2006 Ecosystem Ecosystem services, Child well-being MEA 2005 (adapted) dynamics human macroecology, child’s microecology

Heuristic models propose a set of critical variables that affect child well-being within a given ecological context and suggest frameworks for tracking causal relationships among them. Predictive models support formulation of hypotheses about improvement or deterioration of well-being resulting from postulated effects of change in particular social or ecological variables. The term “predictive” does not necessarily imply the validity of the predictions the models make about child well-being but the logical coherence of the predictions on the basis of the models’ premises. A selection of both types of models and the key variables they address are given in Table 18.2. Evaluating the usefulness of each of these models requires data from multiple cultures. Commonly, heuristic models have been developed through research comparing child development and well-being in two cultural contexts: the ecocultural model to help explain the way parents of disabled children in California, versus parents of children without developmental disabilities, adapt to their children’s needs (Weisner 1997, 2002); the developmental niche model by long-term study of Kipsigis families in Kenya and American families in New England (Super and Harkness 1986); and the cultural mediation model through comparative study of Kenyan Gusii and white middle-class American infants (LeVine et al. 1994). These three models unpack the logic of local socialization practices into widely applicable categories; they therefore function as “middle-range” theories providing 490 E.G.J. Stevenson and C.M. Worthman concrete bases for investigating how pathways of interaction among speciﬁc cultural factors shape trajectories of child development and well-being (Worthman 2010).2 In the next section, we brieﬂy describe each of these heuristic models in turn, focusing on the independent variables that they prioritize, and the outcomes they seek to explain.

18.3.1 Heuristic Models of Child Development and Well-Being

18.3.1.1 The Ecocultural Model The ecocultural model (Weisner 1997, 2002) specifies child well-being as an explicit outcome, defined as “the ability to successfully, resiliently, and innova- tively participate in the routines and activities deemed significant by a cultural community” (Weisner 1998: 75). Child well-being in this formulation varies in definition from culture to culture but in each case is the product of everyday routines that are stable and predictable, display appropriate fit to the ecological context, serve to balance competing interests among family and other community members, and are meaningful to children and caregivers (Weisner 2002). Distinc- tively, the ecocultural model was developed together with a semi-structured interview protocol, the Ecocultural Family Interview, the transcripts of which can be coded to produce a “well-being score” for families. Variation in the ability of families in the United States to sustain daily routines that effectively coordinate and meet the needs of family members has been investigated to understand the effects of stress or policy interventions on child outcomes (Weisner et al. 2005; Fuligni and Hardway 2006). Distinctively, the ecocultural model therefore can be used for modeling variation in child well-being at the subcultural level and even at the level of individual households.

18.3.1.2 The Developmental Niche The developmental niche model was initially conceived to explain variation in child development across cultures (Super and Harkness 1986). It was subsequently expanded to research on child health (Harkness and Super 1994) and may also be applied to well-being. In this model, the key independent variables are settings, customs, caretaker psychology, and endogenous factors in the child (Super and Harkness 1986). Settings comprise the physical and social circumstances of children, being the backdrop and cast of players in the child’s world (which include family poverty or wealth and the number of available caregivers); customs comprise behavior patterns for dealing with children that are not subject to conscious, rational evaluation (e.g., ways of carrying a child or managing his sleep habits); caretaker psychology comprises the beliefs and goals that inform parental strategies for child-rearing (e.g., beliefs that infants are naturally fragile or resilient, naturally

2For graphical representations of the ecocultural and developmental niche models, see Worthman 2010, Figs. 2 and 3. 18 Child Well-Being: Anthropological Perspectives 491 naughty or nice); and endogenous factors in the child consist of congenital and epigenetic characteristics that independently influence child development and also influence caretakers as well as the settings in which children are placed (e.g., infant temperament). The developmental niche model has stimulated a great deal of research (Harkness 1992; Bronfenbrenner 1999; Harkness and Super 1996, 2005; Greenfield et al. 2003) and has proven useful in understanding variation in inci- dence of respiratory infections among the Kipsigis (Super et al. 1994), gendered care and child nutrition among Hagahai of Papua New Guinea (DeCaro et al. 2010), parental knowledge and child health among Tsimane´ of Bolivia (McDade et al. 2007), and markers of stress and cardiovascular regulation in middle-class urban American children (DeCaro and Worthman 2008a, b).

