Department of Occupational and Environmental Health Publications
2-1-2001
Civilization as a threat to human health?
T. Trnovec
Thomas M. Cook
University of Iowa
K. Kahayová
Please see article for additional authors.
Copyright © Czech Medical Association J. E. Purkyne, 2002. Posted by permission.
Central European Journal of Public Health, 9:1 (2001) pp.49-52.
Hosted by Iowa Research Online. For more information please contact: [email protected].
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CIVILIZADON AS A THREAT TO IIUMAN
HEALTH?
Trnovec r.\ Cook T,2, Kahayova K.\ Nyulassy 8. 1
1 Institute
of Preventive and Clinical Medicine, Bratislava, Slovak Republic
of Iowa, Iowa City, USA
2 University
SUMMARY
Civilization can be defined as the distinctly human attributes and attainments of a particular society. In general, the development of civilization is
viewed as a positive step for the well-being of the human species, leading to an increased duration and quality of human life. The accelerated progress
of civilization (mainly industrialization, urbanization and nutrition) has lead to new possibilities for adverse effects on human health. A col!ection of
problems referred to as 'civilization diseases' has become the subject of serious concern but review of available data indicates that this concept
appears to add very little to our understanding of modern environmental influences on human health. Important limitations in the continued use of
this term are its non-specificity, the lack of a unifying scientific foundation, and prOVision of virtually no direction for remediation of these diseases
or for future research. In addition, the use of this term has been localized to primarily post-SOCialist European countries. In view of these /imitations,
it seems more productive for scientists, in all parts of the world, to embrace the discipline of environmental health science and to discontinue use
of the term 'civilization diseases ".
ormal
1997,
Key words: civilization diseases, environmental health
ratory
Address for correspondence: T. Trnovec , Institute of Preventive and Clinical Medicine, Limbovcl 14, 833 01 Bratislava, Slovak Republic.
E-mail: [email protected]
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pacts of the development of industrialization including civilization diseases, can be traced to the 18 th century. Examples are
found in works such as J. J. Rou sseau's "Discours sur les
sciences et les arts" in 1750, and J. Swift's "Travels into several
remote nations of the world" in 1726. The greatest attention
to the concept of di seases of civilization occurred several
decades ago when a number of widely read monographs and
papers on this topic were published (4-13).
The purpose of this review is to stimulate discussio n on the
relationship between the progress of civilizationlindustrialization and human health. We rely on information from
contemporary and hi storical epidemiology, paleopathology ,
historical anthropology and agricultural history. We avoid
wholesale criticism of the concept of civilization diseases, as
has sometimes been displayed in previous literature (14, 15).
Civilization can be defined as the distinctly human attributes
and attainments of a particular society (l). Historically, civilizations developed around 10,000 years ago with the shift from
hunting-gathering to agriculture and pasturing. Today's museums are filled with evidence of the political, social, and cultural
complexities of civilizations on every continent. According to
Murphy (2) historians tend to stress the possession of writing,
cities, occupational specialization and a broad political structure as characteristics of civilizations, while anthropologists
tend to focus rather on the possession of complex social
structures and a wide variety of cultural content. In general, the
development of civilization is viewed as a positive step for the
well-being of the human species, leading to an increased
durati on and quality of human life.
But development of increasingly complex, interdependent,
and crowded societies has always brought with it increased
risks for the inhabitants, including health risks . Especially
during the last several centuries, the accelerated progress of
civili zati on has lead to new possibilities for adverse effects on
human health. Since the onset of the Industrial Revolution,
several new disciplines and specializations have emerged to
deal with the newl y developed and newly recognized health
risks associated with changes in agriculture, industry , technology , transportation , lifestyle, etc. These new disciplines and
speCializations have included public health, industrial hygiene,
environmental science, occupational medicine, and ergonomics, among others.
During this period of rapid industrialization and urbanization, a collection of problems referred to as "civilization
diseases" or "diseases of civilization" became the subject of
considerable discussion within certain medicaVscientific
groups (2, 3). Haffter (3) states that the term civilization
diseases came into use in the 20th century, but that it is linked
to earlier topics such as cultural diseases, cultural damage, and
"The English Malady ". Comments regarding the negative im- --...
