Biocultural approaches to health and mortality in an Old Order Amish community

The assumption that Amish cultural value of cooperation leads to greater longevity, prosperity and well-being among elders was examined using historical demographic and ethnographic analysis in a conservative Old Order Amish community. Migration, fertility, mortality and morbidity data since 1948 were used to identify population structure. The population pyramid in the Amish community (3% of the population over age 60, compared to 18% of the neighboring non-Amish rural area) is largely determined by natural fertility with low infant mortality. Household ethnography explored health beliefs, access to health care, caregiving patterns, and economic strategies. The perception that community cooperation and altruistic behavior were of benefit to Amish health is supported by mortality rates. Amish age standardized death rates were 19% below the US death rate in 1960. Migrating to form new communities and selectively utilizing acute (but not preventive or public) health care services, emerged as strong cultural patterns that facilitate reproductive success among the Amish.