18.3.1.3 The Cultural Mediation Model The cultural mediation model acknowledges the importance of evolutionary design, economic-demographic pressures, and cultural scripts as influences on the social organization of childcare. The model also recognizes that each of these influences is “underdetermining,” that is, that each on its own fails to explain childcare practices in any community (LeVine et al. 1994: 20). In their longitudinal study of infant development among the Gusii of Kenya, LeVine and colleagues observed that care practices in the first years of life – in communities comprised of polygynous households organized around the economic goals of smallholder farming – made different use of universal human potentials than do Western populations. Employing analogies from computing, LeVine and colleagues suggest that Gusii and American approaches to childcare are each the product of organic hardware supplied by natural selection, ecological firmware representing prevailing economic and demographic conditions, and cultural software including values and beliefs about appropriate and efficient parenting. While none of these “wares” determines the others, each ought ideally to be balanced with the others to produce an “optimal parental investment strategy” calibrated to prevailing conditions (LeVine et al. 1994:17).

All three of these models are effective in explaining variation in well-being within particular cultures. They expose culturally distinct logics that govern children’s social position and welfare at speciﬁc places and times. But they are less suitable for the other goal of an anthropology of well-being—that is, identifying regularities in well-being across cultures and through time. Insights from human evolution and developmental ecology provide potential for progress toward this goal.

18.3.2 Predictive Models of Child Development and Well-Being

18.3.2.1 The Discordance Model For the majority of humanity’s history, the primary means of subsistence was hunting and gathering; humans may therefore be adapted by natural selection to the diets and social arrangements of our hunter-gatherer ancestors (Kingston 2007). Skeletal analysis of ancient populations undergoing transition from foraging to 492 E.G.J. Stevenson and C.M. Worthman agrarian lifestyles has demonstrated deterioration in population health accompany- ing the transition (Cohen and Armelagos 1984; Swedlund and Armelagos 1990; Pinhasi and Stock 2011). These observations led to the hypothesis that discordances between evolutionarily expected environments and recent environments of historical experience – including high population density, high-energy and high-fat diets, and sedentary lifestyles – may be underlying causes for modern epidemics of obesity, chronic disease, and mental illness (Burkitt 1973; Trevathan et al. 2008; Konner and Eaton 2010). If diets and social arrangements congruent with hunter-gatherer norms are optimal for child well-being, then we should expect to see superior child well-being associated with hunter-gatherer biosocial traits such as egalitarianism and dietary diversity. A recent proposal congruent with this model is that humans are characterized by cooperative breeding, with dense networks of kin sharing in childcare, and that shifts toward the nuclear family might cause psychobehavioral pathology (Hrdy 2005, 2009; cf. Hill and Hurtado 2009).

18.3.2.2 The Developmental Ecology Model Related to the discordance model, developmental ecology models focus on life course trade-offs in developmental design (Worthman 1999; Kuzawa 2007). The developmental ecology model posits evolved developmental sensitivities speciﬁcally keyed to environmental conditions that, over human evolutionary history, have provided reliable information about circumstances and constraints that the developing child will face. Information derived from early experience drives developmental pathways in functional systems as well as the regulation of resource allocation among growth, maintenance, and reproduction (Gluckman and Hanson 2006). In one case study in France, low birth weight was associated with later propensity to lay down fat reserves, as if in anticipation of food shortages in later life (the “thrifty phenotype” hypothesis) (Meas et al. 2008). Other relevant parameters include immune development (key to maintenance and survival), which relies on exposures from birth onward and is aided by buffering from breastfeeding (McDade 2005); erosion of breastfeeding practices has been linked to enduring changes in immune activity (McDade et al. 2001; Morass et al. 2008). Similarly, current explanations for increases in the prevalence of asthma point to disruption of early exposures to pathogens and parasites on which development of balanced immune function has evolved to rely (Altmann 2009; Raison et al. 2010). A leading edge of research in developmental ecology focuses on how experi- ences in early childhood (in addition to maternal-fetal and infant conditions) may play a role in shifting psychobehavioral development to adversity or advantage (Worthman et al. 2010) and on how gene-environment interactions (Worthman 2009) as well as environmentally responsive phenotypic plasticity (Kuzawa and Sweet 2009) affect child well-being. Ecologically driven psychobiological effects that accumulate over development and across generations offer powerful insights into the bases of health inequalities, as conditions of poverty, discrimination, or privilege drive biological differences that form the grounds of health disparities (Worthman and Kuzara 2005; Gravlee 2009). The power of evolutionary and 18 Child Well-Being: Anthropological Perspectives 493 developmental ecological models to propose fruitful hypotheses explaining major trends in human health has drawn widespread interest to these approaches.

