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9
A BIOARCHAEOLOGY
OF SOCIAL INEQUALITY AND
ENVIRONMENTAL CHANGE
Kenneth C. Nystrom and Gwen Robbins Schug
Introduction
In 2014, the Intergovernmental Panel on Climate Change (IPCC) released its fifth assessment
report and in it identifies three ways in which climate change will impact human health (Smith
et al., 2014) (Figure 9.1):
1. Direct impacts of climate and weather on health (e.g., heatwaves, flooding);

2. Impacts mediated by the ecosystem (e.g., changes in the distribution of vector-borne diseases,
air and water pollution);
3. Impacts heavily mediated through human institutions (e.g., changes in food production,
population displacement).
There is an ever-expanding body of research that explores the connections between climate
change and health consequences that fit within these categories, including increased likelihood
of childhood malnutrition, stunting, and low birth weight (e.g., Grace et al., 2012; Lloyd et al.,
2011; Nelson et al., 2009; Zhang et al., 2017); challenges to crop productivity and resulting food
insecurity (Challinor et al., 2014; Funk and Brown, 2009; Knox et al., 2012); heat-related excess
mortality (Christidi et al., 2012; Fouillet et al., 2006; Honda et al., 2014); changes in the geo-
graphic distribution of pathogens (e.g., Garza et al., 2014; Martens et al., 1995; Medone et al.,
2015); and population displacement (Black, 2001; Castles, 2002; Myers, 2002). While no region
or people will be unaffected by global warming, the health impacts of contemporary climate
change will be most profoundly experienced by people already experiencing substantial mar-
ginalization (Ramin and McMichael, 2009).
In the face of rapid environmental change, social inequality (e.g., income/economic, racial/
ethnic, gender, political) represents a significant risk factor. Social inequality today is measured
using the absolute Gini coefficient and the United Nations Inequality Human Development
Index (HDI), both of which indicate there has been an increase in inequality over the last several
decades (Niño-Zarazúa et al., 2017). The Gini coefficient—developed by economist Corrado
Gini and employed to measure inequality by the World Bank—describes the concentration of
a country’s wealth, with a range of scores between 0 (perfect inequity) and 100 (perfect equity).
However, this coefficient can be misleading as a score of 50 could theoretically mean that half
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K.C. Nystrom and G. Robbins Schug
Figure 9.1 Depiction of the three primary pathways through which climate change will impact
health: direct environmental impacts, ecosystem mediated, and human institution mediated. The stippled
arrow indicates that there may be some feedback, positive or negative, between cultural responses to
health consequences and the factors driving climate change.
Source: Field, C.B., Barros,V.R., Dokken, D.J., Mach, K.J., Mastrandrea, M.D., Bilir, T.E, … White, L.L.
(Eds.) (2014). Climate Change 2014: Impacts, Adaptation, and Vulnerability. Contribution of Working Group II
to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Available at www.ipcc.ch/
report/ar5/wg2/.
the population shares all the wealth and the other half has none at all; or, one percent of a nation’s
population shares most of the wealth, with 49% below that having some, and the bottom 50%
having little at all. Additionally, the Gini coefficient measures wealth at the level of the nation-
state, thus potentially masking inequality at finer scales such as between urban and rural areas.
The United Nations Human Development Index (HDI) takes a broader approach and
incorporates three dimensions: health (measured by life expectancy at birth), standard of living
(measured by gross national income per capita), and education (measured as years of school for
adults 25 years and older and the number of expected years of education for school-age chil-
dren). According to the 2016 United Nations Human Development Report, the HDI value of
the world has increased from 0.598 in 1990 to 0.731 in 2018; thus, trends in the HDI seem to
demonstrate improvement worldwide in health, standard of living, and educational attainment.
Like the Gini coefficient, however, the HDI does not account for within-country inequities,
nor does it reflect differential vulnerability, gender disparity, or empowerment. In recognition
of these problems, the Inequality Human Development Index (IHDI) considered the loss of
development due to within-country inequities in life expectancy at birth, per capita income,
and schooling. In 2018, the global IHDI score was 0.584, which represents a 20.2% drop from
the 2018 HDI (UN, 2019).
The Multi-Dimensional Poverty Index (MPI) was developed and implemented in 2019
to illuminate exactly how many individuals experience poverty regionally, nationally, and
internationally. The MPI provides an in-depth look at social inequality in the form of multi-
dimensional poverty (Figure 9.2). The results indicate that 23% of the world’s population is
impoverished, with two-thirds of them (886 million people) living in middle-income countries.
The MPI report demonstrates conclusively that children are the most vulnerable to poverty.
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A bioarchaeology of social inequality
Figure 9.2 The global multi-dimensional poverty index.

Source: The 2019 Global Multidimensional Poverty Index (UN Development Programme). Available at
http://hdr.undp.org/en/2019-MPI.
Half of the 1.3 billion poor people around the world are under age 18 and one-third are infants
and children under the age of ten years. One in three children worldwide live in multidimen-
sional poverty (Figure 9.3).
The 2019 MPI report puts a spotlight on social inequality in South Asia (measured in 2015–
2016), where 22.7% of children under five years of age experienced intra-household inequality
in nutritional deprivation; in other words, at least one child in the household was and at least
one child was not under-nourished. In Pakistan, this figure is one-third of households.Typically,
this intra-household variation in South Asia is attributed to the passive neglect of daughters due
to a cultural preference for sons. Along those same lines, 10.7% of South Asia’s girl children do
not attend school, but there is substantial variation across the region—with 44% of girls not
attending school and living in a multi-dimensionally poor household. Multi-dimensional pov-
erty affected 28% of the population of India, where 8.8% lived in “severe” multi-dimensional
poverty. The major conclusions were that more than 21% of people were living below the
poverty line (income of less purchasing power than $2 per day), 44.8% of the population had a
low standard of living, 23.4% did not have access to education, and 31.9% had suffered health
impacts from multi-dimensional poverty.
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Figure 9.3 The effect of multi-dimensional poverty on children worldwide.

Source: The 2019 Global Multidimensional Poverty Index (UN Development Programme). Available at
http://hdr.undp.org/en/2019-MPI.
Given the well-established connection between socioeconomic inequality and health (Adler
et al., 1994, 2008; Nguyen and Peschard, 2003), the IPCC report’s prediction that climate
change is expected to exacerbate existing health problems in the short term can be extended to
suggest that these impacts will be disproportionately experienced by the socially marginalized,
the socioeconomically disadvantaged, and the least developed countries. For example, in sub-
Saharan Africa regions already experiencing “alarming” food insecurity (IFPRI, 2017), cli-
mate change is expected to elevate rates of childhood malnutrition (Grace et al., 2012) while
high HIV infection rates will amplify the health consequences of climate change (Ramin and
McMichael, 2009).
Rural populations will be more vulnerable to climate change because they already experi-
ence restricted access to health care services. In urban settings, socioeconomic inequity
structures disproportionate exposure to microbial, physical, and chemical risk factors (Houston
et al., 2004; McMichael, 2000). Climate change is expected to drive more people into pov-
erty1 (Hallegatte et al., 2015), further deepening health-associated risk factors associated with
economic inequality (e.g., food insecurity, riskier jobs, lack of proper sanitation). The cen-
trality of economic inequality2 as a compounding factor influencing health outcomes stemming
from climate change is made starkly evident when the IPCC recommends that one of “the
most effective measure to reduce vulnerability [to the adverse health consequences of climate
change] in the near term” is to “alleviate poverty” (Smith et al., 2014, p. 714).
Still, as noted by the IPCC report (Smith et al., 2014, p. 713), while there have been dem-
onstrable health impacts stemming from climate change, so far its contribution to the global
health burden is relatively small and is “not well quantified.” Three interrelated factors make
it difficult to evaluate and predict the health consequences of climate change. The first is a
matter of temporal scale: rapid climate changes occur on a decadal scale and thus it is difficult
to identify the early impacts of climate change on health. Secondly, it is difficult to isolate the
impact of climate change relative to other “confounding,” non-climatic factors such as eco-
nomic or demographic changes.Thirdly, although in the short term climate change is predicted
to exacerbate pre-existing health disparities, they note that “foreseeing all of the likely types
of future health effects, especially because for many of the anticipated future health impacts it
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may be inappropriate to extrapolate existing risk-function estimates to climatic-environmental