"CIVILIZATION DISEASES"
Sobra and Ceska (16) describe the phenomenon of ci vilization diseases in the foll owi ng way :
In the course of 6-8 generations , but mainl y during the last
2-3 generations, an epidemic of non-infectious di seases, called
"civilization diseases", "diseases of the western culture" or
"metabolic diseases of massive incidence" appeared . These are
tightly interconnected when searching for their origin and can
be perceived as a manifestation of maladaptation 10 a completely new environment, created very fastly, to which the
populations of the industrially developed countries were not
genetically adapted.
From a genetic standpOint, humans living today are Stone
Age hunter-gatherers displaced through time to a world that
differs from that for which our genetic constitution was selected (17). These disease are considered to be the result of
maladaptation to new environment into which the populations
--~-------------------------~
49
of civilized societies were thrown following the industrial
revolution. These populations underwent much greater
changes in life style and nutritional habits during 6-8 generations than their ancestors did in the course of 10,000 years.
There is concern that no living creature is able to live and
survive in an environment completely different from that to
which it is genetically adapted (16).
From thi s and other descriptions, the key elements that have
been used to define diseases of civilization are that they are
predominantly non-infectiou s; they have occurred mainly in
the last 2-3 generations, although present for 6-8; and they are
tightly connected and related to a society's level of industrialization. We would, therefore, expect that these diseases should
be rare or unknown in today's rural (non-industrialized) communities of the third world. We would also expect that these
diseases would have appeared during the last century in societies that were not economically developed at the beginning of
the century but underwent rapid economic development since
then.
A literature search in the database MEDLlNE using INFOTRIEVE for a query using civilization-ADI-diseases listed
45 publications since 1966. (ADI is a Boolean search operator
for records in which the query word that follows it appears
immediately after the word preceding it.) It should be noted
that a high percentage (77.78 %) of papers located in thi s
search was published in languages other than English, reflecting a European, and mainly post-socialist country, preference
for this concept. It is also interesting that several foundations
for prevention of civilization di seases are active in this region
of world. Despite this relatively small number of papers, the
list of non-infectious diseases identified as civilization diseases
is quite long. These papers commonly identify the primary
conditions in this group as: ischemic heart disease, diabetes
mellitus, obeSity, stroke, ischemic disease of the lower extremities, cholecystolithiasis, appendicitis, hemorrhoids,
colorectal and lung cancer, mammary gland cancer, and prostate cancer, but also include other civilization diseases
identified as being related to life-style changes. Table I contains a complete list of these diseases as identified in the papers
from the literature and from an Internet search. As can be seen
from the table, pathologies affecting nearly every organ system
in the body have been classified as civilization diseases, indicating that this term seems to have low specificity.
CIVILIZATION DISEASES AND
INDUSTRIALIZA TION
The period preceding the Second Agricultural Revolution in
Europe can be characterized as follows (18):
• A majority of the population routinely lived on the verge of
starvation.
There was an over dependency on a single food source.
• Food supplies were vulnerable to the devastating effects of
weather and disease.
• Famine occurred sporadically.
• There was a high incidence of deficiency diseases: beriberi
(pellagra), scurvy, rickets, iron deficiency.
• There was a high incidence of infectious diseases: plague,
malaria, tuberculosis; respiratory transmitted diseases; alimentary (faecal) oral transmissions : skin-skin transmissions: leprosy, syphilis, lice.
Ergoti sm and scurvy, particularly, sometimes decimated
whole populations in rural areas or at sea (19).
An important milestone in alleviating many of these conditions was the introduction of some native-American plants into
European agriculture. Mai ze and potatoes rapidl y occupied
a large sector of the European marke ts and, because of their
easier cultivation and higher calorie content, were substituted
for grains such as wheat and rye. In the 16 th and 17 th century.
new di seases were described that were directly related to
dietary intake ( 19).
Since the Second Agricultural Revolution, which occurred
about 300 years ago, a decline in mo rtality has occurred in
many European nations and in America (20). Nearly all specialists agree that improved nutrition is a significant factor
responsible for the recent demographic changes in world population (20, 24, 25). Average daily calo rie intake aro und 17 ~
in Britain and France was 2700 and 2410 kcal per consumin g
unit, respectively. This implies that mature adults of the late
18 th century must have been very small by current standards.