18.3.2.3 Embodied Capital Drawing on concepts from economics and evolutionary biology, Kaplan and colleagues developed the model of embodied capital to explain variation in parental investment in relation to environmental factors (Kaplan et al. 1995, 2000). Embod- ied capital captures the sum of physical and psychobehavioral conditions and capacities that determine an individual’s current and future survival and productivity (Kaplan et al. 2000; Kaplan and Gurven 2006). According to this model, the intensity of parental investment per child will correspond to parents’ perceptions of the embodied capital that their children need for current and future survival and productivity, conditioned on the parents’ own resources and welfare. To the extent that child well-being is determined by the intensity of parental investment, this model offers some promise of predicting variation in child well-being. Where risks to survivorship are high and parent resources are scarce, parents should emphasize producing more children whose embodied capital just sufﬁces for survival and childbearing; where risks to survivorship are low and parental resources are plen- tiful, parents should emphasize producing fewer children with higher embodied capital, particularly where they perceive that their children’s success increases directly with embodied capital (Kaplan 1994). Empirical analyses from the Western societies for which data are most readily available, however, have demonstrated complex relationships between parental resources (income or socioeconomic status) and reproductive behavior, frequently with divergent relationships for men and women and for different ethnic groups or social classes (Kaplan et al. 1995; Fieder and Huber 2007).

18.3.2.4 The Ecosystem Dynamics Model Ecological change, according to one approach in contemporary economics, affects human well-being primarily through its impacts on the availability of ecosystem services, including fresh water, fuel, and nutrient cycling, all of which are ultimately dependent on planetary biodiversity (MEA 2005:vi;see Kareiva et al. 2011). Adapting this model to take account of cultural context permits more specific predictions about the effects of ecological change on child well-being. For any given child, ecosystem services are crucially mediated by the macroecology that includes the political-economic, demographic, and tech- nological context of the society into which he is born, and the microecology constituted by immediate surroundings, caretakers, and childcare customs. These two cultural envelopes serve as conduits and filters for the supply of vital ecosystem services to the child, influencing the quality of food and water she consumes, the degree to which climate and disease ecology penetrate her world, and also the meanings that are attached to the natural and man-made environment in which she lives. Figure 18.1 illustrates these ideas, with the developmental niche model of child development in cultural context 494 E.G.J. Stevenson and C.M. Worthman

Ecosystem services Well-being

Health Provisioning nutrition food development water Developmental niche experience fuel Freedom of choice and action Settings Customs Security personal Regulating safety resource Agency Child access climate Endogenous disease Characteristics Basic material Child’s microecology

Supporting for good life Care- shelter Cultural takers livelihood

Nutrient cycling, soil formation, etc. aesthetic Good social spiritual Human macroecology relations educational (culture, political economy, religion, trust demography, technology) attachment

LIFE ON EARTH –BIODIVERSITY

Fig. 18.1 Model of child well-being in macroecological and microecological context

(in the center) ﬂanked by ecosystem dynamics and human well-being (on the left and right sides of the diagram). The ecosystem dynamics model serves as an example of how anthropological insights can enrich models from neighboring ﬁelds. In the next section, we show how the models discussed above may be applied to analysis of historical transitions in vital rates, education, nutrition and disease, and politics, economics, and ecology, which we contend are among the greatest forces affecting child well-being in the contemporary world.

