Changing biocultural perspectives on health in the Andes.

New directions toward biocultural approaches to health and illness in Andean peoples have emerged since the original Health in the Andes volume was published in 1981. The reformulation of these perspectives was stimulated in part by the growth of political-economic perspectives in Andean ethnography and by critiques of medical ecology by critical medical anthropologists. This paper provides a brief history of changing biocultural perspectives on Andean health, and contrasts two projects dealing with Andean biology and health carried out in the 1960s and 1980s in the District of Nuñoa in Southern Peru. The recent Nuñoa research provides one example of a more critical biocultural approach that attempts to integrate perspectives from ecology and anthropological political economy. The utility of the approach is explored through the Nuñoa case study, which focused on the reproduction of illness and poverty in Andean households in contexts of social and economic change. Findings of this research are compared with recent work in the Andes to illustrate how a more critical biocultural perspective can better articulate with the diversity of approaches in medical anthropology and Andean health studies.

A biocultural perspective on health and household economy in southern Peru.

This article presents a biocultural approach to human health that integrates perspectives from anthropological political economy, ecology, and human adaptability. This approach frames local conditions in relation to macrohistorical forces, and focuses on the social relations that underlie health and responses to illness. It examines the coping responses of human agents operating with a "conditional rationality," and the multiple consequences to these responses. The approach is illustrated with results from a study on the relationship between health and household economy among small-scale farmers of the Nuñoa District in the southern Peruvian Andes. Poor health and nutritional status reflect historical and current economic conditions in the district. Households in illness plant half as many fields at twice the labor cost as healthy households. Among poor households the effects of illness on farming production are exacerbated by their inability to adequately supplement family labor with nonhousehold workers. The consequences of illness can force changes in access to resources and production strategies, thus shaping household health and economy in the future.

Socioeconomic change and patterns of growth in the Andes.

Changes in the pattern of growth over a 20-year period are described for a combined rural and semi-urban population in the District of Nuñoa (Puno) in southern Peruvian Andes. Over the past two decades, Andean regions have experienced many socioeconomic changes, including the implementation of agrarian reform policies and increased integration into a market economy. Local changes in Nuñoa have included improved transportation networks, new markets, an expanded public school system, and improved health care facilities. Secular trends in stature and weight have been found to be associated with social and economic development throughout the developing world, including Peru. The purpose of this paper is to present the findings from a re-study of growth in the Nuñoan population, and to assess whether changing conditions in Nuñoa have resulted in secular increases in growth. A cross-sectional sample of 1,466 children and adults and mixed-longitudinal sample of 404 children (age 3-22), measured between 1983 and 1984, are compared to similar samples collected from the same location between 1964 and 1966. Adolescents are taller, heavier, and somewhat fatter in the present population, although these differences diminish or disappear in adulthood. Age of maturation, peak growth velocities, and cessation of growth may come 1 to 2 years earlier than in the 1960s. As was found in earlier studies, growth velocities are low, the adolescent growth spurt is small, and sexual dimorphism is delayed. No secular trends in adult stature were found. Thus, the effects of social and economic change on nutrition, health, and growth in the population are uneven and generally unclear. This points to inequalities in access to the benefits of change throughout the region.

Biocultural synthesis in medical anthropology.

Medical anthropology has developed distinct and separate biological and cultural approaches to the study of health and disease in human populations. Within cultural anthropology a major focus has been the ethnomedical perspective that analyzes the process of defining disease and describing the social response to disease. In biological anthropology, an ecological perspective considers the interaction of the population, the insult and the environment at the core of the disease process. There has been limited success in integrating the cultural and biological perspective. Some cultural anthropologists claim that the ecological perspective relies on a biomedical model and therefore is not useful in studying non-Western societies. Others are critical of the adaptivist perspective that they believe fails to consider political economic factors that affect the disease process. The lack of a biocultural integration has hindered the systematic analysis of health and disease in contemporary traditional and non-Western groups. An ecological model that addresses these problems will provide a biocultural integration of the disease process.

Household coping strategies and contradictions in response to seasonal food shortage.

