Childhood growth is a mirror for “the material and moral condition” of a society.
– Dr. James Tanner, pediatrician and auxologist (1986:3)
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In 2015, Lital Keinan-Boker and colleagues published a study in The Israel Medical Association Journal that examined whether the Holocaust during WW2 had impacted the long-term health of older Israeli adults (mean age 69 years). They were working within the framework of the Developmental Origins of Health and Disease (DOHaD) paradigm, a body of evidence that shows that an array of stressors including malnutrition early in life (prenatally and/or during infancy) can increase risk for various chronic diseases in adulthood.
The study design compared people who were born between 1940–1945 in Nazi-occupied countries in Europe (which they categorized as the ‘exposed’ group; n=653) to those in Israel to Europe-born parents (‘non-exposed’; n=433). After adjusting for confounding variables, Keinan-Boker et al concluded that those born in Europe during WW2 were significantly more likely to have dyslipidemia, type 2 diabetes, hypertension, and cardiovascular disease. As they wrote, “The results of the current study on fetal and early childhood exposure to malnutrition and hunger and the subsequent long-term outcomes are in accordance with previously published data from research on non-Jewish populations.”
The Finnish-Soviet wars will seem like an esoteric topic and a slight departure from the things I usually write about. I am doing this because of my interests in war and health in a general sense, particularly how conflict-related stress and malnutrition may affect long-term health. It’s important to remember that not all places are affected by war equally, and local details are essential. This is just a place for me to make some notes about how Finnish civilians, especially food supplies, were affected by the different wars from 1939-45. The main source is Olli Vehviläinen’s 2002 book Finland in the Second World War: Between Germany and Russia, in particular Chapter 7, “A Society Under Stress.” I’m also including some relevant photos from Thérèse Bonney’s 1943 photo-essay book “Europe’s Children.”
Over a year ago, I wrote an essay: “Red States versus Blue States: Who Would Win a Civil War in the U.S?” It didn’t get many views. This is a small, personal blog. Sometimes things I write here get shared on social media and are read more, but for the most part that doesn’t happen.
Something interesting happened with this one. It was fairly dormant for a year, then in late May 2020 (coinciding with the George Floyd protests) people started to read it again. As far as I can tell, most of these views have been in the US. And most have been organic, with people finding it individually via search engines, not via social media. I don’t know their motivations for searching for something like this. It could be curiosity, maybe fear. Others may be genuinely enthusiastic about the prospect of a civil war and a chance to kill people they dislike. Some already havekilledpeople. Maybe the people in the pro-war group are on to something, so I started thinking of some reasons that another civil war in the US might be worth considering.
(Updated graph. The October 2020 stats are projected)
16. You have a lot of extra cash you need to dump
Wars are notoriously expensive and a great way of dumping any excess cash you have. For example, the first (only?) Civil War in the U.S. cost an estimated $23 billion and $68 billion for the Confederacy and Union, respectively, in 2019 dollars. That may sound like a pretty good way to spend a lot of money very quickly, but the news gets better because modern wars are even costlier. The Watson Institute for International and Public Affairsat Brown University calculated that the U.S. federal price-tag for the wars in Iraq, Afghanistan, Pakistan, and Syria was close to $6 trillion. Granted, a civil war in the US has the advantage of not having to travel very far, which would reduce transportation costs (you could have a front-row seat from your own home!). Still, modern weaponry would be much costlier than days of yore.
An added bonus is the opportunity costs of war. Eisenhower knew that money poured into war cannot be spent on frivolous things like education, health, science, food, housing, roads, etc. Who needs those things, anyway?
15. You Have an Affinity for Apocalyptic Scenery
If you like the scenery in sci-fi movies like “The Terminator” or “The Book of Eli,” then you can make that fantasy come to life by starting an actual war. Art and reality really can mirror each other.
