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Medieval English Social Inequality and Bone Health: What Lessons are There to be Learnt for the Living?

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Bone Health

Abstract

There is no doubt that modern lifestyles have an effect on our health. The ways in which our bodies respond and adapt to the daily activities we engage in and the types of food we eat are influenced by our socio-economic surroundings. These are further linked to individual frailty, immunity, genetic predisposition to develop certain conditions, and other aspects of physiology that collectively allow us to function in biocultural contexts. The skeletal system, as it serves roles of movement, mineral reservoir, cell production, and organ protection, is paramount when adapting to a spectrum of human behaviours. Within ageing modern populations, bone loss and maintenance require close monitoring to manage increasing skeletal fragility and associated fracture risk. Socio-economic inequality in access to appropriate care, education, and resources is a major factor underlying bone health issues we observe today. To better understand the effect of socio-economic status (SES) on the living skeleton, we ought to turn our attention to past societies of distinct social stratification which is reflected in the health of their surviving skeletal remains. This chapter introduces medieval English lifestyles collated from historical and bioarchaeological accounts to illustrate the impact SES inequality can have on bone health.

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References

  1. Wilkinson RG. Unhealthy societies: the afflictions of inequality. London: Routledge; 2002.

    Book  Google Scholar 

  2. Wilkinson RG, Marmot M. Social determinants of health: the solid facts. Copenhagen: World Health Organization; 2003.

    Google Scholar 

  3. Ilich JZ, Kelly OJ, Kim Y, Spicer MT. Low-grade chronic inflammation perpetuated by modern diet as a promoter of obesity and osteoporosis. Arh Hig Rada Toksikol. 2014;65(2):139–48. https://doi.org/10.2478/10004-1254-65-2014-2541.

    Article  CAS  PubMed  Google Scholar 

  4. Hegsted DM. Fractures, calcium, and the modern diet. Am J Clin Nutr. 2001;74(5):571–3. https://doi.org/10.1093/ajcn/74.5.571.

    Article  CAS  PubMed  Google Scholar 

  5. McKnight A, Steele K, Mills K, Gilchrist C, Taggart H. Bone mineral density in relation to medical and lifestyle risk factors for osteoporosis in premenopausal, menopausal and postmenopausal women in general practice. Br J Gen Pract. 1995;45(395):317–20. https://doi.org/10.5455/medarh.2017.71.25-28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Heaney RP. Nutrition and risk for osteoporosis. In: Marcus R, Dempster DW, Cauley JA, Feldman D, editors. Osteoporosis. 4th ed. San Diego: Elsevier Academic Press; 2013. p. 645–81.

    Chapter  Google Scholar 

  7. Tremblay MS, Colley RC, Saunders TJ, Healy GN, Owen N. Physiological and health implications of a sedentary lifestyle. Appl Physiol Nutr Metab. 2010;35(6):725–40. https://doi.org/10.1139/H10-079.

    Article  PubMed  Google Scholar 

  8. Korpelainen R, Korpelainen J, Heikkinen J, Väänänen K, Keinänen-Kiukaanniemi S. Lifestyle factors are associated with osteoporosis in lean women but not in normal and overweight women: a population-based cohort study of 1222 women. Osteoporos Int. 2003;14(1):34–43. https://doi.org/10.1007/s00198-002-1319-6.

    Article  CAS  PubMed  Google Scholar 

  9. Sievänen H, Kannus P. Physical activity reduces the risk of fragility fracture. PLoS Med. 2007;4(6):e222. https://doi.org/10.1371/journal.pmed.0040222.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Katzenberg MA, Grauer AL. Biological anthropology of the human skeleton. 3rd ed. Hoboken: Wiley; 2018.

    Book  Google Scholar 

  11. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000;15(4):721–39. https://doi.org/10.1359/jbmr.2000.15.4.721.

