Past Pandemics and Social Inequality

Abstract Pandemics are recurring events throughout human history, and there have been many different pandemics of variable etiologies through time. That is, pandemic diseases are not limited to viral respiratory infections but can rather be bacterial in nature and/or transmitted via nonrespiratory pathways. Some past pandemics were so severe that they were erroneously considered indiscriminate in nature and that anyone who became infected with the pathogen and manifested the disease would be equally likely to suffer severe health outcomes (namely, death). However, research has shown that social inequality is a key feature of unequal pandemic experiences, including socioeconomic status, sex and gender, urban versus rural residence, and on the basis of socially marginalized racial categories. Contemporary research on past pandemics has increasingly focused energy and resources on disentangling these past social inequalities to better understand how acute pandemic events disproportionately impacted some populations over others. This body of research is rapidly growing and depends on many fields with integrated, transdisciplinary perspectives of human population health, demography, infectious disease ecology, public health, and epidemiology. Biological anthropologists frame pandemic studies through evolutionary lenses, including epidemiologic transition theory, biocultural anthropology, evolutionary medicine, and syndemics. Social inequalities in historical pandemic research can be uncovered using diverse datasets that can be used independently or in concert with one another to reveal multiple dimensions of past experiences. Such data may exist in the form of human skeletal material, the written historical record, art, statistical vital records, and immunological data. Anthropology contributes critical insights into past pandemics and social inequalities due to anthropologists’ holistic perspective of the human experience in all times and in all places; infectious diseases—and pandemics—have been central to the human experience for thousands of years. Pandemics are anthropogenic, and their origins can be traced to our evolutionary histories, cultures, interactions with the natural and built environments, and human social organization. The anthropological investigation of past pandemics and social inequalities will contribute important insights into past pandemics and how their consequences have shaped contemporary population health. Although proximate causes of pandemics (e.g., causal pathogens) have changed through time, ultimate determinants of unequal pandemic experiences have been remarkably stable. Therefore, the deep understanding of these determinants in past pandemic experiences is highly applicable to our knowledge of how a new acute infectious threat with pandemic potential may unequally affect today’s world.