Destruction of Dresden, 1945
14. You Don’t Like Thinking Too Much…
Adrienne Rich once wrote that “War is an absolute failure of imagination, scientific and political.” If there are people you don’t like because their values seem to be all cockeyed, weird, or deviant, it can be hard to think of solutions to bridging those gaps. So maybe it’s better to not try. Just skip all that mental effort at compromise and go straight to the only logical conclusion – some people need to be wiped out. Maybe a lot of people. History shows that people never change anyway, which is why Samurai warriors, Vikings, and the Spanish Inquisition still exist, most people still believe the earth is the center of the universe, and stone tools are all the rage. And, once people are enemies, they stay that way forever. Reconciliation is a fantasy, which is why most Americans started speaking French after the Revolutionary War, just to spite the British.
13. … But You Do Like Taking Chances
If you’ve ever placed a bet on a Super Bowl or World Series, you probably know there are few guarantees in sports. Predicting the future is not easy. And that’s for sports, where the rules of engagement fall within a confined range, with referees to ensure that everyone is playing fair. The rules in war often go out the window, adding an exciting air of unpredictability. Who knows what will happen?!?! As Clausewitz once wrote: “although our intellect always longs for clarity and certainty, our nature often finds uncertainty fascinating.” Betting on unpredictable, low-stake sports is one thing. How much more fascinating it would be to bet on our lives and homes? What an adventure!
12. Environmental Destruction Doesn’t Bother You
We can’t afford to worry about trivial things like the environment during periods of war. Speed is of the essence, and we can’t delay by taking out all chemical and radioactive contamination from weaponry. For example, naval and aerial bombardment of the island of Vieques left marine vegetation high in concentrations of things like lead, copper, nickel, and cobalt (Massol-Deyá et al. 2005). And that wasn’t even during an emergency. That was just target practice.
Sometimes these things can last quite a while. Long after the Battle of Verdun in WW1, the surrounding area (known as Place-à-Gaz) is still contaminated with lead, arsenic, copper, and mercury as a result of massive artillery shelling and later disposal of ordnance (Thouin et al. 2016). Some plant species still have a hard time growing there, a century later. And in Laos, massive aerial bombardment has left parts of the country contaminated with unexploded ordnance (UXO), 47 years after they were dropped. Up to 20,000 people have been injured or killed after the war ended, and 1600 km2 of the country still cannot be farmed. But fear not. Laos is a small country. We can farm in Alaska when the war is over.
11. You Think Food is Overrated
“Scorched earth” campaigns in war have existed for millennia, leading to food insecurity, even famine. Some people got pretty upset when toilet paper and meat were hard to find early in the coronavirus pandemic. That’s nothing. Wait until people run out of chocolate, pasta, and coffee. In the meantime, we can sustain ourselves on rage.
10. You Don’t Mind Murder and Atrocity
The WW1 veteran Harry Patch once said that “war is organised murder, and nothing else.” If your conscience is intact, then you may need to work on that. You could be at risk for some emotional devastation at taking another human being’s life, something known as “moral injuries.” If you’ve somehow convinced yourself that the people you hate are not really fully human, then you may not have much to worry about. But beware. There have been cases of people who at first convinced themselves that their killings were justified. Some of them, like Anwar Congo below, can build up a pretty sturdy mental wall to keep out any thoughts that might contradict the view of themselves as heroic, only to have that entire edifice come crashing down years later when they accidentally dredged up their buried humanity.
In the 2012 documentary, “The Act of Killing,” Anwar Congo re-enacted a scene of people he had killed years earlier in Indonesia. Though he was considered a hero by many for killing enemies of the state (mostly people suspected of being communists), his illusions were later shattered when he became aware of the emotions that his victims likely felt before they were executed.
9. You Think Civilians Are Fair Game in War
Speaking of murder… Many people think of war primarily as a competition between two military forces. History buffs often discuss the tactics and strategies of past wars, and the decisions made by leaders. Sometimes they’ll talk about the fallen soldiers and officers who were killed and maimed. Deaths of combatants are to be expected in war. After all, you can’t make an omelet without breaking a few eggs, or even tens of millions of eggs. However, statistics show that civilians are not just occasional “collateral damage” in war, due to an accidental misfire. Rather, civilians often comprise the majority of casualties, ranging between 40% in the case of Bosnia to 90% in the case of Cambodia and Rwanda (Roberts 2010).