    Article  CAS  PubMed  Google Scholar 

  12. Turrell G, Kavanagh AM. Socio-economic pathways to diet: modelling the association between socio-economic position and food purchasing behaviour. Public Health Nutr. 2006;9(3):375–83. https://doi.org/10.1079/PHN2005850.

    Article  PubMed  Google Scholar 

  13. Miech RA, Hauser RM. Socioeconomic status and health at midlife: a comparison of educational attainment with occupation-based indicators. Ann Epidemiol. 2001;11(2):75–84. https://doi.org/10.1016/S1047-2797(00)00079-X.

    Article  CAS  PubMed  Google Scholar 

  14. Alswat K, Adler SM. Gender differences in osteoporosis screening: retrospective analysis. Arch Osteoporos. 2012;7(1–2):311–3. https://doi.org/10.1007/s11657-012-0113-0.

    Article  PubMed  Google Scholar 

  15. Cheung CL, Xiao SM, Kung AW. Genetic epidemiology of age-related osteoporosis and its clinical applications. Nat Rev. Rheumatol. 2010;6(9):507. https://doi.org/10.1038/nrrheum.2010.106.

    Article  PubMed  Google Scholar 

  16. Lei SF, Chen Y, Xiong DH, Li LM, Deng HW. Ethnic difference in osteoporosis-related phenotypes and its potential underlying genetic determination. J Musculoskelet Neuronal Interact. 2006;6(1):36.

    CAS  PubMed  Google Scholar 

  17. Howe LD, Galobardes B, Matijasevich A, Gordon D, Johnston D, Onwujekwe O, Patel R, Webb EA, Lawlor DA, Hargreaves JR. Measuring socio-economic position for epidemiological studies in low-and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol. 2012;41(3):871–86. https://doi.org/10.1093/ije/dys037.

    Article  PubMed  PubMed Central  Google Scholar 

  18. McGraw RL, Riggs JE. Osteoporosis, sedentary lifestyle, and increasing hip fractures: pathogenic relationship or differential survival bias. Calcif Tissue Int. 1994;55(2):87–9.

    Article  CAS  PubMed  Google Scholar 

  19. Brennan SL, Henry MJ, Wluka AE, Nicholson GC, Kotowicz MA, Williams JW, Pasco JA. BMD in population-based adult women is associated with socioeconomic status. J Bone Miner Res. 2009;24(5):809–15. https://doi.org/10.1359/jbmr.081243.

    Article  PubMed  Google Scholar 

  20. Brennan-Olsen SL, Cook S, Leech MT, Bowe SJ, Kowal P, Naidoo N, Ackerman IN, Page RS, Hosking SM, Pasco JA, Mohebbi M. Prevalence of arthritis according to age, sex and socioeconomic status in six low and middle income countries: analysis of data from the World Health Organization study on global AGEing and adult health (SAGE) wave 1. BMC Musculoskelet Disord. 2017;18(1):271. https://doi.org/10.1186/s12891-017-1624-z.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Agarwal SC, Stout SD. Bone loss and osteoporosis: an anthropological perspective. New York: Kluwer Academic; 2003.

    Book  Google Scholar 

  22. Mays SA. Osteoporosis in earlier human populations. J Clin Densitom. 1999;2(1):71–8. https://doi.org/10.1385/JCD:2:1:71.

    Article  CAS  PubMed  Google Scholar 

  23. Mays SA. Age-related cortical bone loss in women from a 3rd–fourth century AD population from England. Am J Phys Anthropol. 2006;129(4):518–28. https://doi.org/10.1002/ajpa.20365.

    Article  CAS  PubMed  Google Scholar 

  24. Turner-Walker G, Syversen U, Mays S. The archaeology of osteoporosis. Eur J Archaeol. 2001;4(2):263–9. https://doi.org/10.1177/146195710100400207.

