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Disease and social diversity. By Stephen J. Kunitz. 1994. New York Oxford University Press. 209 pp. ISBN 0-19-508530-2. $49.95 (cloth)

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Book Reuiews
It is a rich source for teachers looking for
illustrations of ultimate versus proximate
WHYWE GETSICK.By Randolph M. Nesse causation. The central strength of the work,
and George C. Williams. New York: Ran- and simultaneously its weakness, is the audom House. 1994. 291 pp. ISBN 0-8129- thors’ wholehearted adoption of the “adaptationist programme” articulated and criticized
2224-7. $24.00 (cloth).
DIVERSITY.By Stephen by Gould and Lewontin in their influential
J. Kunitz. 1994.New York: Oxford Univer- 1979 paper (Proc. R. SOC.London [B] 205:
sity Press. 209 pp. ISBN 0-19-508530-2. 581-598). Our susceptibility t o disease as
well as our defenses against them are seen
$49.95 (cloth).
HISTORICAL,as having been shaped almost exclusively by
PERSPEC-natural selection, with little attention being
TIVES.By James B. Waldram, D. Ann Her- paid to the influence of the other forces of evoring, and T. Kue Young. Toronto: Univer- lution. If a phenomenon, like anemia atsity of Toronto Press. 1995. 334 pp. ISBN tending an infectious disease, can be imagined to be adaptive in an ultimate sense, then
0-8020-6887-1. $18.95 (paper).
such account is offered as the most parsimoWhile we biological anthropologists can nious explanation. When more than one
be distinguished from our biomedical col- adaptive scenario has been postulated, as
leagues through our interest in patterns with menstrual flow, the authors acknowlof variation within and between human edge that the best explanation remains unpopulations, the three books under review known, giving the reader the impression that
illustrate that we can approach variation one of the contending adaptationist stories
in human health at very different levels of will eventually be “proven”true.
Readers familiar with evolutionary theory
organization. Why We Get Sick advances
evolutionary explanations for the nature of may be uneasy about the balance of perspecvariation in disease patterns in our species; tives presented. Readers from other fields
Disease and Social Diversity uses case stud- will be stimulated to look at the biomedical
ies from selected geographic regions t o in- world from a new perspective. The book
vestigate the historical and sociopolitical could fit into undergraduate curricula in sevdeterminants of variation in health; Aborig- eral fields, especially if used as a starting
inal Health in Canada focuses on the bioso- point for discussion.
Of these three books, Disease and Social
cia1 forces promoting changes in disease patterns over time in a single region and empha- Diversity is probably the one which would
sizes the practicalities of policy and planning. most easily fit into the upper level underEach is a valuable contribution and has its graduate curriculum in biological anthropolplace in teaching and research. Not surpris- ogy. Drawing on a rich history of personal
ingly, production values differ, with the vigor- fieldwork and research experience, Kunitz
ously promoted Why being the most carefully gracefully acquaints the reader with the layedited and easiest to read, and the Canada ers of variables contributing to health and
volume in need of some editorial tightening, disease among indigenous populations of
but all represent good value.
North America, Australia, and Polynesia.
Why We Get Sick has received considerable Unlike Nesse and Williams, who attempt t o
attention ever since a precis of the book was develop a general model for understanding
published in the Quarterly Review ofBiology health, Kunitz utilizes what he refers to as
in 1991. Its focus is on “how evolutionary a “particularistic approach” to the study of
ideas can help to explain and prevent or cure disease. Indeed, in introducing and despecific medical diseases,” (p. 182) although fending his perspective, Kunitz is critical of
it goes well beyond diseases into nearsight- broad, overarching explanations of human
edness, sexual jealousy, and menstruation. health patterns:
I contend in this book that diseases in populations
are so diverse that attempts at generalizing may often-but not always-be vacuous and go badly astray.
There is still a lot of mileage to be gotten out of thinking about diseases in their local or national contexts,
even understanding that some processes are universal. Generalizations may be parsimonious. They may
also be impoverished (p. 6).
Kunitz thus employs a “bottom up” approach to understanding disease, in contrast
to the “top down” (theory driven) approach
of Nesse and Williams. I n each geographic
area he examines the specific historical and
sociopolitical factors that have influenced
disease, and from these findings attempts to
infer broader patterns. He effectively demonstrates that social context is critical to
fully understanding variation in morbidity
and mortality among human populations.
Aboriginal Health i n Canada addresses
its subject in a manner similar to Disease
and Social Diuersity, and in doing so finally
fills a void identified by generations of Canadian researchers (including the present editor of this journal and reviewer SP, who often
discussed this need during their student
years). Summarizing the relevant prehistoric, historic and political background in a n
even-handed manner, Waldram, Herring,
and Young adopt a n historical epidemiological approach to explain the tensions now existing between medical traditions in aboriginal cultures and the delivery of health
services through government agencies. Lessons learned from the impact of tuberculosis
and alcohol, two relatively well-studied prob-
lem areas, are intertwined through the text.
The conclusions of each chapter build to a final argument that health delivery must now
be seen as one aspect of aboriginal self-determination. Directing their forthright recommendations toward the political arena, the
authors lobby for dramatic changes in attitude and institutions. For readers from outside Canada, this book could serve as a model
of how to take the biosocial model, apply it to
substantive knowledge of a region, and produce a vehicle which may elicit constructive
change in its health care.
All three of these books embrace the biocultural perspective central to biological anthropology. While Why We Get Sick often
tends to skim across the surface of the
(‘murky intersection between biology and
culture’’ (p. 224), both Disease and Social
Diversity and Aboriginal Health in Canada
wade deeply into it. As such, these books
provide very different, but complementary,
insights into the human condition. They also
emphasize the strengths and limitations of
alternative strategies for understanding human variation. Each has its place within biological anthropology; our suggestion is to
choose your level of organization and enjoy.
Department of Human Biology and
Nutritional Sciences
University of Guelph
Guelph, Ontario, Canada
AND CULTURALtion. The chapter-by-chapter argument is a s
By Robert Bates Graber. follows: 1)assumption: in the absence of cir1995. Kirksville, Missouri: Thomas Jeffer- cumscription, population density and socison University Press. 180 pp. ISBN 0- etal size remain constant (“inertia”) when
there is population growth, 2) definition: in943549-19-1. $36.50 (Cloth).
dices of inhibition relating to areal expanRobert Carneiro’s thesis that political evo- sion and to societal proliferation are defined,
lution is caused by increase in population 3) proposition: population growth in conjuncdensity due to population circumscription is tion with inhibition of area expansion will
given a mathematical foundation in this lead to deproliferation in the number of socibook. Graber uses the mathematical formal- eties (“symmetry thesis”), 4) proposition:
ism to derive consequences implied not only spatial variation in density growth within
for political evolution but for changes in the a society is negligible due to a tendency of
number of societies and for cultural evolu- density growth rates to equalize over rele-
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cloth, university, 508530, isbn, disease, kunitz, 1994, new, york, social, diversity, 209, stephen, pres, oxford
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