conditions not previously encountered” (McCarthy et al., 2001, p. 453).
Social inequality and the human response to short- and long-term climate changes are two
grand challenges for bioarchaeology (Kintigh et al., 2014). In light of this, and given the above
limitations noted in the IPCC report, the biocultural approach that grounds bioarchaeological
research is well suited to contribute to the analysis of climate-related health impacts as it can
address some of the difficulties noted above. Our data—skeletal collections, archaeological and
paleoclimate data, associated historical documents—can span decades if not centuries and thus
can provide insight into long-term impacts. Further, as the biocultural paradigm explicitly
incorporates consideration of non-climatic factors that influence health, bioarchaeology can
also provide a holistic and integrated examination of health. Lastly, as the contributions to this
volume reflect, bioarchaeological investigations can elucidate the variability in human responses
to climate change.
Despite this potential, bioarchaeological research on how humans responded to or tried
to mitigate the effects of climatic changes in the past has not played a central role in the
current scholarly or popular discussions on climate change (McMichael, 2012; Rockman, 2011;
Sabloff , 2009; Van de Noort, 2011). Contributions in this volume document climate-change-
induced changes in health (e.g., Roberts), subsistence (e.g., Berger and Wang), diet (e.g., Snoddy
and colleagues), and lifestyle (e.g., Hudson) but more importantly, these chapters demonstrate
different forms of resilience and the consequences for human communities who remain in
already marginal environments in periods of climate change (e.g., Martin and Harrod).
Bioarchaeologists must work to inform the public and to insert ourselves more deeply into the
scholarly discourse about evidence for climate change in past human communities.
Bio/archaeology of social inequality

In the history of the human species, there is no more significant transition than the
emergence and institutionalization of inequality.
Feinman, 1995, p. 255
Although the emergence and evolution of inequality have long been a central theme in archae-
ology (e.g., Price and Bar-Yosef, 2010), recent studies are starting to consider inequality “as a
phenomenon with high explanatory value in its own right” (Vésteinsson et al., 2019, p. 173).
Mirroring modern social scientists, archaeologists have employed the Gini coefficient to study
inequality. First utilized by McGuire (1983), there has been a recent surge in its application
to archaeological contexts. In these studies, inequality coefficients have been calculated from
house size (Kohler et al., 2017; Porčić, 2019; Smith et al., 2014), house clusters (Pailes, 2014),
household material artifacts including both refuse (Peterson et al., 2016; Peterson and Drennan,
2018) and exotic goods (Prentiss et al., 2018; Vésteinsson et al., 2019), markers of productive
resources (e.g., storage capacity, ground stone artifacts, agricultural plot size; Kohler and Higgins,
2016; Prentiss et al., 2018; Smith et al., 2014;Vésteinsson et al., 2019; Wright, 2014), and access
to ritual space (Vésteinsson et al., 2019). From mortuary contexts, researchers have used data
on burial/grave goods (Porčić, 2019;Windler et al., 2013) and grave furnishing/treatment (Pitts
and Griffin, 2012).
There is recognition of broader interpretive challenges confronting this area of inquiry. First,
inequality is multi-faceted and calculations based on different types of data may reveal different
kinds of inequality. Calculations based on household refuse or grave goods may evaluate eco-
nomic or wealth inequality whereas coefficients based on “productive tools of various kinds”
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may “measure the degree of productive differentiation” which may not fall within the umbrella
of inequality at all (Peterson and Drennan, 2018, p. 40).
Akin to this, single-variable Gini coefficients have been critiqued as not acknowledging how
non-economic/non-material forms of capital (e.g., social, political, educational) influence eco-
nomic capital. In response, Oka et al. (2018) propose a composite index called the Composite
Archaeological Index (CAI) that uses multiple material datasets simultaneously. Drawing inspir-
ation from the United Nations’ Human Development Index, the CAI includes non-economic
factors such as education and life expectancy. Oka and colleagues argue that the CAI not only
“measures both material access” but also attempts to measure “well-being in archaeological
societies” (2018, p. 71). The potential of using Gini coefficients based on multiple datasets and
from different contexts is that it may allow us to parse out the nature of inequality, revealing
differential access to food resources (Prentiss et al., 2018), material wealth (differential access to
ritual spaces;Vésteinsson et al., 2019), and diachronic changes in inequality (e.g., Peterson et al.,
2016;Winder et al., 2013). Of course, these analyses may contradict previously held assumptions
about the nature of inequality (e.g., Smith et al., 2014).
Though some of the above archaeological literature alludes to the lived experience of
inequality (e.g., “well-being” Oka et al., 2018, p. 71; “affected people’s lives” Vésteinsson et al.,
2019, p. 173) the human impact of inequality is largely missing from this literature. Gini
coefficients derived from house size or storage capacity represent a measure of inequality for a
social or productive “unit.” Coefficients calculated from mortuary data (e.g., grave goods, mor-
tuary treatment) reflect a “performed” context (Quinn and Beck, 2016). In both instances, we
are not capturing the individual experience of inequality and it is only with the inclusion of
skeletal data that records the physiological responses to social inequality will we be able to dis-
cuss “well-being.”
The impact of social inequality/status has long been a focus of bioarchaeological research as
well (e.g., Powell, 1991). Not surprisingly, bioarchaeologists use the same material manifestations
of inequality as described above: grave goods (Ambrose et al., 2003; Harrod, 2012; Schrader,
2015; Woo and Sciulli, 2013), burial location (Harrod, 2012; Schrader, 2015; Pechenkina and
Delgado, 2006; Robbins Schug, 2017), and burial treatment (Ambrose et al., 2003). In this
research, the lived experience of inequality is investigated via paleopathological conditions such
as infection, caries, and dental abscesses (Pitts and Griffin, 2012; Robbins Schug, 2017), mor-
tality risk (Redfern and DeWitte, 2011), diet and nutritional stress (Ambrose et al., 2003; Le
Huray and Schutkowski, 2005), exposure to trauma (Harrod, 2012; Robbins Schug et al., 2012;
Torres-Rouff , 2011; Watkins, 2012), activity markers (e.g., degenerative joint disease, entheseal
changes; Klaus et al., 2009; Schrader, 2015; Woo and Sciulli, 2013), and stature (Harrod, 2012).
One example of bioarchaeological research that integrated the derivation of Gini coefficients
based on archaeological data with skeletal and dental health indicators is the research of Pitts
and Griffin (2012) on late Roman Britain (c. 250–410 CE). The researchers sought to inves-
tigate connections between inequality, health, and settlement type (i.e., urban, nucleated, and
rural), regionality, and road connectivity using data on eight different pathological conditions.
For the skeletal and dental health indicators, they employed Gower’s composite similarity index,
which calculates similarity for each health indicator and represents the average similarity across
all health indicators. Gini coefficients were calculated based on the relative distribution of grave
goods within a cemetery, though, as cautioned by the authors, measuring inequality in this
manner actually measures “inequality of the distribution of artifacts within a cemetery rather
than inequality in the distribution of wealth within a living population” (Pitts and Griffin, 2012,
p. 265). Based on these measures, the authors identified a tendency for urban cemeteries to
have lower Gini coefficients (greater equality) and better health when compared to cemeteries
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from rural or nucleated settlements, but that there is not a consistent relationship between
variables. For instance, whereas the prevalence of enamel hypoplasias corresponds positively
with Gini coefficients for rural (i.e., higher Gini coefficient, higher hypoplasia prevalence) and
urban samples (i.e., lower Gini coefficient, lower hypoplasia prevalence), nucleated settlements
exhibited an inverse relationship (i.e., high Gini coefficient, lower hypoplasia prevalence).
Although the above research is an excellent example of how bioarchaeologists are exploring
and quantifying inequality in the past, it also raises an important caveat. As the reader will see
moving forward, although there is research that considers the intersection of inequality and
health and there is research that explores behavioral responses to climate change (e.g., dis-
placement, health), the intersection of all three factors—social inequality, behavioral responses/
health, and climate change—is not common. Still, bioarchaeological research has a role to play
in the current discussion on climate change and its potential consequences because of the
biocultural paradigm that grounds our discipline. With the hopes of providing a framework
for bioarchaeologists to consider this nexus of factors in future research, the following dis-
cussion provides a framework to proceed using a structure provided by the three IPCC cat-
egories listed above: direct impact due to extreme weather, ecosystem-mediated impacts, and
impacts mediated through human institutions. In each category, we will attempt to illustrate
how bioarchaeologists can inform on the human impact of climate change, highlighting both
potentials and limitations.
Direct impacts of climate and weather on health: Impacts