    Article  Google Scholar 

  25. Kneissel M, Boyde A, Hahn M, Teschler-Nicola M, Kalchhauser G, Plenk H Jr. Age-and sex-dependent cancellous bone changes in a 4000y BP population. Bone. 1994;15(5):539–45.

    Article  CAS  PubMed  Google Scholar 

  26. Dequeker J, Ortner DJ, Stix AI, Cheng XG, Brys P, Boonen S. Hip fracture and osteoporosis in a XIIth dynasty female skeleton from Lisht, upper Egypt. J Bone Miner Res. 1997;12(6):881–8. https://doi.org/10.1359/jbmr.1997.12.6.881.

    Article  CAS  PubMed  Google Scholar 

  27. Agarwal SC, Grynpas MD. Bone quantity and quality in past populations. Anat Rec. 1996;246(4):423–32. https://doi.org/10.1002/(SICI)1097-0185(199612)246:4<423::AID-AR1>3.0.CO;2-W.

    Article  CAS  PubMed  Google Scholar 

  28. Miszkiewicz JJ, Mahoney P. Ancient human bone microstructure in medieval England: comparisons between two socio-economic groups. Anat Rec. 2016;299(1):42–59. https://doi.org/10.1002/ar.23285.

    Article  Google Scholar 

  29. Roberts CA, Cox M. Health and disease in Britain: from prehistory to the present day. Gloucester: Sutton Publishing; 2003.

    Google Scholar 

  30. Dyer C. Making a living in the Middle Ages: the people of Britain 850–1520. New Haven: Yale University Press; 2002.

    Google Scholar 

  31. Keen MH. England in the later Middle Ages. London: Routledge; 2004.

    Google Scholar 

  32. Dyer C. Everyday life in Medieval England. London: Bloomsbury; 2000.

    Google Scholar 

  33. Bennett JM, Hollister CW. Medieval Europe: a short history. New York: McGraw-Hill; 2006.

    Google Scholar 

  34. Jordan WC. Europe in the high Middle Ages. London: Penguin; 2004.

    Google Scholar 

  35. Wilkinson B. The later Middle Ages in England 1216–1485. London: Routledge; 2014.

    Book  Google Scholar 

  36. Dunn A. The Peasant’s Revolt: England’s failed revolution of 1381. Stroud: Tempus Publishing Limited; 2004.

    Google Scholar 

  37. Jotischky A, Hull CS. The Penguin historical atlas of the medieval world. London: Penguin; 2005.

    Google Scholar 

  38. Platt C. King death: the Black Death and its aftermath in late-medieval England. London: Routledge; 2014.

    Book  Google Scholar 

  39. Bridbury AR. The Black Death. Econ Hist Rev. 1973;26(4):577–92. https://doi.org/10.1111/j.1468-0289.1973.tb01955.x.

    Article  CAS  PubMed  Google Scholar 

  40. Webber R. The Peasants’ Revolt: the uprising in Kent, Essex, East Anglia, and London in 1381 during the reign of King Richard II. Sudbury: T. Dalton; 1980.

    Google Scholar 

  41. Ormrod WM. Political life in Medieval England 1300–1450. London: Red Globe Press; 1995.

    Book  Google Scholar 

  42. Bartlett R. England under the Norman and Angevin kings: 1075–1225. Oxford: Clarendon Press; 2000.

    Google Scholar 

  43. Clark E. Some aspects of social security in medieval England. J Fam Hist. 1982;7(4):307–20. https://doi.org/10.1177/036319908200700401.

    Article  Google Scholar 

  44. Rigby SH. Urban population in late medieval England: the evidence of the lay subsidies. Econ Hist Rev. 2010;63(2):393–417. https://doi.org/10.1111/j.1468-0289.2009.00489.x.

    Article  Google Scholar 

  45. Ganshof FL. Feudalism. Toronto: University of Toronto Press; 1996.

    Google Scholar 

  46. Hull BB. Religion, afterlife, and property rights in the high Middle Ages. Stud Econ Anal. 1989;12(1):3–21.

    Google Scholar 

  47. Hilton R. Bond men and mad free: Medieval peasant movements and the English rising of 1381. New York: Routlegde; 1973.

