Bioarchaeology of Care through Population-Level Analyses considers how a Bioarchaeology of Care (BoC) approach might incorporate population-level analyses of health-care provisioning to understand how communities in the past cared for individuals who experienced disease, injury, or impairment. The BoC approach serves as a methodological and theoretical framework for analyzing how individuals in the past received assistance and accommodation when confronted with impairment (L. Tilley and M. F. Oxenham, “Survival Against the Odds: Modeling the Social Implications of Care Provision to Seriously Disabled Individuals,” International Journal of Paleopathology 1:35–42, 2011). Alecia Schrenk and Lori A. Tremblay outline the general steps to the BoC approach, which involve constructing a differential diagnosis of the pathological condition, determining how the pathology would have affected the individual's daily life, and evaluating what care would have been available to that individual at the community level using archaeological and ethnographic information. In the traditional BoC framework, the focus remains on the lived experiences of the individual, as well as the responses and care that individual may have received within their community. As the editors explain in the first chapter of the volume, the challenge is to extend the BoC approach to examine health care provisioning beyond the individual, at the community and regional levels.
As Schrenk and Tremblay recognize, rescaling the BoC approach to include population-level analyses cannot be accomplished by a one-size-fits-all model. Rather, the editors of the volume intentionally selected contributors who used a variety of methodologies, conceptual models, and theoretical approaches to investigate health care provisioning at the population level. For example, in an analysis of subadult individuals from late medieval and early modern England, Bennjamin J. Penny-Mason combines life course theory with the composite osteobiographies of multiple individuals to consider how age may have impacted health care in the past. Using an entirely different methodological approach, Anna-Marie C. Casserly and Briana R. Moore modify the Index of Care (which operationalizes the BoC) to consider how Archaic-period hunter-gatherer communities may have accommodated and cared for individuals with mobility-limiting conditions. The contributions from Penny-Mason and Casserly and Moore underscore the fact that dissimilar analytical techniques can yield informative results about the BoC at the population level. Indeed, as another contributor notes, there is not “a standardized, universally applicable model for such research,” and community of care analyses should be tailored to the skeletal sample in question by “incorporating features of other relevant methodological and theoretical approaches as necessary” (p. 124).
Several key themes are reiterated throughout the volume and reinforce the notion that analyzing health care provisioning at the population level is complex and necessitates culturally contextualized approaches suited to the questions being asked. For instance, several contributors highlight the dangers of bioarchaeologists—who are often most familiar with a Western medical model of health care—discussing and interpreting health care provisioning in the past. In a chapter addressing the complexities involved in providing health care today and identifying caregiving in populations in the past, Charlotte A. Roberts points out that caregiving is dependent on a community's beliefs regarding the cause of a given illness or injury, as well as beliefs about how that illness or injury should be treated or managed. The challenges of identifying and interpreting evidence of caregiving in individuals and populations from bioarchaeological contexts is further exemplified in a chapter by Diana S. Simpson, who draws attention to the ways in which Western medical perspectives of health care may not be appropriate in bioarchaeological studies of cultures in the past. Simpson uses archaeological, skeletal, and ethnohistorical evidence to reevaluate the validity of “care” and “violence” as diametrically opposed concepts in a possible case of assisted death in a Late Archaic burial. In such cases, only a culturally contextualized approach can uncover community-level views of care in the past.
Although the volume focuses on cultures and contexts from North America and Western Europe, the methodological and theoretical approaches described by the contributors are suitable for readers whose research or teaching centers on different geographic regions or time periods. The volume—especially if parsed into thematic chapter groupings—would be an appropriate addition to an advanced undergraduate or graduate seminar on bioarchaeology or health care provisioning in the past. Particularly, the chapters in this text would complement literature that delves into life course theory, bioarchaeological approaches to the study of structural violence, and the Index of Care model, as well as paleodemography and population-level approaches in paleopathology more generally. This volume is an essential first step in the study of community-level experiences with and responses to health care provisioning in the past, and it serves as a model and a foundation for future expansions of the Bioarchaeology of Care approach.