directly associated with extreme weather events
IPCC conclusions
It is currently predicted that climate change will lead to an increase in the frequency, intensity,
duration, and geographical distribution of extreme weather events (Sauerborn and Ebi, 2012).
This includes projected increases in temperature extremes, increases in the length and frequency
of heatwaves, heavier and more frequent precipitation, and a likely increase in droughts. The
2014 IPCC report focuses on the impact of temperature change (i.e., heat- and cold-related),
floods and storms, and ultraviolet radiation.
High ambient temperatures place stress on the thermoregulatory and circulatory system
and increasing temperatures will increase morbidity and mortality particularly for those with
underlying heart, vascular, and respiratory problems. There is a strong correlation between tem-
perature increases and declining immune function (Schulte and Chun, 2009) and an increase
in the number of hot days is also associated with increases in mortality (Honda et al., 2014;
Takahashi et al., 2007), though this is influenced by several other factors (e.g., whether higher
temperatures occur in or out of season, the temperature of preceding winter seasons, age). The
basic physiological mechanisms associated with heat-related morbidity and mortality are dehy-
dration, fatigue, heat exhaustion (body temperature above 38°C/100°F), syncope, decreased
tolerance to environmental toxins, and heat stroke (body temperature above 40.6°C/105°F)
(Schulte and Chun, 2009).The IPCC report concludes and that it is “likely” that the number of
heat-related deaths has increased and will continue to do so in the future, though there might be
some offset in total numbers of deaths due to a decrease in cold-related deaths. Morbidity will
depend on individual factors like age, weight, overall fitness, metabolism, medical conditions,
and use of alcohol or drugs (Schulte and Chun, 2009). The increased mortality burden will fall
on communities that are more vulnerable because they are the least acclimatized to heat stress
(Kalkstein, 1989).
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Extreme weather events—mega-storms, flooding, drought, wildfires, landslides—are already

on the rise globally. Flooding is the most common natural disaster and with the frequency
of these events increasing globally, it is likely we will witness impacts to mortality and mor-
bidity including hypothermia; injuries, including from encounters with animals that have been
displaced from their habitats; electrocution; falls; drowning; exposure to carbon monoxide,
sewage, toxins, mold, and infectious diseases; contaminated food, famine, and malnutrition; and
declining mental health from depression and anxiety (Jakubicka et al., 2010; Schnitzler et al.,
2007; Schulte and Chun, 2009). Flood-related mortality is increasing at a global scale (e.g.,
Ferreira, 2011) and there is evidence to suggest that mortality increases due to flooding could
eventually be offset by economic development trends (Patt et al., 2010).
Although many have not considered this issue in their personal lives, excessive UV radiation
has led to 60,000 premature deaths in the year 2000 alone and is estimated to have resulted in
the loss of approximately 1.5 million disability-adjusted life years (Schulte and Chun, 2009).
Increased UV radiation is associated with cataracts, neoplasm, and cancers of the eye (Schulte
and Chun, 2009). Controlling for skin pigmentation, UVA radiation is also a major cause of
preventable skin cancer worldwide (Geller et al., 2002). Although it is predicted that UV radi-
ation levels may diminish by mid-century due to increasing cloud cover, the projected increase
in temperature due to global warming will result in increased UV exposure. Researchers have
already demonstrated a correlation between increasing temperature and an increased incidence
of certain types of non-melanoma skin cancers (van der Leun et al., 2008). Others, however,
found that while there was a slight increase in risk of basal cell carcinoma as temperature
increased, it was not a significant trend (Freedman et al., 2015).
Bioarchaeological research
It seems unlikely that bioarchaeological analyses will be able to investigate the intersection
between social inequality and health impacts directly related to extreme weather events. The
physiological consequences of heat exhaustion and heat stroke are acute processes and thus
there will typically not be any skeletal manifestations for bioarchaeologists to consider. Some
potential avenues of investigation could lie in detecting biochemical markers of the body’s
physiological stress response (Webb et al., 2010; Scott et al., 2016) which could be linked to
paleoclimatic data, though directly attributing this to increases in temperature would be dif-
ficult.3 Similarly, it would be difficult to identify flooding as the causative agent of death or
injury from skeletal evidence alone. Of course, the presence of archaeological evidence would
certainly increase the chances of contextualizing such deaths and/or injuries (e.g., presence of
water-borne deposits) and though catastrophic death assemblages linked to extreme weather/
natural disasters do exist, they are infrequent.
For obvious reasons, it would be very difficult to discuss the risk of UV exposure over time
using archaeological, historical, or skeletal data. It is important to note that Kirkpatrick et al.
(2018, p. 8) call on researchers to report and discuss “temporal, geographical, environmental,
archaeological, demographic and socio-cultural contextual information” when presenting
paleo-oncology data but the detection and diagnosis of neoplastic lesions based on skeletal and
mummified remains is rare. There is growing recognition and documentation of metastatic car-
cinoma (Binder et al., 2014; Hunt et al. 2018; Kirkpatrick et al. 2018; Klaus, 2018; Lieverse et al.,
2014) but we are a long way from a bioarchaeological description of a historical relationship
between increased temperature, UV radiation, and neoplasm—if there ever was one. Given the
above discussion of a predicted relationship between temperature/UV exposure and incidence
of skin cancer, there is only a single case of basal cell carcinoma, observed in a 16th-century
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mummy from Italy, described in the paleopathology literature (Minozzi, 2018). This research is
not linked to social inequality or climate-related factors.
However, archaeologists and bioarchaeologists can and do investigate the consequences of
drought (Fischman, 1996; Harrod and Martin, 2012; Hoggarth et al., 2017; Kennett, 2005;
Knudson and Torres-Rouff , 2009; Lambert, 1994; Raab and Larson, 1997; Schwitalla and
Jones, 2016; Walker and Lambert, 1989) and famine due to climatic changes (DeWitte, 2015;
Horocholyn and Brickley, 2017;Yaussy et al., 2016). Increases in global temperature are already
exacerbating drought conditions, disruptions to food supplies, and food shortages. It is the
impacts of food shortage related to climate change where bioarchaeology has the most to say
and it is also these impacts that are most clearly related to inequality. In this way, bioarchaeologists
can also work to address the question of social relations of climate change—who is harmed and
who benefits from inequality and how (Tschakert et al., 2013)?
For example, Yaussey and colleagues (2016) investigated selective mortality due to famine
in Medieval London and found significant associations between developmental stress and mor-
tality due to famine, suggesting that stressed individuals or those who had been stressed early in
their life course were more susceptible to death in the context of famines. As they pointed out,
famine—whether caused by drought, flooding, blight, war, inadequate infrastructure, political
or economic factors—has a high rate of mortality primarily through the effect of malnutri-
tion on immunocompetence; individuals who have grown up in impoverished circumstances
are already more vulnerable to immune compromise and are more likely to live in crowded
or unsanitary conditions that can promote communicable disease. These individuals, who have
lived their lives in impoverished circumstances, are also less likely to have body fat reserves that
aid in survival during famine conditions. Finally, because inequality and famine both have their
greatest impacts on infants and children, mortality from climate change is likely to be greatest in
the youngest age categories. Indeed, Yaussey and colleagues (2016) demonstrate the numerous
famines experienced in Medieval London during the so-called Little Ice Age led to high levels
of mortality for London’s poor and those who had already experienced childhood deprivation.
Ecosystem-mediated impacts of climate change on health outcomes