18.4 Historical Transitions and Their Impacts on Child Well-Being

The theoretical models that we have surveyed embrace the relevance to child well- being of timescales from the evolutionary to the intergenerational and ontogenetic. Because evolutionary processes move slowly, because cultural diversity is difficult to reduce to common denominators, and because we now live in a globalized world, attending to global patterns of socioecological change through historical time can be the most effective way of identifying conditions that promote or threaten child well-being. Among the historical transitions of the past century that impinge on child well-being, five may be considered as particularly influential: 18 Child Well-Being: Anthropological Perspectives 495

Table 18.3 Positive and negative influences of historical transitions on child well-being Pro Con Demography () child mortality () sibling contact (+) parent to child ratio Epidemiology () infectious disease (+) chronic disease Nutrition () undernutrition (+) overnutrition, obesity Education (+) literacy () socialization by near-peers () local ecological knowledge Politics/economics (+) codiﬁed law, individual rights (+) social inequality Ecology (+) temperate climates at high latitudes (+) climatic unpredictability () biodiversity

1. Demographic transition, including secular trends in decreasing fertility and mortality 2. Epidemiological and nutritional transitions (a) from infectious diseases to chronic diseases, and (b) from under- to overnutrition 3. The rise of mass schooling as a common feature of the life course 4. Political and economic transitions in which the state and the market have acquired new inﬂuences over children and their development 5. Ecological transitions, including climate change and declining global biodiversity In the case of each transition, there have been both gains and losses for child well-being – and for some children, in some populations, more than others (Table 18.3). A full accounting of these transitions, which are tightly interconnected, and their implications for children’s well-being, is impossible given the current state of knowledge. What we aim to do here is to illustrate the possible pathways of inﬂuence suggested by anthropological models and their potential to add to analysis.

18.4.1 Demographic Transition

The secular trend in declining birth and death rates over the past century (Notestein 1945; cf. Kirk 1996) has both direct and indirect consequences for child well-being. Declines in rates of mortality by definition have increased chances of survival beyond the first years of life – a sine qua non of well-being – but in many populations, declines in fertility rates have radically altered the social ecology within which children grow up. Smaller family sizes imply “more parents for each child,” and therefore a potential increase in the intensity of parental caregiving (Mead 1971; Richter 2004). Furthermore, with lower risks of mortality, parents can plan for their children’s future with greater confidence of their surviving to adulthood (Johnson-Hanks 2008), signaling a shift in caregiver psychology (to use the terms of the developmental niche model). But compared to a child born in 1900, one born today is likely in many countries to have a smaller network of siblings, aunts, uncles, and cousins to help out with childcare, resulting in an altered social setting for childhood. The discordance model predicts that decreasing support from 496 E.G.J. Stevenson and C.M. Worthman extended kin should have adverse effects on child well-being, and this is borne out in that smaller networks of care and attachment are associated with increased child mortality in pre-demographic transition populations (Sear and Coall 2011; Strassmann and Garrard 2011) and with compromised socioemotional adjustment in post-demographic transition populations (van IJzendoorn et al. 1992; Sagi et al. 1995). A further consequence of the demographic transition is that, although child mortality has declined globally, disparities among populations and subpopulations have stagnated or increased, such that infant mortality among African-Americans in the United States is 2.4 times that of whites (MacDorman and Mathews 2011; Krieger et al. 2008) and mortality before age 5 is 20 times higher in sub-Saharan Africa than in North America and Europe (Maddison 2001; IGME 2011). Because disparities in child mortality correspond closely to economic cleavages, many observers have focused on economic determinants (e.g., Behm and Vallin 1982; Palloni 1990; Kim et al. 2002). A growing body of anthropological research, however, is demonstrating the cultural and political-economic dimensions of child mortality (notably Scheper-Hughes 1993; see also Nations and Rebhun 1988; Einarsdo´ttir 2004; Lane 2008). Among the few studies that have tracked demographic parameters over time and also employed ethnographic methods, the Gusii Infant Study demonstrated how, during a period of rapid mortality decline in the 1970s (a fall in under-five mortality of almost 25% within a decade), mismatch between demographic trends and cultural scripts for childcare (ecological firmware and cultural software in LeVine’s terms) led to adverse child health outcomes (LeVine et al. 1994). With higher child survivorship as a result of public health interventions (including cholera vaccination campaigns and increasing use of latrines, which decreased vulnerability to diarrheal pathogens) and with increasing population pressure diminishing family ownership of land and cattle and hence per capita availability of food, the culturally sanctioned reproductive strategy of conceiving approximately every 2 years and devoting great effort to protecting infants led to larger family sizes, poorer-quality child feeding, and a rise in child malnutrition. These findings provide compelling evidence that culturalaswellaseconomicfactorsinfluence child well-being, and that “parental practices that [are] adaptive or effective under one set of historical conditions may not be so when conditions change” (LeVine et al. 1994:269).