Uncertainty is a primary consideration in adjusting to seasonal environments as attempts are made to synchronize productive inputs with critical periods in the annual cycle. Coping responses of small scale producers therefore rely on the coordination and control of diverse resources, and on flexibility in choosing between multiple options. Generalizations concerning seasonal coping responses to food shortage of households, and of women within households, are reviewed. Particular attention is given to how socio-economic differentiation affects the capacity to use such strategies, and how these differ with regard to the degree of resource commitment and reversibility once initiated. Our primary concern is in exploring the process whereby seasonal strategies become eroded. Thus, as seasonal uncertainties are exacerbated by unpredictable fluctuations in commercial economies, and as productive resources become less accessible to households, adaptive conflicts and contradictions are introduced. Uncertainty is further intensified by illness and unequal access to adaptive options based on class and gender. The increasing inability of small scale producers to cope with seasonal uncertainty emphasizes the need to understand this erosive process.

Contributions of nutrition versus hypoxia to growth in rural Andean populations.

Previous research on diet and nutrition among peasant agriculturalists in the Andes has produced inconsistent results. As a consequence it has been difficult to determine the extent to which nutritional factors contribute to the slowed, prolonged growth and resultant small adult body size that is characteristic of these highland populations. The study examines patterns of diet and growth in the rural highland community of Nuñoa, Peru (elevation 4,000 m), and compares them to similar data collected on this community during the 1960s. Additional data from other locations in the Andes are then evaluated to discern critical determinants of growth variation. Analyses of the Nuñoan data indicate that nutritional factors have played a significant role in shaping statural growth at this location. Comparisons of other growth surveys indicate that Nuñoans remain among the smallest of all Andean populations. Additionally, urban/rural differences in growth are quite evident in the highlands, with the magnitude of this difference being greater than in other regions (i.e., coastal or jungle). It appears that income level and access to land strongly interact to direct and constrain food consumption patterns. The resulting differences in nutrition, in turn, appear to be strong predictors of growth variation. Consequently, studies that consider 1) dietary intake, 2) level of variability in diet, and 3) relative contributions of purchased and home-produced food to diet should contribute to furthering our understanding of growth variation in the Andes.

Work performance of high-altitude Aymara males.

The sample for this study consisted of 28 Aymara males between the ages of 15 and 43 years. The subjects were rural high-altitude natives who were temporarily working as porters in La Paz, Bolivia (3700 m). Mean VO2max was 46 X 5 ml/kg/min. There was a significant negative relationship between VO2max and age in adult porters . However, there was also a significant positive relationship between maximal work output and age and a significant negative relationship between VO2 during submaximal exercise and age. Relative work intensity (VO2/VO2max) during submaximal exercise did not change significantly with age. Thus, even though VO2max decreased significantly with age, these data suggest that there may not be a substantial decrease with age in the adaptive status of these men. Minimal support was found for the hypothesis that chest size in Andean highlanders influences the effectiveness of the oxygen transport system.

Anthropometric survey of high-altitude Bolivian porters.

This paper presents the results of an anthropometric survey of 138 rural Aymaran high-altitude males who were working as porters in La Paz, Bolivia (3700 m). All subjects were measured for stature, weight, upper arm circumference, and triceps skinfolds. The body size and composition of the porters were then compared to an Aymaran rural population from the Bolivian highlands, and urban mestizo labourers from La Paz. The porters were smaller than the urban sample, but appeared to be generally representative of rural Aymaran natives with respect to body size and composition, and nutritional status. It is suggested that towards one extreme of nutritional variability, some degree of undernutrition may be indicated, which should be considered in future studies of adaptation to hypoxia among these Andean highlanders.

Maximal aerobic power in trained youths at high altitude.

The sample for this study consisted of 25 males and 19 females between the ages of 8.8 and 19.5 years. The subjects were healthy, well nourished and trained swimmers residing in La Paz, Bolivia (mean altitude 3700 m). The purpose of this study was to provide normative values for the work capacity of high-altitude youths. Mean VO2 max was 46.9 ml/kg/min in males and 39.3 ml/kg/min in females. VO2max increased significantly with age in males but not in females. Mean VO2max tended to be 10-20% lower in the swimmers than in sea-level athletes.