In order to place western diseases in an evolutionary context it is necessary to consider the experience of human disease throughout human evolutionary history. To achieve this I adopt a framework drawn from the work of Boyden (1987) and Cohen (1989), illustrated in Table 2.1. This approach emphasises the need to understand the way of life, ecology and health experience of hunter–gatherer people, because such an understanding informs us about the context in which members of our species lived for so much of its evolutionary history. An examination of the enormous impact of agriculture and then of urban living on human health illustrates how changes in ways of life have had profound effects on disease experience in the past. As will become clear in later chapters, it is also increasingly apparent that an understanding of the evolutionary history of human exposure to infectious disease and nutritional pressures, which was profoundly affected by these innovations, is relevant to our understanding of western diseases. Finally, I consider the decline of infectious diseases and rise of non-communicable disease in the west, the so-called epidemiologic transition, and trends in the prevalence of western diseases over the nineteenth and twentieth centuries.

Human ecology and health in the Palaeolithic

Anthropologists have used various kinds of evidence to try to find out more about the ways of life of humans during this period, and to characterise their experiences of health and disease.