8. You Like Travelingand Moving Around a Lot
People have a tendency to move around a lot during war, and they get to see many new places. In fact, 1% of the world’s population (about 80 million people) was displaced by the end of 2019. Being displaced is sort of like a vacation only without money, food, freedom, or the ability to really do many things that are traditionally considered “fun.” Instead of seeing beautiful scenery or new cities, people tend to end up in camps. Some of these camps are huge tent cities, with the chance to meet new neighbors living right next to you. It’s kind of like a summer camp, only you can’t really leave when you want. So let that be a fair warning: sometimes these camps are final destinations, your ability to travel after that may be severely curtailed with authorities keeping an eye on you, indefinitely in some cases. But, hey, it’s the journey that counts, not the destination. Some lucky Americans will really get to travel by being resettled in other countries (maybe; we haven’t been very open to accepting refugees lately, so it’s not clear how open other nations might be toward us).
7. You’re OK with Trading Mental Health for “Character”
As everyone knows, suffering builds character. For the fortunate people who survive the war, they can expect to have a lot of character-building experiences, and these can last for the rest of their lives. In a review of refugee populations, Bogic et al 2015 found that rates of depression, PTSD, and anxiety were as high as 80 to 88% in some groups, years after resettling in other countries. “Life, liberty, and the pursuit of happiness” become a little more difficult under conditions of war, but if you’re one of the lucky few people to get there, I bet the payoff would be pretty sweet.
6. You Want Your Children to Be Shorter and Developmentally Delayed
With food shortages, unclean water, increased infection, and psychological stress, kids who grow up under war conditions tend to be malnourished and shorter, sometimes by a huge amount. This is a very consistent pattern, and these effects are usually permanent since you can’t get those years of growth back. That’s fine. Althoughheight seems to be correlated with earning potentialin adulthood, shorter kids (and adults) can save money by living in smaller homes and driving smaller cars. See? It all evens out.
Countries where studies show child growth has been negatively affected by war. This is probably an incomplete list, however (studies came from I review I did last year; Clarkin 2019).
5. Sexual Violence Doesn’t Bother You That Much
If the idea of a civil war sounds exciting to you, the prospect of being avictim of sexual violence may not have crossed your mind. Yet, history shows that this is fairly common across wars once social controls have weakened or as a deliberate method of terrorizing a population. In a review, it was found that victims of sexual violence often experience pregnancy, traumatic genital injuries, fistulae, sexual dysfunction, STDs, anxiety, PTSD, depression, social rejection, and spousal abandonment (Ba and Bhopal, 2017). This may not affect you directly, but maybe the people you hate. I’m sure everyone you know and love will be fine. Only other people are victims.
4. You Think Trust Is for Losers
Pierluigi Conzo and Francesco Salustri found that European who were exposed to World War 2 before age 6 had lower levels of trustin adulthood. In their review of background literature, the authors noted that trust is considered almost like a social “lubricant” in helping a society run more efficiently; it is an important factor in economic development, the quality of institutions, and subjective well-being. Once it is lost, it takes a long time to rebuild trust and survivors can view each other with suspicion for decades.
On the other hand, if people had been less trusting before WW2, they would have been better prepared for the coming chaos. Think about it.
3. We Don’t Need No Education
War-affected children often don’t have access to a lot of basic things that wetake for granted, including school. In 2017,61% of refugee children attended primary school, compared to 92% of children globally. Those numbers dropped to 23% and 84%, respectively, for secondary school. Education is great and all, but no one will really have time for it after the war because the survivors will be too busy doing other important things, like clearing rubble.
