AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 155:181–185 (2014) Reconciling “Stress” and “Health” in Physical Anthropology: What Can Bioarchaeologists Learn From the Other Subdisciplines? Laurie J. Reitsema1* and Britney Kyle McIlvaine2 1Department of Anthropology, University of Georgia, Jackson St., Athens, GA, 30602 2Department of Anthropology, University of Northern Colorado, Greeley, CO 80639 KEY WORDS bioarchaeology; human biology; interdisciplinary; skeletal stress; paleopathology ABSTRACT The concepts of “stress” and “health” are ent in a population, but in assessing these markers, bio- foundational in physical anthropology as guidelines for archaeologists are not measuring “health” in the same interpreting human behavior and biocultural adaptation way as are human biologists, medical anthropologists, or in the past and present. Though related, stress and primatologists. Rather than continue to diverge on sepa- health are not coterminous, and while the term “health” rate (albeit parallel) trajectories, bioarchaeologists are encompasses some aspects of “stress,” health refers to a advised to pursue interlinkages with other subfields more holistic condition beyond just physiological disrup- within physical anthropology toward bridging “stress” tion, and is of considerable significance in contributing and “health.” The papers in this special symposium set to anthropologists’ understanding of humanity’s lived include bioarchaeologists, human biologists, molecular experiences. Bioarchaeological interpretations of human anthropologists, and primatologists whose research health generally are made from datasets consisting of develops this link between the concepts of “stress” skeletal markers of stress, markers that result from and “health,” encouraging new avenues for bioarchaeolo- (chronic) physiological disruption (e.g., porotic hyperosto- gists to consider and reconsider health in past human sis; linear enamel hypoplasia). Non-specific indicators of populations. Am J Phys Anthropol 155:181–185, stress may measure episodes of stress and indicate that 2014. VC 2014 Wiley Periodicals, Inc. infection, disease, or nutritional deficiencies were pres- In physical anthropology, understanding stressors ideally to represent health (Goodman and Armelagos, implicit in human interactions with the environment 1989). Expressions of “health” exist on a continuum, and with each other is a key component of interpreting, meaning that even if consensus is reached over the and even anticipating, human health. Human skeletal meaning of health as a concept, the meaning of “healthy” remains offer a deep well of information about human remains vague. As difficult as health, lifestyle, and well- variation, activity patterns, use of landscapes, diet and being are to define and measure in living populations, food distribution, demography, disease, and stress. these aspects of human existence become even more elu- Extrapolating from skeletal data sets, bioarchaeologists sive when dealing with past populations, whose symp- make inferences about health and lifestyle of past popu- toms and etiologies are less apparent and more difficult lations. Yet, the relationship between skeletal stress and to interpret (Wood et al., 1992). health is difficult to pinpoint. “Stress” can be defined as Although we may never be able to agree on what rep- a physiological change caused by strain on an organism resents “healthy,” we may be able to agree that physio- from environmental, nutritional, and other pressures logical changes in the body as a result of stress are (Huss-Ashmore et al., 1982; Goodman et al., 1988), and “unhealthy”; although they are examples of human is a useful proxy for estimating some aspects of past adaptation and adaptability (Seckler, 1980; Stuart- health. “Health” is a holistic concept used colloquially to MacAdam, 1992), physiological changes often exert a tax encompass elements of quality of life, daily functioning, on the human body. Viewed in this manner, stress is a and community interaction, and is at the crux of evolu- useful proxy for health in past populations (Goodman tionary and biocultural approaches in anthropology. et al., 1988; Goodman and Armelagos, 1989). Generally Although “health” has broad colloquial recognition, it speaking, bioarchaeologists are aware that stress and has been difficult to quantify. In practice, health is per- haps most commonly understood to be something that is compromised when any number of factors, including dis- *Correspondence to: Laurie J. Reitsema. Department of Anthro- ease, infection, nutritional quality, or psychological fac- pology, University of Georgia, 250 Baldwin Hall, Jackson St., Ath- ens, Georgia 30602, USA. E-mail: [email protected] tors, affect an individual’s quality of