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The Health Consequences of Development

Reprinted from Sarawak Museum Journal Volume XXXVI, No. 57 (New Series):43-74, 1986.
G. N. Appell


Development clearly has significant health consequences. In many cases it may improve the health of a village or a population. In other instances the demands for change come so fast and are of such magnitude that a population may be overwhelmed. As a result physiological, psychological, and behavioral impairments may begin to rise. We have all witnessed demoralized, unhealthy apathetic people who have not been able to cope with rapid social change and as a result may never be able to participate in a growing economy.

Even where development has improved health, as in new village drinking water schemes or inoculations for contagious diseases, the demand to adapt to new medical and public health regimes puts an added load on a population, and this may have its adaptation costs. Social change requires adaptation, and thus does not occur without health impairments, as has been demonstrated in a number of studies from a variety of disciplines. But these have never been brought together into any coherent framework or theory. And therefore the amount of social change required before health impairments arise and the extent and duration of such health impairments have never been fully investigated.

Thus, the anthropology of development has two great challenges. First, it must devise a theory to explain why some populations can adapt to change with relatively few negative effects, while other populations are overwhelmed. This article is an attempt to sketch out the parameters of such a theory, which I term General Adaptation Theory. It attempts to incorporate all levels of response to demands for coping, the behavioral, the psychological, and the physiological.

The second major challenge to the anthropology of development is to provide useful and uncomplicated guidelines for the administrator so that he can manage development and social change successfully and with a minimum of adaptation demands on a population.

The goal here is also to provide such guidelines. Consequently, we will try not to complicate the presentation by a discussion of the theoretical issues involved in General Adaptation Theory beyond what is necessary to serve as a background for such guidelines. (For those interested in further discussion of the theoretical issues underlying General Adaptation Theory, please see Appell n.d.).

To organize the various studies on health impairment associated with development and social change into a coherent framework or theory, I have developed a series of interlinking postulates which serve as the basis of General Adaptation Theory. Under each postulate I present those studies that illustrate and support the postulate. This method has two functions. It should help direct further research to elucidate these postulates and their implications. And these postulates should serve as useful guidelines for administrators and development planners.

But first it is necessary to define the terms we will be using as "adaptation," "adaptation capacity," "adaptation load," "adaptation potential," and "adaptation overload."



Adaptation is the continuing process of all organisms to achieve a better environmental-organism fit in responding to changes in their environment. Adaptation always involves the social world of which the individual is a member, and therefore it is useful to view adaptation as also a characteristic of a population.

Adaptation Load

The adaptation load is the sum of the demands placed upon a population to cope with changes in its external and internal environments.

Adaptation Capacity

Adaptation capacity is the total of the resources available to a population to respond to demands for coping.

Adaptation Potential

The adaptation potential for a population at any point in time is the net figure of adaptation capacity minus its adaptation load. This represents the resources that are available to meet further demands for adaptation.

Adaptation Overload

Adaptation overload occurs when the demands for coping are such that they overwhelm the adaptation potential of a population and produce various health impairments. There is a repertoire of responses to such demand overload, and these can include physiological, psychological, and behavioral dysfunctions.


The thesis of this article is that changes in the adaptation load on a population can be measured by the degree of health impairment. That is, by measuring the changes in the level of health in a population one can get a measure of how well it is adapting to social change. But how do we measure health? We take a broad view of health here, as our argument will show, to include not only physiological impairments but also psychological and behavioral impairments. Thus, if accidents rise or rates of divorce, stealing, or vandalism rise, these are indicators of a rising level of stress in the population as it attempts to cope with the demands of social change, and if this stress reaches too high a level, the adaptation capacities of the population may be overwhelmed.


Postulate One. The adaptation capacity of a population is limited.

A population has limited resources for dealing with the demands for coping that the biophysical and social environments present. Social change puts added demands on a population. This appears to occur even when the change is desired and anticipated with feelings of happiness (see Postulates Five and Six). The nature of the demands for coping will vary with the timing of change and its quality and quantity. But until the new demands are coped with and change integrated into the sociocultural system, the adaptation resources of the population will be committed to the degree of the demands made, and will not be available to deal with subsequent challenges.

Postulate Two. Every population is engaged in a series of energy exchanges with its biosocial environment; social change may disrupt both the quantity and quality of these exchanges and therefore adds to the adaptive load on the population.

