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
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
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.
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 is the total of the resources available to
a population to respond to demands for coping.
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 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.
HOW DO WE MEASURE ADAPTATION LOAD AND CAPACITY FOR ADAPTATION
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
Postulate One. The adaptation capacity of a population
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
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
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