The bottom 10 % of the labor force lacked the energy for
regular work and the next 10 % had enough energy for less
than three hours of light work daily. Poor body builds increased
vulnerability to both contagiOUS and chronic diseases (26-28) .
Comparisons of the prevalence of chronic diseases among
Union Army men ages 65 and older in 1919 (BMI = 22.8) with
surveys of veterans of the same ages in the 1980s (BMI= 264)
indicate heart disease was 2. 9 times more prevalent, muscu loskeletal and respiratory di seases were 1.6 times more
prevalent, and digestive diseases were4 .7 times more prevalent
among veterans aged 65 or older in 1910 than in the peri od
1985-1988 (28). Further statistical treatment of these data
showed that the average decline in chronic respiratory problems, valvular heart disease, arteriosclerosis, and joint and
back problems was about 66 %. Occupational shifts accounted
for 29 % of the decline; the decreased prevalence of infectio us
disease accounted for 18 %; the remainder are unexplained
(29). It follows that the young adults born between 1822 and
1845 who survived the deadly infectious diseases of childhood
and adolescence were not, as some have suggested, freer of
degenerative diseases than persons of the same ages tod ay;
rather they were more afflicted (28).
According to Fogel and Costa (28) " ... during the last 300
years, particularly during the last century , humans have gained
an unprecedented degree of control over their environment a degree of control so great that it sets them apart not only from
all other species, but also from all previous generation of Homo
sapiens. This new degree of control has enabled Homo saPiens
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· Arterial hypertension
I' Deep vein thrombosis
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I High level of cholesterol
! Obesity
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I Diabetes mellitus
lower extremities
Migraine
Cholecystolithiasis
Appendicitis
Hemorrhoids
Hiatus hernia
Auto-immune diseases
Chronic fatigue
Bronchitis
Dementia
Benign tumors
Colorectal cancer
Mammary gland cancer
Prostate cancer
Oesophageal tumors
Lung cancer
Cancer of ovary
Pancreas cancer
Oral cavity tumors
Nephrosis
Kidne stones
Asthma
Salmonella infection
Lactose intolerance
Diverticular disease
Ulcerative colitis
Indigestion
Syphilis
BSE
AIDS
Gout
Osteoporosis
Arthrosis
Arthritis
Backache
Postural impairments
Muscle cramps
Dental caries
Disorders
of maxilofacial growth
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Table 1. Conditions identified as "Civilization Diseases"
Ischemic heart disease
I,: Stroke
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Increase I[S average Doay sIze Dy over )V '10, to Increase ItS
average longevity by more than 100 %, and to improve greatly
the robustness and capacity of vital organ systems." The trend
towards decreasing prevalence of chronic diseases is continuing since, in many countries, death rates from ischemic heart
disease have declined by approximately 50 % since mid-1960s
(20) and WHO is optimistic that countries can still make
considerable progress in lowering mortality rates from heart
disease.
Childhood environment may be even more important in
determining disease patterns throughout life than was previously thought. For instance, part of what is regarded as the
genetic contribution to ischemic heart disease may in fact be
the effect of the early postnatal or even intrauterine environment (30). Many reports have been published (31-37) on
possible links between early-life conditions, including the
mother's (mal)nutrition, and anthropometric measures and major chronic diseases. There is a detectable increased risk of
morbidity and mortality associated with short stature. Since the
childhood environment is an important determinant of adult
stature it is also important for adult health (38).
Examination of the evidence seems to support the contention
that human physiology has been significantly altered during
the period of increasing industrialization over the past 8-10
generations (28, 29). However, these technological developments have been associated with a decline, rather than an
increase, in the prevalence of many chronic degenerative diseases which have often been included as civilization diseases .
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UNIFYING FACTOR(S) FOR CIVILIZATION
DISEASES
There have been numerous attempts to find one or more
unifying causative factors to support the concept of civilization
diseases. Among various etiopathogenic factors, free oxygen
radicals have been regarded as providing universal validity for
chronic degenerative diseases. Indeed, the results of numerous
studies have formed the basis of many preventive protocols
aimed at cardiovascular diseases and cancer. Some other
pathogenetic factors suggested as a common denominator to
civilization diseases are listed in Table 2.