18.4.1.1 Epidemiological Transition While some infectious diseases that can threaten child survival (e.g., scarlet fever, measles, smallpox) have registered dramatic declines over the past 50 years, during the same period some chronic diseases (e.g., asthma and type II diabetes) have registered large rises ﬁrst among adults and increasingly among children (Omran 1971; Gribble and Preston 1993; Pinhas-Hamiel and Zeitler 2007). Both the discordance and the developmental ecology models offer explanations for the rise 18 Child Well-Being: Anthropological Perspectives 497 of chronic diseases. For example, poor uterine conditions (e.g., nutrition, stress) lead to low birth weight and energy-sparing adjustments in the fetus that, under mismatched postnatal conditions of overnutrition and sedentism, lead to obesity, metabolic dysregulation, and diabetes (Victora et al. 2008). Similarly, increased rates of disordered immune regulation, such as asthma, allergies, or autoimmunity, may be attributable to changing ecologies of early immune development as public health and sanitation practices have dramatically altered patterns of exposure to parasites and pathogens (Bach 2005; Duse et al. 2007; Garn and Renz 2007; Jackson et al. 2009). The transition from infectious to chronic diseases as the primary health burden for children has not been universal, however. Among children in Africa and Asia, respiratory infections, diarrheal diseases, and malaria together remain responsible for most deaths at ages 1–4 (Morris et al. 2003; Lopez et al. 2006; cf. Heuveline et al. 2002). Mortality from infectious diseases may exert strong effects on the demographic structure of populations, changing the social settings of development. HIV/AIDS, which increases mortality at peak productive and reproductive ages, has led – especially in Southern Africa – to a rise in orphanhood and child-headed households, eroding networks of support available to children (Ghosh and Kalipeni 2004). The persistence of ancient infectious diseases and the emergence of new infections such as HIV/AIDS also contribute to child malnutrition, while epidemics of chronic disease are partly driven by overnutrition.

18.4.1.2 Nutrition Transition Measures of child growth status are sensitive markers of environmental quality, reﬂecting the extent to which genetic growth potential is realized given children’s diets and level of disease burden (Eveleth and Tanner 1990). Growth measures can serve both as markers of current circumstances and as bellwethers of future well- being, because nutritional status in early life is linked through a multitude of pathways to later-life health. Even mild to moderate stunting is associated with higher rates of child illness and death, cognitive impairment, and reduced school performance (Black et al. 2008; Victora et al. 2008), while childhood overweight and obesity predispose to diabetes, cardiovascular disease, and cancer (Wang and Lobstein 2006). Population changes in nutritional status therefore have important implications for child well-being. The nutrition transition is commonly understood to refer to a shift from undernutrition to overnutrition, but in fact epidemic under- and overnutrition now coexist as a double burden in many developing countries (Popkin 1994; Caballero and Popkin 2002). Prevalence of overweight and obesity has risen rapidly among children and adults in rich and poor countries alike over the past decades, with the highest levels being among the low-income segments of wealthy countries, and females being at somewhat higher risk than males (Drewnowski and Specter 2004; Due et al. 2009; Freedman 2011). Evolutionary nutrition points to taste preferences for sweet and fat related to their limited availability in ancient diets, and the 498 E.G.J. Stevenson and C.M. Worthman discordance model predicts high consumption of foods rich in sugar and fat when they are available (Armelagos 2010; Konner and Eaton 2010). In industrial food systems, sugar and fats have replaced whole grains as a source of cheap calories (Popkin and Nielsen 2003), and this partly explains the high prevalence of overnutrition among the poor. Contemporary changes in the settings and customs of childhood are also important. Declines in physical activity among the urban poor, for example, are partly a product of built environments that lack parks and other facilities for physical recreation (Gordon-Larsen and Popkin 2006; Currie 2011), and partly due to widespread cultural shifts, such as school attendance and the spread of television, that promote sedentism and erode child sleep budgets (Brownson 2005; Gradisar et al. 2011; Matricciani et al. 2011).