IPCC conclusions
Climate is known to be a key determinant of health and, in particular, it has a large role to
play in the co-evolution of humans and the pathogens that cause disease. Changes in tempera-
ture, precipitation, and other aspects of weather and climate determine the geographic range
of pathogens and vector species; climate change can bring humans into contact with envir-
onments and species that do not typically interact with our species, leading to the emergence
of new infectious pathogens; storms and natural disasters exacerbated by climate change also
lead to disease outbreaks (Epstein, 2001). Economic inequality strongly shapes the risk of these
eventualities and many of the emerging infections—AIDS, ebola, infection by toxic strains of
E. coli, hantavirus, Legionnaire’s disease, Lyme disease, antibiotic resistant MRSA, zika—and re-
emerging diseases—cholera, diphtheria, malaria, tuberculosis—in the past 45 years have had the
biggest impacts on marginalized communities worldwide (Epstein, 2001).
Climate change influences pathogens, hosts, intermediate hosts, and vectors (Epstein, 2001).
In particular, the IPCC warns of changes in the geographical distribution of, and risk of
exposure to, disease arthropod vectors such as mosquitos and ticks (that carry malaria, zika, and
Lyme disease, among others) as well as food- and water-borne bacteria (e.g., the cause of his-
torically important diseases like Vibrio cholera).
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Although arthropod life cycles are closely linked to temperature, predicting the impact of
climate change on vector distribution is complex as other, non-climatic and non-linear factors
will influence the outcome (Medlock and Leach, 2015). For example, in their modeling of
climate change on the geographic distribution of two vectors of Trypanosoma cruzi (Rhodnius
prolixus, a tropical species, and Triatoma infestans, a temperate species) in Venezuela and Argentina,
Medone et al. (2015) found heterogeneous results. Rather than a simplistic, across-the-board,
expansion of range, they found differential impact, with the range of R. prolixus expanding even
as the range of T. infestans was predicted to decrease. Similar studies have been conducted for
Ixodes scapularis (vector for Lyme disease; Ogden et al., 2006) and the many different mosquito
species (vectors for malaria, dengue,West Nile; Medlock and Leach, 2015;Van Kleef et al., 2010).
Ecosystems have evolved webs of interacting organisms—opportunists, parasites, commensal
communities, competitors, predators, decomposition agents or recyclers—and in most natural
environments, that delicate balance will be upset by rapid climate change (Epstein, 2001). The
distribution of disease vectors and their predators will be changed by global warming. Given
the scale of malarial exposure and infection and its connection to socioeconomic inequality,
for example, predicting the impact of temperature changes on the distribution of the mosquito
vector is vitally important (WHO, 2018a; b). Malarial infection rates and deaths are associated
with inequality. In 2017, almost 80% of worldwide malaria deaths were from 17 countries in the
WHO Africa Region and India, with just under half of those deaths recorded in African coun-
tries. Malaria also “disproportionately affects vulnerable groups, including women and children,
particularly from the poorest households” (WHO, 2018b, p. 2). Given this, predicting how
changes in temperature may impact vector development and therefore the risk of exposure is
vitally important. Studies have found a non-linear and vector-specific response (Smith et al.,
2014); moderate warming may increase vector and transmission, while at higher temperatures
this warming may actually reduce transmission.
Although it may be difficult to identify the intersection of health, social inequality, and changing
ecological conditions that influences vector distribution in the archaeological record, there is
a lot of promise for this type of research because all infectious diseases require pathogens and
hosts interacting within an environment (Epstein, 2001; Schulte and Chun, 2009). Contrary to
the more limited bioarchaeological potential of the first IPCC category, there is the possibility
for the identification and diagnosis of pathogenic infection based on changes in skeletal, soft-
tissue morphology, biochemical and biomolecular methods. Research is ongoing on the chan-
ging presence and prevalence of infectious diseases of concern in the contemporary context of
global warming and the sixth epidemiological transition (see Roberts, this volume), including
malaria, Chagas disease, leishmaniasis, leprosy, tuberculosis, cholera, schistosomiasis, and plague.
The first four of these diseases will be highlighted here purely in the interests of space but
paleopathological research has yielded insights on how climate change and social inequality
could potentially impact all of these infections (c.f., DeWitte, this volume).
Many neglected tropical diseases—parasitic, protozoan, food- and water-borne—are likely
to increase as global warming advances tropical and sub-tropical habitats and leads to increased
storm activity, and social inequality promotes the spread of urban slums and limits access to
healthcare in human communities around the world (Hotez, 2018). Mosquito- and other insect-
borne diseases are perhaps among the most sensitive to environmental changes. Global warming
will change the distribution of mosquitos, their level of biting activity and reproduction, and the
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rate at which the falciparum malaria pathogens mature within them, which in turn affects trans-
mission rates for disease (Epstein, 2001).Warmer winter temperatures will allow mosquitoes and
other insects to over-winter while changing patterns of rainfall, humidity, and standing water
will provide suitable microenvironments for breeding (Schulte and Chun, 2009).
Both skeletal and mummified tissues have yielded molecular evidence of the most severe type
of malaria, caused by infection with Plasmodium falciparum (e.g., Bianucci et al., 2008; Smith-
Guzmán, 2015a; b). But molecular work is limited by the preservation of DNA, permission
to conduct destructive analysis, and cost factors. Some bioarchaeologists have approached the
question of malaria in past populations by looking for evidence of genetic anemias associated
with resistance to malaria. For example, Tayles (1996) found evidence of long-term adapta-
tion to the presence of malaria in the form of skeletal evidence for thalassemia in a sample
of skeletons 4000 years old from Khok Phenom Di, Thailand. There was a limited amount of
similar evidence for malaria from the Iron Age in Thailand (Pietrusewsky and Douglas, 2002)
and, based on high levels of infant mortality, King and colleagues (2017) demonstrated that by
that time, deforestation for rice paddy construction and increasing use of open water-storage
facilities (due to faltering monsoon and increasingly dry conditions) changed transmission rates
of mosquito-borne diseases.
Maternal health, as well as that of infants and children, primarily suffers from the environ-
mental challenges that lead to high rates of malaria. While the presence of skeletal evidence for
genetic anemias and certain demographic patterns may be suggestive of the presence of this
disease (Halcrow et al., 2016; Lovell, 1997), fortunately, diagnosis based on skeletal evidence is
becoming increasingly reliable. Malaria causes severe hemolytic anemia, which leads to expan-
sion of hematopoietic spaces in bone (Buckley and Tayles, 2003; Gowland and Western, 2012;
Walker et al., 2009) and, according to Smith-Guzmán’s (2015b) groundbreaking work on skel-
etal manifestations of this disease, it also causes porosity through an imbalance in bone remod-
eling. Malaria may thus be detectable in human skeletons based on the presence of lesions often
associated with anemia: abnormal porosity on the cranium, vertebrae and sacrum, humeral and
femoral necks, and long bone diaphyses (Smith-Guzmán, 2015b). Again, malaria is particu-
larly likely to affect pregnant women, infants, and children whose immunity is suppressed—in
the case of pregnant women—or for whom acquired immunity has not had time to develop
(Bourbou, this volume; Smith-Guzmán, 2015b).
The WHO has suggested that climate change-induced increases in rates of infectious diseases
like malaria will be concentrated in the poorest populations at low latitudes where climate-
related health outcomes are already substantial and where vulnerability to climate effects is the
highest; for example, Africa has the lowest emissions of greenhouse gases of any continent and
yet these countries are in sum, predicted to suffer the greatest consequences from inequalities in
health due to climate change (Sunyer and Grimalt, 2006). Malaria can also be used to examine
social inequality in the context of climate and environmental change in the past. Bourbou
(this volume) describes Greco-Roman notions of how environmental conditions affected the
prevalence of malaria: Roman authors suggested disease was more likely in the summertime,
particularly if it were a hot and wet summer; pregnant women and children were likely to
suffer fevers in the fall, and leading elites in society constructed their villas away from “marshy
ground”. Her work demonstrates the direction bioarchaeologists can take to address questions
of social inequality, marginality, challenging environments, and the prevalence of mosquito-
borne diseases in the past.
Chagas disease is caused by infection with the protozoan Trypanosomiasis cruzi. It is endemic
to Latin America and is associated with impoverished circumstances, in which blood-sucking
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insects can invade poorly constructed housing and parasite-laden feces enter the body through
mucous membranes, eyes, or insect bites (Jong and Stevens, 2011; Machado et al., 2012). Like
many infectious diseases discussed here, it is more likely to be fatal in children who do not
possess acquired immunity (Machado et al., 2012). Also, like many of these diseases, climate
change will play a role in the prevalence of infection: warm temperatures accelerate the life
cycle of the pathogen within the host and allow for two generations annually and rising
temperatures in northern latitudes allow for the expansion of the vectors and animal reser-
voir species into new geographical areas (Carcavallo, 1999). Changing levels of precipitation
and humidity and increases in severe storms may cause an increase in the infestation of houses
(Gage et al., 2008).
Arthur Aufderheide and colleagues (2004, p. 2038) reconstructed infection rates of Chagas
disease based on soft tissue samples taken from cultural groups spanning 9000 years (from
7050 BC to AD 1850). Interestingly, despite this broad time-span, they found no significant
changes in infection prevalence through time. Though the authors do not explicitly con-
sider how environmental change may have influenced vector distribution, they do note that
infection rates are the result of the interaction between the environment, human behavior
and biology, and the biology of the vector/pathogen. Given the consistent prevalence rate
through time, Aufderheide and colleagues (2004, p. 2036) suggest that the construction of
wattle and thatch housing may have provided an anthropogenic environment that may have
buffered the Chagas vector, resulting in the “maintenance of an equilibrium between the
biology of the trypanosome and its vector, the environment, and human behavior/biology.”
The results of this analysis support the suggestion that as climate changes and the disease
spreads into new regions, impoverished people, living in poorly constructed homes, will be
at greatest risk of disease.
Leishmaniasis is an infectious disease caused by Leishmania protozoan species endemic to
tropical regions of the world and which are transmitted through the bite of female blood-
feeding sandflies of the genus Lutzomyia (González et al., 2010). There are several mammalian
host species—dogs, monkeys, rodents, marsupials—who serve as a reservoir for the pathogen
because humans are only an incidental host (Ready, 2008). For 20 years, endemic areas have
been spreading (Ready, 2008) and this trend is predicted to continue. For example, González
and colleagues (2010) used ecological niche and species dispersal modeling as well as predicted
global warming scenarios to demonstrate that contemporary climate change will dramatically
expand the range of this disease from Mexico into the United States and southern Canada.
Human-induced habitat modifications will also dramatically increase incidental contact between
humans and species that serve as reservoirs and the flies that serve as the vector for this pathogen.
There is also an association between El Niño cycles, drought, and the incidence of the disease
in some areas, like Brazil (Ready, 2008).
Mucocutaneous leishmaniasis is the most disfiguring of the diseases caused by this infec-
tion and it is visible in past populations through facial lesions on human skeletons. Marstellar
and colleagues (2011) looked at the presence of this disease in pre-Columbian (AD 500–1000)
populations from the Chilean highland. The authors were looking at social inequality in the
form of profound stigmatization, social isolation, and marginalization suffered by people with
leishmaniasis in this region today, despite its lack of person-to-person communicability. These
authors point out that 90% of contemporary cases of this disease occur in Peru, Bolivia, and
Brazil and thus studying the ideological aspects of this stigmatized disease in the past sheds light
on the role of culture in shaping health outcomes for this disease.
There is an environmental change dimension to this research in that the evidence for this
disease was uncovered in a cemetery located in the Atacama Desert, far from lowland tropical
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areas where the disease is found today, suggesting that females who had evidence of the disease
contracted it through their interactions as traders in lowland areas. Males may have been less
likely to demonstrate lesions due to sexual division of tasks in the lowlands, leaving females
more vulnerable to exposure or, paradoxically, because their immune response to infection
was weak enough that they died before expressing the most severe skeletal lesions. Mortuary
treatment and rates of traumatic injury were similar to unaffected females, suggesting that social
inequality, marginalization, and stigma were not part of the experience of this disease in the past.
Stigmatization also does not seem to have been part of the social experience of people
with leprosy in the Bronze Age of South Asia, when climatic and environmental changes
combined with socioeconomic interaction to stimulate the rise and fall of the first urban
phase of South Asian prehistory and witnessed the introduction of this infection to the sub-
continent (Robbins Schug 2016; 2017; Robbins Schug et al., 2012; 2013). The 4.2 ka event
was a period of rapid climate change in South and West Asia that seems to have initially
fostered the immigration to urban areas to participate in a long-distance exchange network
that led to high levels of prosperity for the Indus civilization of South Asia from 2600 to
2000 BCE (Wright, 2010). However, after 200 years of increasing aridity and disruptions
to monsoon rainfall and to the societies that comprised the interaction sphere, South Asia’s
urban areas were largely abandoned (deMenocal, 2001; Dixit et al., 2018; Giosan et al., 2012;
Staubwasser et al., 2003).
Leprosy results from infection with Mycobacterium leprae and, like leishmaniasis, it can lead to
severe disfigurement if left untreated. Like all of the infectious pathogens discussed here, it has a
well-known relationship with social inequality, being associated worldwide with impoverished
circumstances (Rodrigues and Lockwood, 2011), but, particularly in India since at least the
colonial era, the disease is so strongly stigmatized (Barrett, 2005) that patients occupy a liminal
position between “patient and prisoner” (Buckingham, 2002). Based on the presence of skeletal
lesions associated with leprosy at two sites in the Bronze Age Indus civilization of South Asia, it
appears to have entered the subcontinent in the third millennium BCE as a result of the inter-
action sphere and growing urbanism (Green and Jones, 2020; Robbins et al., 2009). The disease
was most prevalent in marginalized burial communities (Robbins Schug et al., 2013), where
traumatic injuries and other signs of infection and disease were also much more common than
in the city cemeteries (Robbins Schug et al., 2012). Leprosy’s association with social inequality
seems to have begun very early in the past and appears to have run along fault lines in a hetero-
geneous society whose cities grew rapidly and ended just as rapidly in the face of climate and
other changes (Robbins Schug, 2017).
Recent research addressed the history of this stigmatization using an exegesis of ancient
Vedic texts, skeletal evidence for the disease, and mortuary behavior (Robbins Schug, 2016).
Initially, the disease may have been recognized in its sufferers, but there was no apparent diffe-
rence in the mortuary treatment provided to its sufferers until climate, socioeconomic, and
political changes led to the abandonment of the cities (Robbins Schug, 2016). In the inter-
mediate-period burials (2000–1900 BCE) and those of the post-urban cemetery (1900–1700
BCE) at the city of Harappa, individuals with visible signs of leprosy were interred without
their feet. At the rural site of Balathal, special burial treatment was provided for an individual
with leprosy; he was interred under five layers of burned cow dung inside of a 50×50 m stone
enclosure. These treatments suggest possible attempts to ameliorate the effects of the disease on
the journey to the afterworld. Vedic hymns composed around this time (Atharva Veda) suggest
the disease was seen as a sign of spiritual corruption but that the spiritual corruption and the
disease were treatable; it was not until the first millennium BCE that people with leprosy were
stigmatized to the point of exclusion.
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Health impacts mediated through human institutions