2. You’re OK with Chronic Diseases
Wars have a tendency to “get under the skin.” Researchers who study things like the Developmental Origins of Health and Disease (DOHaD) idea have found that early adversity in life, including in war, can lead to long-term increased risks for chronic diseases like diabetes, schizophrenia, cardiovascular diseases, and obesity (Clarkin 2019). They can even affect your genes and possibly be passed down to the next generation. Some of these maladies can cut off years of your life, but they tend to be the years that areconsidered expendable anyway.
1. You Like Fairness and Sharing Power
Infighting in civil wars tend to leave countries weakened. How could it not? The good news is that in our compromised state, power abhors a vacuum, giving other countries a turn at being global leaders. I’m sure whichever nations step forward, they will be willing to give up the stage after they’ve had their turn.
References
Ba I, Bhopal RS. Physical, mental and social consequences in civilians who have experienced war-related sexual violence: a systematic review (1981–2014). Public Health. 2017 Jan 1;142:121-35.
Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC international health and human rights. 2015 Dec 1;15(1):29.
Clarkin PF. The Embodiment of War: Growth, Development, and Armed Conflict. Annual Review of Anthropology. 2019 Oct 21;48:423-42.
Massol-Deyá A, Pérez D, Pérez E, Berrios M, Diaz E. Trace elements analysis in forage samples from a US Navy bombing range (Vieques, Puerto Rico). Int. J. Environ. Res. Public Health. 2005 2(2):263–66
Roberts A. Lives and Statistics: Are 90% of War Victims Civilians? Surviv. Glob. Polit. Strateg. 2010 52(3):115–36
Thouin H, Le Forestier L, Gautret P, Hube D, Laperche V, et al. Characterization and mobility of arsenic and heavy metals in soils polluted by the destruction of arsenic-containing shells from the Great War. Sci. Total Environ. 2016. 550:658–69
Been looking forward to this. I just published an article in the Annual Review of Anthropology titled “The Embodiment of War: Growth, Development, and Armed Conflict.” In essence, the article conceives of war as an extreme “environment” that has many long-term effects on human biology, particularly for civilians in the earliest stages of life (children, infants, and prenatally).
Obviously, most people know that civilians are harmed during war, including through injuries (fatal and non) and psychological distress. I tried to go beyond this, reviewing the effects various wars have had on biological variables, including birth weight, child growth, maturation (ex. menarche), and the development of chronic diseases via the DOHaD hypothesis.
I’m hoping to build on this.
Figure 2. Some of the stressors faced by conflict-affected populations.
“Armed conflicts lead to hunger and reduced food production and economic growth in developing and transition countries. Reciprocally, food and economic insecurity and natural resource scarcities–real and perceived–often precipitate violence.”
-Marc Cohen and Per Pinstrup-Andersen (1999)
Recent images coming out of war-torn Yemen are heartbreaking. After three years of fighting between Houthi rebels and a Saudi-led coalition (backed by the US, UK and France), an estimatedeight million people are near starvation. The war has exacerbated the nutritional situation in what was already one of the poorest countries in the region, causing infrastructure to crumble and unemployment rates to skyrocket. Ablockade of Yemen’s portshas also led to a rise in food prices and to a lack of medical supplies, leaving people dependent on insufficient amounts of food aid.
A malnourished infant in Yemen, with a low upper arm circumference (source: BBC).
This has been building for a while. Nearly two years ago,a BBC report cited statistics from the UN that 370,000 children in Yemen were starving. Even infants, who may be buffered from difficult economic conditions via breastfeeding, were not spared as many mothers were too malnourished to produce milk.
“Cruelty is surely the very worst of human sins. To fight cruelty, in any shape or form – whether it be towards other human beings or non-human beings – brings us into direct conflict with that unfortunate streak of inhumanity that lurks in all of us.” – Jane Goodall (2010: 306)
An infant cries as U.S. Border Patrol agents process a group of immigrants in Granjeno, Texas, June 2014. (Photo: Jerry Lara, Staff / San Antonio Express-News).