    Book  Google Scholar 

  48. Gransden A. Childhood and youth in Mediaeval England. Nottingham Medieval Studies. 1972;16:3–19. https://doi.org/10.1484/J.NMS.3.53.

    Article  Google Scholar 

  49. Bilezikian JP. Primer on the metabolic bone diseases and disorders of mineral metabolism. Hoboken: Wiley-Blackwell; 2018.

    Book  Google Scholar 

  50. Sievänen H, Józsa L, Järvinen M, Järvinen TA, Kannus P, Järvinen TL. Fragile external phenotype of modern human proximal femur in comparison with medieval bone. J Bone Miner Res. 2007;22(4):537–43. https://doi.org/10.1359/jbmr.070102.

    Article  PubMed  Google Scholar 

  51. Wadhwa PD, Buss C, Entringer S, Swanson JM. Developmental origins of health and disease: brief history of the approach and current focus on epigenetic mechanisms. Semin Reprod Med. 2009;27(5):358–68. https://doi.org/10.1055/s-0029-1237424.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Barker DJP, Osmond C, Golding J, Kuh D, Wadsworth MEJ. Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. Br Med J. 1989;298:564–7. https://doi.org/10.1136/bmj.298.6673.564.

    Article  CAS  Google Scholar 

  53. Armelagos GJ, Goodman AH, Harper KN, Blakey ML. Enamel hypoplasia and early mortality: bioarcheological support for the Barker hypothesis. Evol Anthropol. 2009;18(6):261–71. https://doi.org/10.1002/evan.20239.

    Article  Google Scholar 

  54. Watts R. The long-term impact of developmental stress. Evidence from later medieval and post-medieval London (AD1117–1853). Am J Phys Anthropol. 2015;158(4):569–80. https://doi.org/10.1002/ajpa.22810.

    Article  PubMed  Google Scholar 

  55. Steckel RH. Young adult mortality following severe physiological stress in childhood: skeletal evidence. Econ Human Biol. 2005;3(2):314–28. https://doi.org/10.1016/j.ehb.2005.05.006.

    Article  Google Scholar 

  56. Steckel RH, Rose JC. The backbone of history: health and nutrition in the Western Hemisphere. Cambridge: University Press; 2002.

    Book  Google Scholar 

  57. Steckel RH, Larsen CS, Roberts CA, Baten J. The backbone of Europe: health, diet, work and violence over two Millennia. Cambridge: University Press; 2018.

    Book  Google Scholar 

  58. Larsen SC. Stress and deprivation during the years of growth and development and adulthood. In: Larsen SC, editor. Bioarchaeology: interpreting behaviour from the human skeleton. Cambridge: University Press; 1997. p. 6–63.

    Chapter  Google Scholar 

  59. Razi Z. Family, land and the village community in later Medieval England. Past Present. 1981;1(93):3–6.

    Article  Google Scholar 

  60. Harding A. England in the thirteenth century. Cambridge: University Press; 1993.

    Book  Google Scholar 

  61. Holt JC. Politics and property in early Medieval England. Past Present. 1972;1(57):3–52.

    Article  Google Scholar 

  62. Clegg NW, Reed CG. The economic decline of the church in medieval England. Explor Econ Hist. 1994;31(2):261–80. https://doi.org/10.1006/exeh.1994.1011.

    Article  Google Scholar 

  63. Roffey S, Tucker K. A contextual study of the medieval hospital and cemetery of St Mary Magdalen, Winchester, England. Int J Palaeopath. 2012;2(4):170–80. https://doi.org/10.1016/j.ijpp.2012.09.018.

    Article  Google Scholar 

  64. Hicks M, Hicks A. St Gregory’s priory, Northgate, Canterbury: excavations 1988–1991. Canterbury: Archaeological Trust Limited; 2001.