IPCC conclusions
The IPCC report identifies several different consequences of climate change that would be
heavily mediated by human institutions: occupational and mental health, nutrition, and con-
flict as it relates to climate change. Although strictly speaking population displacement is not a
“health” impact and the IPCC report does not explicitly include displacement in this category,
the potential range and severity of health consequences resulting from climate-change-related
migration will be significantly influenced by how human institutions respond; thus, it is included
in the following discussion. Mental health has not typically been addressed by bioarchaeologists;
however, the effects of socioeconomic inequality, environmental and dietary change on mental
health in modern Italy are discussed in a succeeding chapter (Miller et al., this volume).
Occupational health
Global warming, population growth, socioeconomic inequality, urbanization, and environmental
change are expected to lead to the following hazardous conditions: higher temperatures, air
pollution, UV radiation, extreme weather, changes to the built environment, industrial and other
occupational hazards, and expanding habitats for infectious diseases (Schulte and Chun, 2009).
The occupational health effects of these conditions will be in the following categories: fatigue,
heat stress, cardiovascular and respiratory diseases, lung cancer, immune dysfunction, eye and
skin diseases (including cancer), allergies, infectious diseases, traumatic injuries, musculoskeletal
disorders, mental stress, and acute death (Schulte and Chun, 2009). Many of these conditions are
not visible in the bioarchaeological record although respiratory diseases in the form of sinusitis
have been investigated in the context of air pollution and environmental change (Davies-Barrett
et al., this volume; Roberts, this volume). Mental health, infectious diseases, musculoskeletal
changes, and traumatic injuries specifically related to occupational hazards induced by a changing
climate or environment have not been well-studied although there is potential if the right sample
were investigated. These will not be discussed further in this chapter.
Population displacement
One of the most commonly cited consequences of climate change is the potential size and scope of
population displacement, with estimates ranging from 150 to 250 million people becoming “envir-
onmental refugees” or “climate refugees” by 2050 (Byravan Rajan, 2006; Gemenne, 2011; Myers,
2002). Celia McMichael and colleagues (2012) differentiate between three different manifestations
of climate-related migration based on a projected scale (e.g., community, large-scale) and des-
tination (e.g., urban, within-country): forced displacement, planned resettlement, and voluntary
migration. Whichever type of climate-related migration occurs, the projected health risks will
mimic those experienced by other categories of refugees, including lack of necessities such as
food, water, sanitation, housing, increased risk of infectious disease, and mental health problems.
Those most vulnerable will be women, children, the elderly, and those with pre-existing conditions
(McMichael, 2015). Although the human security literature tends to portray migration as a neces-
sary consequence of climate change, and certainly there are circumstances where it will increase,
the archaeological record demonstrates migration is not always part of adaptation to climate change
and often people have chosen not to migrate even when climate modeling suggests nearby regions
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were perhaps more suitable environments where people could have settled.While we cannot cover
every instance of migration or every time people chose to stay behind, we will discuss some basics
of this aspect of climate and environmental change in the bioarchaeological record.
Violence and conflict