18.4.2 Education Transition

The worldwide expansion of schooling – doubling over the past 30 years alone (Gakidou et al. 2010) – has affected child well-being through multiple channels including increases in literacy. From the perspective of anthropology, however, education, in the sense of embodied capital and social learning, is “built in” to the contexts of rearing, whether or not it involves formal instruction (Fortes 1938; Greenfield 2009). In cultures without schools – indeed for all human history until the development of complex states – childhood learning occurred mainly in the context of mixed-age play groups (Lancy 1996; Cole 2005) and apprenticeship-type arrangements between adults and children (Lave and Wenger 1991; Rogoff et al. 1995; Gaskins and Paradise 2010). Schooling, by contrast, is characterized by didactic instruction, a shift in the frame of reference to district, national, and global locales, and a relatively standardized curriculum based on European templates (Meyer et al. 1992). These features permit more efficient transfer of standardized skills such as literacy to large cohorts. But they also have downsides for psychological well-being, including an atmosphere of intense competition that can induce psychological distress (Lock 1986), and an emphasis on performance by the individual in isolation as opposed to the interpersonal competences inculcated by other systems of socialization (Weisner 1998). Correlations among schooling, women’s autonomy, and economic growth are widely noted (Hobcraft 2000; Hannum and Buchmann 2003) and have provided additional momentum for efforts to widen access to formal education (Schultz 2002; Rose 2003). From an anthropological perspective, however, the associations among schooling, women’s empowerment, and economic change are contingent on cultural supports. When these supports are absent, schooling may not be associated with women’s empowerment or increased economic opportunities. In North India, for example, prevailing gender and caste roles means that schooling for high-caste women is associated with greater rather than lesser seclusion, in conformity with traditional marriage customs (Jeffery and Jeffery 1997). And in all contexts, for 18 Child Well-Being: Anthropological Perspectives 499 men as well as women, success in converting school-acquired skills into livelihoods – finding jobs – depends to a great extent on the prevailing economic environment. When economic conditions are unfavorable, graduates may either be unable to find employment or opt to remain unemployed rather than taking on jobs below their station (Jeffrey et al. 2008; Mains 2012). Variable quality of schooling within and between countries also affects the extent to which schooling can improve lifetime opportunities, with children from poorer households often encountering poorer learning environments at school (Kozol 2005; Woessmann and Peterson 2007). Improvements in child well-being cannot therefore be seen as automatic outcomes of formal education but are to a large extent contingent on the fit between home community and school on the one hand and school and society on the other.

18.4.3 Political and Economic Transitions

The growing importance of schools in the lives of children is one component of a process of shifting of responsibilities for children from family units to the state and the market, including responsibility for health care (e.g., vaccinations), sanitation and water, childcare, and recreation (e.g., playgrounds, media). This process has been markedly uneven, however, and especially in the case of populations newly incorporated into states, the extension of services such as schooling and medical care has often been blocked by cultural barriers and discrimination. Ethnographically documented examples of populations neglected or abused by the states in which they live include the !Kung San of Namibia (Marshall 1980; Wilmsen 1989), the Gwembe Tonga of Zambia (Colson 1971) and the peoples of Venezuela’s Orinoco Delta (Briggs 2004; see also, generally, Bodley 2008). The tendency to bypass minorities and the poor on equal shares in progress constitutes a strong justiﬁcation for tracking well-being at the level of subpopulations as well as at the level of states or individuals. It also underscores the value of an ecological approach, since the impacts on children of ethnic and racial discrimination are likely to operate through the developmental niche they encounter (Harris 2006; Krieger 2005). Studies of child development under conditions of economic inequality demonstrate insults inﬂicted both through material poverty and through psychosocial channels including heightened perceptions of social inferiority and upward comparison (Adler and Rehkopf 2008; Sapolsky 2005; Kuzawa and Sweet 2009). Economic inequalities are especially visible in cities, which now accommodate more than half of the world’s population (UN-HABITAT 2006; Davis 2006). A new generation of anthropological research is now beginning to measure the impacts of economic and political change on human well-being through panel studies. The Tsimane´ Amazonian Panel Study, for example, was designed to assess the impact of increasing market integration on the well-being of the Tsimane´ of the Bolivian Amazon (Leonard and Godoy 2008). Annual surveys between 2006 and 500 E.G.J. Stevenson and C.M. Worthman