    Google Scholar 

  65. Mate ME. Trade and economic developments, 1450–1550: the experience of Kent, Surrey and Sussex. Woodbridge: Boydell Press; 2006.

    Google Scholar 

  66. Erler M, Kowaleski M. Women and power in the Middle Ages. Athens: University of Georgia Press; 1988.

    Google Scholar 

  67. Stubbs W. The historical collections of walter of coventry. Rolls Series 1872–73 (II xiv–xv). London; 1872.

    Google Scholar 

  68. Theilmann JM. Medieval pilgrims and the origins of tourism. J Pop Cult. 1987;20(4):93–102. https://doi.org/10.1111/j.0022-3840.1987.9841353.x.

    Article  Google Scholar 

  69. Dyer C. Standards of living in the later Middle Ages: social change in England, 1200–1520. Cambridge: University Press; 1989.

    Book  Google Scholar 

  70. Biddick K. Medieval English peasants and market involvement. J Econ Hist. 1985;45(4):823–31. https://doi.org/10.1017/S0022050700035117.

    Article  Google Scholar 

  71. Judd MA, Roberts CA. Fracture trauma in a medieval British farming village. Amer J Phys Anthropol. 1999;109(2):229–43. https://doi.org/10.1002/(SICI)1096-8644(199906)109:2<229::AID-AJPA7>3.0.CO;2-Y.

    Article  CAS  Google Scholar 

  72. Hofmeister A. Puer, iuvenis, senex. Zum Verständnis der mittelalterlichen Altersbezeichnungen. Papsttum und Kaisertum. 1926:287–316.

    Google Scholar 

  73. Buikstra JE, Ubelaker DH. Standards for data collection from human skeletal remains. Arkansas Archaeological survey research series no. 44, Fayetteville; 1994.

    Google Scholar 

  74. Baxter-Jones AD, Faulkner RA, Forwood MR, Mirwald RL, Bailey DA. Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass. J Bone Miner Res. 2011;26(8):1729–39. https://doi.org/10.1002/jbmr.412.

    Article  PubMed  Google Scholar 

  75. Heaney RP, Abrams S, Dawson-Hughes B, Looker A, Looker A, Marcus R, Matkovic V, Weaver C. Peak bone mass. Osteoporos Int. 2000;11(12):985–1009. https://doi.org/10.1007/s001980070.

    Article  CAS  PubMed  Google Scholar 

  76. Robertson JC, Sheppard JB. Materials for the history of Thomas Becket, archbishop of Canterbury. Paternoster Row: Longman and Company; 1876.

    Google Scholar 

  77. Graham H. A woman’s work: labour and gender in the late medieval country side. In: Goldberg PJP, editor. Woman is a worthy wight: women in medieval English society c. 1200–1500. Bridgeend: Alan Sutton Publishing; 1997. p. 126–48.

    Google Scholar 

  78. Leyser H. Medieval women: social history of women in England 450–1500. New York: Hachette UK; 2013.

    Google Scholar 

  79. Power E. Medieval women. Cambridge: University Press; 2012.

    Google Scholar 

  80. Goldberg PJP. Woman is a worthy wight: women in medieval English society c. 1200–1500. Bridgeend: Alan Sutton Publishing; 1997.

    Google Scholar 

  81. Lewis M. Work and the adolescent in Medieval England AD 900–1550: the osteological evidence. Med Arch. 2016;60(1):138–71. https://doi.org/10.1080/00766097.2016.1147787.

    Article  Google Scholar 

  82. Groves S, Roberts C, Johnstone C, Hall R, Dobney K. A high status burial from Ripon Cathedral, North Yorkshire, England: differential diagnosis of a chest deformity. Int J Osteoarch. 2003;13(6):358–68. https://doi.org/10.1002/oa.696.