Chapter 19 in the 2014 IPCC report synthesizes research on the impact of climate change on
human security, defined as having the “freedom and capacity to live with dignity” and having
the “material and non-material elements necessary for people to act on behalf of their interests”
(Adger et al., 2014, p. 759). One aspect of security discussed is the state of the research on the
causal relationship between climate change and conflict. Focusing exclusively on armed conflict,
defined as conflict with more than 25 battle-related deaths per year, the authors conclude that
while “there is justifiable common concern that climate change or changes in climate vari-
ability increase the risk of armed conflict, ...” “...confident statements about the effects of future
changes in climate on armed conflict are not possible given the absence of generally supported
theories and evidence about causality” (Adger et al., 2014, p. 773). Although the causal linkage
between future climate change and armed conflict is not well established, on the surface it seems
reasonable to imagine it can be “a risk multiplier” (Levy et al., 2017), exacerbating pre-existing
risk factors associated with violence, including socioeconomic disparities and political instability.
Nutrition
Of the three factors that the IPCC identifies as influencing nutrition, socioeconomics (e.g.,
food prices), food/nutrition-related diseases, and agricultural production, the impact of climate
change has only been modeled archaeologically for the latter. Recent meta-analyses predict
that climate change will result in declining agricultural yields, even after factoring in poten-
tial increases in yield due to adaptation (Challinor et al., 2014; Funk and Brown, 2009; Knox
et al., 2012). The health consequences that follow from reduced productivity include reduced
per capita calorie availability (Nelson et al., 2009), an increase in the likelihood of childhood
stunting (Lloyd et al., 2011), and an increased risk of under-nutrition-related childhood mor-
tality (Grace et al., 2012). Bioarchaeological work on stunting and nutritional deficiency in the
context of environmental change and social inequality is discussed below.
Bioarchaeological research has great potential to contribute to the discussion on institutionally
mediated health impacts of climate change. The biocultural paradigm that grounds our discip-
line explicitly incorporates culture as a factor influencing our ability to respond to stressors. In
this volume, there are multiple chapters devoted to documenting the impact of climate change
on occupationally related respiratory disease, infectious disease, social inequality, urbanism, vio-
lence, musculoskeletal markers, activity, diet, and “health.” That being said, it is generally not
common to find research that examines the intersection between social inequality, climate
change, and these consequences; there is research that considers the impact of social inequality
on health while only tangentially considering the impact of climate, while others will discuss
mobility and climate change without explicitly weighing the impact of social inequality. The
following discussion attempts to summarize what bioarchaeologists have learned about these
issues in the past several decades despite these limitations.
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Population displacement
Over the last several decades, radiogenic and stable isotopic ratios have provided bioarchaeologists
with a powerful means of reconstructing mobility in the past (Bentley, 2006). When articulated
with other data (e.g., skeletal, archaeological, historical), we have the opportunity to ask a wide
range of questions related to the movement of peoples in the past, including the impact of inter-
regional socio-politics (e.g., Buzon and Simonetti 2013), social identity and inequality (Torres-
Rouff and Knudson, 2017), imperialism (Tung and Knudson, 2011), enslavement (Price et al.,
2006), and subsistence strategies (Haverkort et al., 2008).These types of studies provide nuanced
reconstructions of human behavior in response to myriad social, political, and economic factors.
Bioarchaeologists are also beginning to reconstruct how humans responded to climate
change through the lens of mobility. It is important to note first that the examples discussed
below focus exclusively on climate-related changes in mobility—their primary goal is not how
climate-induced displacement may have been influenced by social inequality or the resulting
health consequences. The following examples span a wide temporal and geographic range, and
actually come to slightly different conclusions; ultimately, however, they are united in that
they highlight the potential our discipline has to examine the consequences of climate change
and suggest directions for future research on the nexus of climate change, mobility, and social
inequality.
One of the claims made by the human security literature is that climate change invariably
leads to environmental migration. A second major claim is that environmental migration and
competition for resources lead to inter-personal violence and societal collapse. In some cases,
the relationship between climate change and migration is supported by archaeological evidence.
For example, Christopher Beekman (2015) looked at paleoclimate, archaeological, and skeletal
sources to evaluate the causes of migration in Epi-Classic Northern Mexico. He found that the
archaeological evidence from the Guanajuato and Jalisco regions of Northern Mexico in the
Epi-Classic period demonstrates that large-scale migration events coincided with prolonged
drought in the period from 700 to 1200 AD. Drought and socio-political changes were triggers
for large-scale migration, which in turn led to more socio-political instability.
On the other hand, Stojanowski and Knudson (2011; 2014) also examined mobility in the
context of environmental change in human populations from Niger, in the Sahara region of
North Africa. In this case, they found more subtlety in human migration patterns in the face of a
harsh environmental and climate change. From the early (c. 9.7–8.3 kya) to middle Holocene (c.
7.2–4.9 kya), the central Niger region of Africa experienced a climatic shift from relatively wet
and humid conditions to an increasingly arid climate, lower lake levels, and greater humid-arid
variability. Generating radiogenic strontium isotope data from skeletal material from early and
middle Holocene components at the site of Gobero, Niger, Stojanowski and Knudson (2011;
2014) were able to examine specific human responses to aridification.
Early Holocene populations settled in the region and this sedentism is associated with a high
prevalence of biocultural stress markers—signs in the bones and teeth that suggest a period
when homeostasis and/or growth was disrupted—in the bones and teeth of the younger gen-
eration. The early Holocene fisher-forager inhabitants of Gobero demonstrate little evidence
of migration and exhibit largely homogeneous strontium ratios with one notable exception;
while all bone isotope data fall within the expected “local” range, enamel from two individuals
fell outside that range. Individuals who died as juveniles have “local” isotopic ratios for both
bone and enamel with little variability. The “non-local” enamel results were found in individ-
uals who died as adults. The variability that was observed is interpreted as being indicative of
transhumance.
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In the middle Holocene, climate change led to aridification and these environmental
changes were associated with higher levels of mobility. Data from middle Holocene inhabitants
of Gobero initially appeared to reflect a similar pattern; the majority of individuals exhibit
“local” bone data plus a mixture of “local” enamel data (i.e., they were born and died at Gobero)
and “non-local” enamel data (i.e., they were born somewhere else but spent the last part of
their adult life at Gobero). Five adult individuals, however, had “non-local” strontium ratios for
both bone and enamel data. The authors offer several interpretations. First, while some people
at Gobero may have responded to climate change through increased mobility (i.e., those with
“non-local” bone and enamel) others remained relatively sedentary.
Alternatively, radiocarbon dates support the idea that the results may reflect changing
behavior with time, with increased mobility (e.g., those adults with both “non-local” bone and
enamel data) only occurring at the end of the middle Holocene (Stojanowski, 2013). Finally, the
contrasting results may reflect different forms of subsistence and therefore behavioral responses
to aridification. Ultimately, the authors’ “overall interpretation is that climatic deterioration
and increasing aridity was accompanied by subtle shifts in mobility that may only have been
adopted by the terminal occupants of the region immediately before the final abandonment
of the area” (Stojanowski and Knudson, 2014, p. 91). In this case, responding to increasing
aridity through an increase in population mobility led to fewer signs of growth disruption in
childhood. Importantly, there is no evidence that this increase in mobility resulted in socio-
political instability or inter-personal violence.
Bioarchaeologists working in other areas of the world have found that there are many
different historical and socio-cultural circumstances where the relationship between cli-
mate change and migration does not follow a pattern predicted by scientists who work with
only contemporary scenarios. Kelly Knudson and colleagues (2015) examined migration as
a response to environmental and political disruption in the San Pedro de Atacama region
of Northern Chile. Using bioarchaeological and isotopic techniques they found migration
levels which had been high in the Middle Horizon, were significantly reduced during a
protracted and severe drought in the Late Intermediate Period (AD 1100–1200). Despite
environmental impacts from drought, declining population size, and large-scale site abandon-
ment, migration to nearby unaffected areas was not the preferred solution. Rather human
populations consolidated into larger, more fortified settlements. Environmental migration
happens sometimes—like in the Sahara example, above—but in this case, climate change was
associated with declining mobility, increasing insularity, and a decline in outside contact and
exchange (see also Torres-Rouff , this volume).
Similarly, in the Oman Peninsula, rapid aridification in the third millennium BC was
accompanied by a change in material culture, shifting mortuary practices, and a breakdown in
interregional trade relations with Mesopotamia and the Indus Valley. Lesley Gregoricka (2016)
used oxygen, carbon, and strontium isotopes to demonstrate that the human community here
was impacted by aridification but her examination of the human responses to climate changes
in the UAE for 1400 years suggests that a model of climate change–migration–societal collapse
is inappropriate in this context. Rather the isotopic data demonstrate that these communities
were remarkably homogeneous in their lifeways over time and maintained a highly successful
adaptation to changing circumstances (see also Gregoricka, this volume).
Migration and health