2009 have shown improvements in nutritional status and declines in reported anger but increases in the frequency of reported illness episodes (Godoy et al. 2009; see also Reyes-Garcia et al. 2010). Although these results concern the well-being of adults, they demonstrate that amelioration in one dimension of well-being does not necessarily imply equivalent change in another. Because levels of household wealth changed little during the period of study, it is not possible to determine the degree to which the observed changes in well-being were due to market integration as opposed to other factors. Further studies may allow researchers to “move beyond a snapshot” (Godoy et al. 2009) to unravel the forces affecting child well-being over time.

18.4.4 Ecological Transition

The most momentous historical transition of our time is an ecological transition, the course of which can be measured in declining biodiversity due to the direct action of humans in the environment (e.g., deforestation and conversion of biomes for monocrop agriculture) and in rising average global temperatures driven by expo- nentially increasing concentrations of greenhouse gases in the atmosphere (IPCC 2007; UNEP 2012). Although these processes are global, the effects on human well-being to date can only meaningfully be assessed on the level of communities. In Mongolia, for example, where average temperatures have risen by 0.37 C per decade since 1950 (among the highest for any country on record), a series of dzud events – extremely dry summers followed by extremely cold winters – has devas- tated forage and livestock holdings for herders (Girvetz et al. 2012; Murphy 2011). If these trends continue, Mongolian youth will be hard pressed to succeed in adulthood by means of the traditional livelihood strategy of herding. Such shifts in livelihood can bring about a cascade of changes in well-being, as they disrupt the routines and activities that are signiﬁcant to cultural communities. For families facing unpredictable returns from traditional livelihoods, investing in formal schooling for children – an intervention to alter the microecology of children’s development – is often an attractive option. But if, in the macroecological context, schooling cannot be translated into remunerative employment, and if time invested in schooling takes away from learning the local social and ecological landscape, as some studies suggest (Galaty 1989; Benz et al. 2000; Zent 2001; Sternberg et al. 2001), then schooling may further increase families’ vulnerability to ecological change. This may be especially true where procurement of food, water, and fuel cannot be secured through market institutions but requires community members to forage for themselves or engage with complex local systems of regulation (see, e.g., Lansing and Fox 2011; Wutich 2011). To summarize, the ﬁve historical transitions we have surveyed probably have large implications for child well-being. Anthropological models can help to parse out the channels through which macro-environmental forces impact on the child’s microenvironment. Few studies have yet been conducted outside of Europe and North America that assess child well-being in culturally relevant ways and follow 18 Child Well-Being: Anthropological Perspectives 501 the well-being of individual families and children over time in relation to historical changes. Existing models and data relevant to the capacities underlying well- being – such as health, nutrition, and social support – can, however, be leveraged to inform policy.