life. However, the World Health Organization includes the stipulation that Received 18 July 2014; revised 7 August 2014; accepted 8 August health is “a state of complete physical, mental, and 2014 social well-being and not merely the absence of disease, or infirmity” (WHO, 1999). Even a new infant with ten DOI: 10.1002/ajpa.22596 fingers, ten toes, and all of their organs in place is recov- Published online 19 August 2014 in Wiley Online Library ering from the trauma of birth and cannot be said (wileyonlinelibrary.com). Ó 2014 WILEY PERIODICALS, INC. 182 L.J. REITSEMA AND B.K. MCILVAINE health are not coterminous (McIlvaine and Reitsema response. Links with human biologists, primatologists, [2013] report a metanalysis of authors’ use of these and geneticists help to identify those social and cultural terms in leading journals during past decades). Bioarch- conditions that contribute to physiological stress, but aeological stress models account for synergistic interac- that cannot be directly observed in bioarchaeological tions of environmental constraints, biology, cultural samples. Two papers in this issue use a molecular buffering systems, and psychological disruption in con- approach to address the effects of very early life condi- tributing to a physiological stress response (Goodman tions—particularly, social stressors—on growth, develop- et al., 1988; Temple and Goodman, this issue). Other ment, health, and well-being using epigenetic proxies proxies for interpreting health may include a popula- (Kinnally [this issue]; Rodney and Milligan [this issue]). tion’s access to proper sanitation and nutrition, changes Erin Kinnally examines the relationship between early in living conditions within a person’s lifetime, the partic- maternal care quality, DNA methylation, and later-life ular timing of onset of disease or malnutrition, commu- health outcomes among rhesus macaques. Kinnally’s nity structure and family or community support, and data show that better maternal care, in the form of posi- traits of resistance or susceptibility to stress and disease tive contact, relates to lower methylation of a possible from the genome and epigenome. Contextual elements stress pathway gene (serotonin transporter, 5-HTT). such as these may or may not be available to the bio- Furthermore, among rhesus infants whose 5-HTT region archaeologist, but should be included in all assessments was methylated, poor health outcomes were observed of skeletal remains, where possible, to better understand later in their lives. These outcomes include low body the etiology and pathophysiology of skeletal stress weight, overall poor body condition, and lifetime inci- markers (Goodman, 1993; Goodman and Leatherman, dence of inflammatory disease (diarrhea). Studies of 1998). DNA methylation in osteoclasts, which are related to To infer past human health from skeletal stress white blood cells, may play a role in bioarchaeology. requires a middle ground. Conveniently for physical Very early life and intergenerational effects play a anthropologists, this middle ground can be built by com- considerable role in health and stress. Sobering evidence municating across anthropology’s subfields. The articles of this phenomenon is presented by Rodney and Mulli- in this issue stem from a symposium organized for the gan (this issue), who explored the biological consequen- 2013 meeting of the American Association of Physical ces of war stress on mothers and their infants in the Anthropologists, conceived initially by the authors as a Democratic Republic of Congo. Exposure to war stress, means to draw together interdisciplinary perspectives on and especially experience of rape, is associated with low stress. The effort to understand ancient stress and infant birth weight and methylation levels. The authors health scientifically crystallized notably with the 1984 find that effects of war stress on the epigenome are not publication of the edited volume, “Paleopathology at the genome wide, but targeted at specific genes—in this Origins of Agriculture” (Cohen and Armelagos, 1984). case, glucocorticoid receptor gene NR3C1. The relation- Enthusiasm for this topic is evidenced by the continued ship between glucocorticoids and skeletal growth implies scholarly work undertaken and published in the decades that psycho-social stress has effects on the growth and that followed. The goal of the symposium was to re-cast development of subsequent generations. In addition to light on the relationship between stress and health, and providing new perspectives on the relationship between refocus researchers on the symposium’s theme—fleshing early life stressors and health outcomes, the papers by out the skeletal record with insights from the other Kinnally and Rodney and Mulligan in this issue are