There is bioarchaeological research that considers the health impacts of migration, though
again it is important to note that in the following examples, climate change is not explicitly
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considered as a factor in displacement. Although the following are not examples of “environ-
mental refugees,” they can prove illustrative of the potential for bioarchaeology to inform us
about institutionally mediated health consequences.
Stojanowski and Carver (2011) document a decrease in the frequency of localized hypoplasia
of the primary canine (LHPC) from the early to middle Holocene at Gobero. Most likely
reflecting dietary deficiencies during early childhood, this decrease in frequency is interpreted
as related to a shift in subsistence strategy, from fisher-foragers to pastoralism, which itself was
likely a response to aridification.
Combing stable isotope analyses and paleopathological data, Redfern and colleagues (2018;
Redfern, this volume) examined the impact of migration on health patterns during the Roman
occupation of Britain (AD 43–410). Although the results reveal significantly higher frequen-
cies in migrant versus local populations for several health indicators (e.g., periosteal new bone
formation, rib lesions, residual rickets, and dental health variables), the researchers stress that
Roman-period settlements, consisting of both migrants and Indigenous Britons, created “het-
erogeneous disease environments” and that it was the disease experiences that migrants brought
with them that at least in part impacted their experience of Roman Britain. This reflects a
point made above, that health status, and one’s health history, influences vulnerability when
encountering new sources of stress (e.g., crowded urban conditions).
The social and economic marginalization that migrants experience may result in
them engaging in, or being forced to engage in, more hazardous work with serious health
consequences (e.g., Holmes, 2006). Researchers examining skeletal collections representing
Chinese migrant mine-workers in South Africa (Meyer et al., 2013) and railroad laborers in the
United States (Harrod et al., 2012) have observed high levels of trauma. Meyer and colleagues
attribute high perimortem trauma prevalence to hazardous working conditions, while Harrod
and colleagues (2012, p. 99) attribute high trauma rates to “a pattern of endemic abuse” and
“violent encounters” rather than the nature of the job itself.
Migration and conflict

There are six chapters devoted to the topic of climate change and violence in this volume so
we will not belabor the point much here except to say that another one of the claims made by
the human security literature is that climate change and migration increase pressure on nat-
ural resources, which stimulates a natural human tendency toward violent behavior (Robbins
Schug et al., 2019; see, for example, Scheffran et al., 2012). Ryan Harrod and Debra Martin
(2014) suggested a biocultural model for examining the different pathways that lead to vio-
lence in human societies in the face of climate and environmental change. They examined
evidence from sites belonging to Ancestral Pueblo people of the southeastern United States
and found that societies engage in different strategies to cope with environmental change,
including, but not limited to, migration and warfare (see also Martin and Harrod, this volume,
for another perspective). Some of the alternate strategies included reaching out to form
cooperative alliances with other communities, exchange, resource redistribution, and, in some
cases, migration or warfare.
Research by Robbins Schug and colleagues has examined human-environmental interactions
in South Asia for the past 4500 years.This work was mentioned briefly above regarding the role
of climate change and social inequality in shaping patterns of infectious disease. These authors
have also documented variation in the experience of climate and environmental change for
residents of urban societies versus rural, agrarian villages. During the 4.2 ka event in Pakistan
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and northwest India—when a rapid climate change event led to reductions in the amount
of monsoon rainfall and changes to the patterning of the rains—increasing aridity and the
opportunities afforded by a newly emerging urban lifestyle and participation in a long-distance
exchange network initially stimulated people to move from the hinterlands and rural villages
into cities, like Harappa or Mohenjo Daro (from approximately 2200 to 2000 BC). However,
after centuries of climatic changes affecting the entire region, the trade network known as the
Middle Asian Interaction Sphere started to crumble. Once the opportunity for long-distance
exchange was lost, South Asian cities began to deteriorate and were eventually abandoned
around 1900 BC.
Human skeletal remains from some of these cities demonstrate the effects of these envir-
onmental and political changes on human communities. Infectious diseases like leprosy were
discussed above but there was also an increase in interpersonal violence with climate change
and the collapse of the Indus civilization. Contrary to claims made in the human security
literature, however, there is no evidence that migrants suffered from interpersonal violence.
Rather, it was the people who stayed behind and lived in these cities during the “post-urban”
period that demonstrate the highest prevalence of traumatic injuries. Mortuary treatment—the
way bodies are treated after death—suggests the risk of interpersonal violence and disease was
shaped by social inequality (Robbins Schug, 2017). The injuries recorded at Harappa were pri-
marily depression fractures on the skull, many of which were examples of clubbing, or healed
broken noses, while one individual (a middle-aged adult male) exhibited a perimortem sharp
force trauma to the face.
The greatest risk of both trauma and infectious disease at Harappa appears to have been
for the individuals who were interred after the urban period, after climate and environ-
mental changes made life in the city difficult enough that a large proportion of the popula-
tion abandoned the urban lifestyle for a millennium. For those who stayed behind after 2000
BC, the archaeological record demonstrates that social control in the city of Harappa was
relatively lax, migration away from the cities was at a very high rate, and previously defined
social divisions combined with climate change may have contributed to the higher rates of
violence and disease in some communities or groups.Violence, in this case, was not associated
with migration but rather was experienced by those who, for whatever reasons, were unable
to or chose not to emigrate from the urban areas. In the context of urban societies, built on
a foundation of social inequality and disintegrating due to social, cultural, economic, and cli-
matic forces, violence was one response that affected some members of the community more
than others.
This is not an anomalous result, limited to one city. There is evidence for traumatic injuries
in most of the cities that have yielded skeletal remains. Kennedy (1984; 1990; 2000) found
evidence for healed injuries at Harappa and Mohenjo Daro, Sharma (1999) reported injuries
in the skeletal material from Kalibangan, Lee and colleagues (2019) reported cranial trauma at
Rakhigarhi, Mushrif-Tripathy and Shinde (2019) documented a cranial depression fracture at
Farmana, and Sarkar (1972; 1985) noted injuries in the remains found at Lothal.
Skeletal stunting and micronutrient deficiencies