18.5 Policy Implications and Research Directions

18.5.1 Policy Implications/Recommendations

In discussing the policy implications of anthropological approaches to child well- being, we focus on three possible points of intervention: in early childhood, at school age, and at the youth-adult transition. Early interventions to improve child nutrition and environments of care may be particularly effective in promoting well-being. The lifetime impacts of improved early nutrition have been clearly demonstrated by the INCAP program in Guatemala, which showed that protein and energy supplements provided to age 2 were linked to improvements in later-life physical status and school performance and, for men, higher wages in adulthood (Martorell 1995; Martorell et al. 2010). Consistent with anthropological models suggesting that shared care should benefit children, programs that provide moral and practical supports to families expecting or caring for children have been shown in randomized con- trolled trials to reduce neonatal deaths (Sibley et al. 2009) and to improve child health and psychomotor function in the first years of life (Olds et al. 2007;Sweet and Applebaum 2004; see also Super et al. 1990). Peer-mentoring programs involving mothers in the community whose children are flourishing may offer a promising, sustainable approach for low-resource settings (Cooper et al. 2002; Rotheram-Borus et al. 2011). From early childhood onward, an expanded vision of education is needed to enhance resilience, life satisfaction, and subsistence options in a broader range of environments. Building on the observation that much learning in preindustrial cultures happens in the context of mixed-age playgroups, more space could be made in schools or other public places for youth to educate each other, including with the aid of computer technologies (Mitra 2005; Smith et al. 2009; Hirji et al. 2010;Gray2011). Complementary approaches include ecological education programs that teach literacy and other skills at the same time as engaging children with the natural environments in which they live (Orr 1992) and programs that target the “hearts” as well as the minds of young people by promoting emotional and social skills (Napoli et al. 2005; Durlak et al. 2011). As described above, youth who transition to adulthood in times of rapid social or ecological change may be particularly prone to derailment, as they find that the futures for which they have been prepared fail to materialize (Lloyd 2005; Worthman 2011). Social support programs for this demographic group are particularly urgent, but few models are available. The potential of peer-mentoring and 502 E.G.J. Stevenson and C.M. Worthman skill-development programs to buffer against unemployment and deprivation constitutes an important area for future research. Attending to youth in transition to adulthood also draws attention to the interface between generations, the connections between micro- and macro-contexts in children’s development, and the need for structural changes to improve the macro-environment. Direct interventions – such as nutritional supplementation programs, education reforms, and social supports – are the vehicles for immediate change, and individual parents, households, and children are the logical targets of these programs. But structural approaches that may relieve burdens on caregivers, for example, by reducing economic inequality, are also urgently needed.

18.5.2 Research Directions

Anthropological models provide a rich source of hypotheses regarding the processes that promote child well-being, but evaluating the usefulness of these models requires comparable data from multiple cultures. To develop more effective interventions to promote child well-being worldwide, we need studies in a wider range of populations, employing appropriate research methods. Using mixed methods (Bernard 2006; Axinn and Pearce 2006;Harknessetal.2006), for example ethnography together with surveys and biomarkers, would allow triangulation among different dimensions of well-being. This is crucial because well-being includes qualitative states that inevitably vary from culture to culture: the same tool will not work everywhere. What are needed are standard protocols for “working down” from qualitative data that accommodate rich descriptions of locally relevant dimensions of well-being, to quantitative data that permit formal hypothesis tests. One way of doing this is by quantitative coding of qualitative texts, as in the Ecocultural Family Interview (Weisner 2002). Modifications to standard research designs are also needed to permit stronger inferences about the impacts of ecological and social factors on child well- being. Panel designs, for example, offer promise for tracking the effects of cultural and ecological changes on individual families and children while controlling for some common confounds (Gravlee et al. 2009). The Tsimane´ Amazonian Panel Study constitutes one example of this approach; more such studies are needed. Because of the multidimensional nature of well-being, and the fact that one dimension can improve while another deteriorates, we must admit that at present we do not know what net effects global socioecological transitions are having on human well-being. This should not hold us back from addressing stark inequities in health and opportunities for development that are closely related to well-being. But it does alert us to the fact that “health is not enough” (Izquierdo 2005). To move beyond a narrow focus on health, researchers will need to combine methodological rigor with cultural theory and broad geographical/demographic scope. This effort will require collaboration between anthropologists and colleagues in epidemiology, psychology, public policy, and allied fields. In the process, scientists and practi- tioners will gain opportunities to refine their working models of child well-being and expand the proportion of humanity to which they are relevant. 18 Child Well-Being: Anthropological Perspectives 503

Acknowledgments EGJS was supported during preparation of this chapter in part by National Institutes of Health / Fogarty International Center grant R24 TW008825-01. We extend thanks to Neil Endicott, Jill Korbin, Kenny Maes, and Kay Gilliland Stevenson for comments on an earlier draft.

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