Healthmaking in the past: Using the social determinants of health in paleopathology

This paper presents the Social Determinants of Health (SDoH) as a framework to explain health patterns in past populations and to evaluate how social factors shaped differential health outcomes.

Primary data derive from a case study of Deir el-Medina, Egypt, New Kingdom (1550-1080 BCE) comprised of at least 134 individuals and 1725 skeletal elements. Comparative case studies from published research across ancient and historical contexts are also discussed.

The Deir el-Medina case study compares data from skeletal stress indicators such as enamel hypoplasias and cranial porosities with historical records. Additional examples illustrate similar integrations of bioarchaeological and historical data.

Case studies demonstrate that food security, social support, and healthcare access likely impacted health patterns. The SDoH framework provides a systematic approach to identifying social factors that influenced health outcomes.

The SDoH framework is a valuable tool for systematically investigating social impacts on health in past populations. It addresses how social structures-not just biology or ecology-produced health disparities across communities.

Applying the SDoH allows bioarchaeologists to reveal social sources of heterogeneous frailty. It also contributes historical perspectives to modern public health discussions.

The SDoH framework is most suitable for community-based populations with historical data and is less useful in prehistoric or poorly contextualized sites.

Future research could apply the SDoH framework to identify when the social health gradient emerged and the broader applicability of the SDoH across varied archaeological contexts.