Let us look at some obvious examples. A population that has depended on fishing for its source of protein is moved from the coastal strand to a new agricultural settlement, where it must grow cassava to survive. Denied sources of protein, with no provision made by the development planners to supplement this loss, the incidence of kwashiorkor rapidly rises among the children.

Gross and Underwood (1971) report the case of the introduction of change producing a net loss in the energy exchange. Sisal agriculture was introduced into a region of Brazil where previously the population existed on cattle raising and subsistence agriculture. The work demands on the sisal workers were such that they had to consume a disproportionate amount of the available food calories to support their performance on the job. Wages being too low to maintain an adequate diet for the whole family, the children experienced nutritional deprevation. Hughes and Hunter (1972) provide a number of other examples of the detrimental effects on the energy exchange system of a population when change is introduced.

The system of energy exchanges between a population and its biosocial environment can also be disrupted through changes in the structure of the ecosystem. This can have deleterious effects of various types, including a greater pathogenic load for the population to cope with. For example, in certain sections of central Africa, as well as in Malaya, the clearing of jungle for agricultural production increases the number of breeding places for mosquito species that are vectors for the most virulent types of malaria (see Livingstone 1958; Wiesenfeld 1967; Meade 1976). In central Africa the adaptation response of the population to this new parasite load was primarily genetic. Individuals who are heterozygous for the sickle-cell gene are relatively immune to falciparum malaria while normal populations in comparison have higher mortality and lower fertility in malarious environments.

However, for populations who are exposed to greater malaria parasitism through land development schemes but who have not developed a genetic adaptation, other measures have to be taken to offset this new disease load.

To rephrase this postulate: For every change in the system of energy exchanges between a population and its biosocial environment there is a reaction. But what this reaction in each instance will be will depend on the type of change and the character of the energy exchange. Prediction of the reaction can be facilitated by an analysis of the energy exchange prior to the introduction of social change.

Postulate Three. In the process of adaptation every population develops defenses against the predators, parasites, and pathogens in its environment; social change can destroy or invalidate these defense mechanisms or present new challenges for which there are no defenses, precipitating an increase in disease and disability and adding to the population=s adaptation load.

A fundamental part of the energy exchange network between a population and its biosocial environments includes predators, parasites, and pathogens. Assuming that these are not recent challenges, every population has developed defenses against being overwhelmed by these threats. These defenses may be genetic, as in the sickle-cell trait; chemical, as in indigenous pharmacopeias and food habits; or behavioral and cultural.

To put this in another way, anticipating Postulate Four, each population has its idiosyncratic disease load. This is the resultant of the disease pressure on the population from its environment and the techniques developed for coping with this pressure. Social change disrupts this dynamic equilibrium between a population and its environment causing an increase in disease and disability.

For example, with the introduction of irrigation agriculture, the incidence of schistosomiasis has been found to rise as the population of the aquatic snail host rises and human exposure to the infective larvae is increased (see Hughes and Hunter 1972; Shiff 1972; and van der Schalie 1972).

Dunn (1972) reports that when forest dwelling swidden agriculturalists in Malaya adopt a more sedentary existence as a result of change in economy and live in a more simplified habitat than the tropical forest, the intensity and prevalence of intestinal parasites increases, which indicates some measure of the disease burden that was imposed by sociocultural change.

As an example of cultural defense mechanisms, I will summarize the cultural ecology of the longhouse among the Rungus of Sabah as it was in the 1960s. Domestic pigs were allowed to run free to scavenge under the longhouses. They upset coconut shells and other hollow objects that could contain water, and churn through mud holes, all breeding places for the malarial mosquito. They ate disease-carrying and disease-producing matter. Pigs were also sacrificed periodically in religious ceremonies providing protein for the population, particularly during those high demand periods when there was illness. However, government representatives had stated that the pigs must be raised in enclosures; and missionaries had argued that the Rungus would make more money if pigs were sold in the market place rather than being used for sacrifices. It could be anticipated that a shift in the human-pig ecology will produce health impairments unless other measures are taken.