    Article  Google Scholar 

  83. Farahmand BY, Persson PG, Michaëlsson K, Baron JA, Parker MG, Ljunghall S, Swedish Hip Fracture Study Group. Socioeconomic status, marital status and hip fracture risk: a population-based case–control study. Osteoporos Int. 2000;11(9):803–8. https://doi.org/10.1007/s001980070.

    Article  CAS  PubMed  Google Scholar 

  84. Robling AG, Castillo AB, Turner CH. Biomechanical and molecular regulation of bone remodeling. Annu Rev. Biomed Eng. 2006;8:455–98. https://doi.org/10.1146/annurev.bioeng.8.061505.095721.

    Article  CAS  PubMed  Google Scholar 

  85. Suen LK. Occupation and risk of hip fracture. J Public Health. 1998;20(4):428–33. https://doi.org/10.1093/oxfordjournals.pubmed.a024798.

    Article  CAS  Google Scholar 

  86. van Oers RF, Ruimerman R, van Rietbergen B, Hilbers PA, Huiskes R. Relating osteon diameter to strain. Bone. 2008;43(3):476se–82. https://doi.org/10.1016/j.bone.2008.05.015.

    Article  Google Scholar 

  87. Varenna M, Binelli L, Zucchi F, Ghiringhelli D, Gallazzi M, Sinigaglia L. Prevalence of osteoporosis by educational level in a cohort of postmenopausal women. Osteoporos Int. 1999;9(3):236–41. https://doi.org/10.1007/s001980050143.

    Article  CAS  PubMed  Google Scholar 

  88. Wang Q, Seeman E. Skeletal growth and peak bone strength. Best Pract Res Clin Endocrinol Metab. 2008;22(5):687–700. https://doi.org/10.1002/9781118453926.ch16.

    Article  PubMed  Google Scholar 

  89. Mays S, Turner-Walker G, Syversen U. Osteoporosis in a population from medieval Norway. Am J Phys Anthropol. 2006;131(3):343–51. https://doi.org/10.1002/ajpa.20445.

    Article  CAS  PubMed  Google Scholar 

  90. Roberts CA, Manchester K. The archaeology of disease. Ithaca: Cornell University Press; 2007.

    Google Scholar 

  91. Bhote T. Medieval feasts and banquets: food, drink, and celebration in the Middle Ages. New York: Rosen Publishing Group; 2003.

    Google Scholar 

  92. van der Veen M. When is food a luxury? World Archaeol. 2003;34(3):405–27. https://doi.org/10.1080/0043824021000026422.

    Article  Google Scholar 

  93. Manchester K, Roberts C. The palaeopathology of leprosy in Britain: a review. World Archaeol. 1989;21(2):265–72. https://doi.org/10.1080/00438243.1989.9980105.

    Article  CAS  PubMed  Google Scholar 

  94. Roberts CA. Health and welfare in medieval England: the human skeletal remains contextualised. In: Gilchrist R, Reynolds A, editors. Refections: 50 years of medieval archaeology, 1957–2007. Leeds: Routledge; 2009. p. 307–25.

    Chapter  Google Scholar 

  95. Rogers J, Waldron T. DISH and the monastic way of life. Int J Osteoarchaeol. 2001;11(5):357–65. https://doi.org/10.1002/oa.574.

    Article  Google Scholar 

  96. Stuard SM. Ancillary evidence for the decline of medieval slavery. Past & Present. 1995;1(149):3–28.

    Article  Google Scholar 

  97. Hammond PW. Food and feast in Medieval England. Stroud: Sutton; 1993.

    Google Scholar 

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Miszkiewicz, J.J. (2019). Medieval English Social Inequality and Bone Health: What Lessons are There to be Learnt for the Living?. In: Miszkiewicz, J., Brennan-Olsen, S., Riancho, J. (eds) Bone Health. Springer, Singapore. https://doi.org/10.1007/978-981-13-7256-8_1

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