Several authors (16, 39, 40) suggest that in order to elucidate
relationships among many of these diseases it is necessary to
consider the geographic, socioeconomic and temporal distribution of all of these diseases rather than to look for a particular
factor(s) increasing risk for a single disease. This is important
with respect to the working hypothesis for directing further
research and the intervention approach in health care targeted
mainly to chronic degenerative diseases but also to many other
pathologies.
A concept somewhat related to civilization diseases is the
issue of "environmental illness". This term has been characterized as, "A polysymptomatic condition believed by clinical
eCOlOgIsts to result trom Immune ClysregulatlOn mCluceCl by
common foods, allergens, and chemicals, resulting in various
physical and mental disorders". The medical community has
remained largely skeptical of the existence of this" disease",
given the plethora of symptoms attributed to environmental
illness, the lack of reproducible laboratory abnormalities, and
the use of unproven therapies to treat the condition (41).
In view of the heterogeneous character of civilization diseases and the discordant views on their pathogenesis, it is not
surprising that the concept of civilization diseases provides
little information regarding preventive measures nor does it
lead to the formulation of working hypotheses for further
research. The imprecision of this classification is reflected in
the broad spectrum of recommended measures for their prevention found in the scientific literature or on the Internet.
Table 3 contains a partial listing of proposed treatments.
ENVIRONMENTAL RISK ASSESSMENT
In contrast to the concept of civilization diseases, and the
search for a common causative factor or set of factors to
explain a collection of pathological conditions, environmental
health is the science of controlling or modifying those conditions, influences, or forces surrounding humans that relate to
promoting, establishing, and maintaining health (42). These
conditions include also those associated with the "Western
lifestyle": little physical activity, obesity, smoking, alcohol
use, etc. Compared to the MEDLINE database search for
civilization diseases, a similar search using INFOTRIEVE for
the query environmental-AD1-health since 1966 yielded
17,103 references with 81.47 % of these papers published in
English. The focus of environmental health is to identify health
risk factors but it is not the task of this research discipline to
establish a causal relationship between a certain risk factor and
a particular disease in an individual case. Establishing such an
individual diagnosis is the responsibility of occupational medicine. Even in the case of an exposure of large populations to
a particular risk factor it may be very difficult to establish
a causal relationship to a particular pathology. The discipline
of environmental health recognizes the increasing complexity
of today's highly industrialized and rapidly changing environments and uses modern analytical techniques to answer
questions regarding the interactions of environmental, inclusive nutritional, factors and human health.
As indicated by the above review, the concept of "civilization diseases" appears to add very little to our understanding
of modern environmental influences on human health. Important limitations in the continued use of this term are:
• It is highly non-specific.
Table 3. Examples of treatments and products for "Civilization
Diseases"
Treatments
Human motion
Sports
Healthy life style
Sitvotherapy
Chromotherapy
Music therapy
Bibliotherapy
Spa therapy
Breast-feeding
Stress management
Reading book
Cervical massage
Special ized hospital stay
1----____
Table 2. Reported causes for "Civilization Diseases"
th
Deficiency of undigested (cereal) fibre
Denatured civilization food
Nutritional deficiency
Dominance of sympathetic-adrenergic
system
Inability to excrete iron
Alcoholism
Inadequate blood supply to organs
Esterified fatty acids
Consumption of meat, eggs, milk products
Allergic reaction to grains
Noise
Chronic, lOW-level fear
Nutritional habits
Profactor-H
Overweight
Magnesium deficiency
Allergic reaction to sugar
Carbohydrates in the diet
Dietary fats
------.~~~~-
51
Products
Regalen (herbs)
HERBALIFE
Bell, natural plant oil
Solar energy aroma device
Hyposol (salt compound)
Femigard (herbal concentrate)
Bonita (vitaminized drinks)
Musli bars
Increased fruit intake
Vegetarian diets
Nutritional starch
Pycnogenol (antioxidant)
Ayurveda medical secrets
.
----
• It lacks a unifying scientific foundation.
• It provides virtually no direction for remediation of these
diseases or for future research.
• Its use has been localized to primarily post-socialist European countries.
In view of these limitations, it seems more productive for
scientists, in all parts of the world, to embrace the diseipline of
environmental health science and to discontinue use of the term
"civilization diseases".
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42, http://www.nebi.nlm.nih.gov/entrezlmeshbrowser.cgi~retrievestring=
&mbdetail=n&term=environmental+illness
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