A large volume of research has examined the impact of dietary transitions, particularly the shift
to food production, in human health in the past (e.g., Armelagos and Cohen, 1984; Cohen and
Crane-Kramer, 2007; Oxenham and Buckley, 2016). Typically, these studies are not explicitly
related to climate change or social inequality though they do demonstrate substantial impacts of
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agriculture and diet in general on the health and well-being of human populations. Agricultural
production will face significant impacts from climate change and thus the vast bioarchaeological
literature on this related topic is valuable for thinking about our future. In general, that litera-
ture is describing increased reliance on agriculture as a health challenge; however, there is one
example of environmental changes driving the abandonment of agriculture and significant
health impacts that followed, which might also be instructive for climate scientists interested in
social determinants of health.
Robbins Schug and colleagues (Robbins Schug, 2011; Robbins Schug and Blevins, 2016;
Robbins Schug and Goldman, 2014) have done research on environmental changes one thou-
sand years after the end of the Indus civilization, which demonstrates a very different set of
strategies and very different outcomes in the rural villages of west-central India during the
period known as the Deccan Chalcolithic (2200–700 BCE). There, people were living in small
villages that had sprung up in the river valleys of the present state of Maharashtra after the end
of the Indus civilization and the first urban period in South Asia. They had a mixed economic
system, farming a mix of north and south Indian crops—wheat, barley, rice, lentils, peas, gram—
and keeping cattle, sheep, and goats. They hunted deer and other animals and they gathered
wild foods in nearby forested tracts of land. By 1400 BC, there were hundreds of settlements
here, ranging in size from small herder encampments to large villages of 5000 people. These
communities particularly seemed to be flourishing in the increasingly arid Early Jorwe phase
(1400–1000 BC).
Eventually, population growth and unsustainable farming practices led to environmental
changes and the region was less conducive to food production. By 1000 BC, the majority of
these settlements were abandoned. The town of Inamgaon was occupied for another 300 years
despite the depopulation of much of the region. The people persisted here through a mixed
strategy of increasing mobility, reducing their reliance on agriculture, and shifting from a focus
on keeping cattle to one on herding sheep and goats. In this rural context, the human experience
of surviving environmental crises and socio-cultural resilience was one of slow suffering: skel-
etal emaciation in infants and children was due to the lack of cereal weaning foods and socio-
sanitation problems, life expectancy at birth plummeted, and the population eventually either
moved away or perished.
The skeletal remains of infants and children from these villages tell a different story of the
experience of remaining behind in a settlement after much of a region is abandoned. Unlike the
people at the city of Harappa, who experienced increases in interpersonal violence and disease,
the rural population at Inamgaon experienced a rise in infant and childhood skeletal emaci-
ation, stunting, reduced BMI, and osteopenia—increased porosity in the cortical bone (Robbins
Schug, 2011; Robbins Schug and Goldman, 2014). These infants and children experienced a
significant increase in abnormal surface porosity as well, in some cases related to micro-nutrient
deficiencies like scurvy (Robbins Schug and Blevins, 2016).
The only sign of developmental disturbance that decreased over time at Inamgaon was
enamel defects in the primary dentition (localized hypoplasia of the primary canine, or LHPC,
and IPCH, or interproximal contact hypoplasia). At Inamgaon, infants living during the agri-
cultural early period had a higher frequency of LHPC and IPCH than infants who died in the
later period, after agriculture had been abandoned (Lukacs, 1999; Lukacs and Walimbe, 1998).
Both of these defects can be associated with socioeconomic deprivation and hypovitaminosis
A (Lukacs, 1991; Guatelli-Steinberg and Lukacs, 1999). The defect known as LHPC was also
associated with growth stunting in modern Indian children, thus suggesting the short stature
and skeletal emaciation may have been attributable to low birth weight and maternal gestational
stress (Lukacs et al., 2001)
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Conclusion/discussion
Climate change will have its greatest effect on those who have the least access to the
world’s resources and who have contributed least to its cause. Without mitigation and
adaptation, it will increase health inequity especially through negative effects on the
social determinants of health in the poorest communities.
Costello et al., 2009
The IPCC report distinguishes between impacts that will be heavily mediated through human
institutions and those that are not—mortality and morbidity will be directly associated with
extreme weather events and indirectly associated with ecological changes in addition to the
social determinants of health. In reality, all of the above health impacts will be influenced by how
human cultures respond.As this chapter has illustrated, herein lies one of the primary strengths of
the bioarchaeological approach. Though there are some areas where bioarchaeological research
may not be able to offer insight (e.g., mortality directly associated with heatwaves), the strength
of our research lies in the biocultural approach and the explicit incorporation of the intersection
of social inequality and climate change in shaping human health over time.
In this chapter, we have seen how in the face of the predicted course of climate change,
social inequality will represent a significant adaptive challenge, perhaps the most salient issue
at stake. It is predicted that climate change will drive more people into poverty and exacerbate
pre-existing health disparities, disproportionately impacting the socially marginalized and the
socioeconomically disadvantaged. In turn, these disparities will make pandemics spread faster
and wider, create severe backlogs in medical and other resources, and limit access to care for all
but the wealthiest 5% of the global population.
Although humans have not faced global anthropogenic climate change of this magnitude
before, there are many examples throughout the Holocene of how human groups have responded
to naturally occurring climate changes in the past; thus, there are ways that both historical and
bioarchaeological research can contribute to the discussion and inform policymakers engaged
in mitigation and adaptation efforts. Primarily, bioarchaeology’s unique role will be found in
our deep understanding of health in the face of changing human-environmental interactions,
epidemiological transitions, and re-/emerging pathogens, dispelling unilateral models of human
behavior based on misconceptions of human “nature” and evolution, and in bringing nuanced
perspectives based in historical, socio-cultural, and critical medical anthropological theory to the
discussion. These perspectives are critical and we hope that bioarchaeologists will come to the
table prepared to recognize the power of our data to address these urgent “real-world” problems.
Acknowledgments
The authors would like to thank all of the scholars and bioarchaeologists cited in this chapter,
those who are contributors to this volume, and others who are working to understand the
complex web of human-environmental interactions. Their important and highly relevant work
inspired this chapter.
Notes
1 Recent reports found that natural hazards (e.g., hurricanes, flooding) have exacerbated income inequality
in the United States (Howell and Elliot, 2018a; 2018b). The researchers found that, on average, the
wealth of white residents of areas that received FEMA funding increased while the wealth of black
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residents of the same area decreased. A recent story by NPR examined the distribution of FEMA prop-
erty buyouts and found that a disproportionate number of these went to white communities: www.npr.
org/2019/03/05/688786177/how-federal-disaster-money-favors-the-rich. However, this has not been
explored bioarchaeologically and is thus left as a footnote.
2 Socioeconomic status is of course only one possible dimension of social inequality. For instance, studies
have demonstrated that psychosocial stress, such as associated with racial discrimination, can negatively
impact health (e.g., Chae et al., 2015; Foster et al., 2000). The IPCC discusses “vulnerability” to the
health impacts of climate change in terms of socioeconomics, public health and other infrastructure,
geographic location, age, gender, and current health status. A brief discussion of the impact of race and
ethnicity on health status is contained in the section on vulnerability due to socioeconomic status. Race,
being a relatively new social phenomenon though one that has been considered bioarchaeologically, is
not discussed in this chapter.
3 It is not certain that it is possible to generate paleoclimatic data that are fine-grained enough to cap-
ture the physiological impacts of “heatwaves.” Some researchers have derived δ18O isotopic ratios from
tooth enamel to discuss larger scale temperature changes (e.g., Medieval Climatic Anomaly, Fricke et al.,
1995; Little Ice Age, Daux et al., 2005; 4000 years-worth of climate in the Nile River Valley, Touzeau
et al., 2013) but for most regions of the world, the paleoclimate data or the radiocarbon dates for skeletal
material are not that fine-grained.
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159

1. Direct impacts of climate and weather on health (e.g., heatwaves, flooding);

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K.C. Nystrom and G. Robbins Schug

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Figure 9.2 The global multi-dimensional poverty index.

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Figure 9.3 The effect of multi-dimensional poverty on children worldwide.

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may be inappropriate to extrapolate existing risk-function estimates to climatic-environmental

Bio/archaeology of social inequality

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K.C. Nystrom and G. Robbins Schug

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Direct impacts of climate and weather on health: Impacts

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K.C. Nystrom and G. Robbins Schug

Extreme weather events—mega-storms, flooding, drought, wildfires, landslides—are already

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Ecosystem-mediated impacts of climate change on health outcomes

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A bioarchaeology of social inequality

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A bioarchaeology of social inequality

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Health impacts mediated through human institutions

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Violence and conflict

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Migration and health

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Migration and conflict

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Skeletal stunting and micronutrient deficiencies

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K.C. Nystrom and G. Robbins Schug

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A bioarchaeology of social inequality

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