Postulates Two and Three can be summed up as follows. Social change disarticulates a population from its local biosocial environment and articulates it to a wider network of exchanges. In some instances this wider network can include the world economic system. Whatever, the wider network has the characteristic of being more fragile, more easily disrupted by exogenous economic factors, which lessens the control of the population over its future adaptation. I have provided a number of examples of this in Appell (1975a, 1975b, and 1975c). One example is particularly useful. It illustrates both Postulates Two and Three. It involves a change in the quality and quantity of exchanges between a population and its biosocial environment, and it illustrates how the breakdown of defense mechanisms against the pathogenetic load of the population=s biosocial environment creates impairment. This is the substitution of bottle feeding of infants for breast feeding. It results in a lower quality of nutrition for the infants, the loss of immunity to certain diseases obtained through breast feeding from the antibodies in the mother=s milk, and the exposure of the infant to new pathogens as the result of the lack of hygienic procedures to insure that the bottles and milk remain relatively germ free (see Jelliffe 1972; Knodel 1977).

Postulate Four. Every population has a characteristic rate of impairment produced by interaction with its biosocial environment as translated through its sociocultural system.

A population is in a situation of dynamic equilibrium with its biosocial environment that involves a variety of complex positive and negative feedback loops. As the population reacts to changes in its environment, this causes chains of reactions that impinge on the environment. One of the intrinsic driving forces in this exchange is that of population growth.

As a result of this cybernetic relationship with its biosocial environment, no population has a perfect genetic and sociocultural fit to its environment. There is always an intrinsic rate of impairment in the population. While the particular expression of this impairment is related to the nature of the defense mechanisms developed, it is also related to other aspects of the population=s sociocultural system. Demands for coping must always be translated through the population=s sociocultural system, and this produces characteristic types of impairments for each society. For example, societies in which the modal personality tends to be intropunitive as opposed to those in which the modal personality is extrapunitive should have different types and rates of impairment. Field (1963) investigated mortality rates of fifty leading causes of death in the United States and correlated these to indices of aggression management derived from homicide and suicide rates in the various states. He concluded that the extrapunitive dimension appears to correlate with hypertension and several infectious diseases such as tuberculosis, syphilis, and influenza. The intropunitive dimension appears to be related to leukemia and aleukemia, lymphatic neoplasms, acute poliomyelitis and possibly gastric and duodenal ulcers (also see Appell 1966).

Thus all behaviors that result in impairment, from disease to sociopathic behaviors, including accidents, are a unique product of the pathways made available in each society through the interaction of the sociocultural system with the population=s biosocial environment. Certain of these pathways can also be viewed as weak links in the population=s adaptation to its biosocial environments, and it is these which will be most vulnerable to an increased adaptation load.

Postulate Five.
The mobilization of resources for adaptation involves a set of interlinked hierarchical systems: the behavioral, psychological, physiological, and genetic.

Reaction to new demands for coping may be expressed in the behavioral, psychological, or physiological system, or eventually the genetic (see also Caudill 1958). What system is involved depends on the nature of the demand and the resources available for coping. Little research has been focused on how the nature of the demand affects the type of response. Consequently, we are not able to discuss this aspect of the coping process further here.

In every population there are some individuals with ample resources who can adapt to increased demands with a minimum of impairment. Theoretically, some of these individuals, whose resources far exceed the demands put on them in their present biosocial environment, may display health impairment from insufficient challenge. Thus, with social change, these individuals will move into a closer environment-personal fit (cf. French, Rodgers, and Cobb 1974) and will develop improved health in situations of change. There is a U-curve of adaptation where dysfunction occurs when there are too few or too many stimuli (cf. Levi 1974: 13; French, Rodgers, and Cobb 1974).

For individuals who experience demand overload from social change, one or more of the interlinked hierarchical systems become involved. When demands for adaptation override the capacities for coping in one of these hierarchical systems, the individual will shut down coping activity at that level and shunt the problem to another. That is, coping is stepped down to a lower level system. Two examples will illustrate this. An individual who is having difficulty coping with the psychological demands at his work situation may suffer a heart attack. Psychosocial stress, that is a failure to cope at the psychological level, can depress the immune system permitting infection to occur (see Postulate Eight for further discussion).

One of the consequences of overload of adaptation capacities is a significant loss of productivity, not only from the health impairment that follows but also because this impairment requires the activation of support and maintenance activities to deal with the impairments. Simply, overloading adaptive capacities in a population can produce a series of positive feedback loops demanding the input of greater resources for maintenance and support, which causes further deviation int he sociocultural system.

As we pointed out in discussing Postulate Four, the structure of the interaction between the population and its biosocial environment as translated through its sociocultural system will determine which of the hierarchical systems is the primary target for demands for coping. Further evidence for the involvement of these interlinked hierarchical systems under increased adaptation loads is discussed under other postulates, particularly the following one.

The argument in the preceding sections can be illustrated by Figure One.