Earlier this month Attorney General Jeff Sessions gave a public speech in Scottsdale, Arizona where he announced that the departments of Justice and Homeland Security would separate all children from adults who crossed the U.S. border, regardless of whether they did so illegally or were claiming asylum. Sessions framed this somewhat ambiguously by referring to the “smuggling” of children. Yet it was also clear that he meant for this to be adeterrent to parents, as they would have their own children taken from them:
“If you are smuggling a child, then we will prosecute you and that child will be separated from you as required by law. If you don’t want your child to be separated, then don’t bring them across the border illegally.”
Several advocacy groups immediatelydenounced the policy as cruel and inhumane, including Amnesty International, the ACLU, and theWomen’s Refugee Commission. The group Kids in Need of Defense stated that in addition to being cruel, the policy would make it more difficult to process cases for families who are seeking asylum from violence, since it is harder to get information from parents and children who are kept in separate places.
The Situation in Central America
The need to process asylum cases efficiently is especially relevant today. Last year saw 294,000 people from Central America (primarily El Salvador, Honduras, and Guatemala) claim asylum or refugee status in other countries as they fled from rising levels of violence. According toUNHCR, that number was sixteen times higher than it was in 2011. In addition, roughly714,500 peoplein Guatemala, Honduras and El Salvador remained internally displaced in June 2017. That is, they were forced from their homes but had not crossed an international border. Data from the Igarapé Institute in Brazil show that homicide rates in Central America areamong the highest in the world, with levels of violence that rival war-torn countries.
Furthermore, the number of Central Americans seeking asylum had also increased in Belize, Mexico, Panama, and Costa Rica, showing that while some cases may be economic migrants looking for work in the U.S., many are simplydesperate peoplefleeing organized gang violence, human trafficking, extortion, and corrupt police/ judicial systems. And some may choose to leave based on a combination of factors. Regardless of the cause, it cannot be an easy decision to make, particularly for parents.
UNHCR’sFrancesca Fontaninisaid that short-term solutions, (which would include things like deportations and parent-child separation) were not likely to ameliorate the situation. In fact, they could even make things worse. According toRobert Muggah, one factor exacerbating the situation in Central America is the sheer scale of deportations from the U.S., in particular people with criminal records:
“Between 2013 and 2015, the US government authorised the deportation of more than 300,000 Hondurans, Guatemalans and Salvadorans with criminal records, many of them children of refugees from the 1970s and 1980s. Another 550,000 Mexicans were also deported over the same period.
The return of so many people, many of them convicted felons, coincided with a sharp uptick in criminal violence in Central America and Mexico. The policy of deporting Latin Americans was actually expanded during the Obama administration. For years the returnees have strained local criminal justice and penal systems to breaking point – overcrowded prisons are even referred to as “crime colleges” or “finishing schools for crime.”
Fontaniniadded that “we need the states who are receiving these people to invest in longer-term solutions.” What that would entail, she did not say. But it is clear that instability perpetuates itself, and that this does not stay neatly contained within national borders. It is also clear that innocent Central Americans are being crushed between organized crime in their home countries and a sense of indifference or hostility from neighboring nations. President Trump evenwent so far as to sayabout “unaccompanied alien minors” (i.e., children), “they look so innocent. They’re not innocent.” The implication was that organized criminals, including members of the notorious gang MS-13, were infiltrating across the border with some pretending to be asylum seekers.
The statistics show that this does occur, though rates appear to be low. According toThe New York Times, 240,000 unaccompanied minors entered the US between 2012 and 2017. Only fifty-six of those were linked to MS-13. There is a moral imperative to avoid painting innocent people as the very perpetrators of violence from whom they are fleeing (the same could be said about refugees from Syria and other war-torn countries, who are often conflated with terrorists). Furthermore, Trump’s claim was contradicted by his Chief of Staff, John Kelly, who indicated that the primary reason for preventing immigration from Central America wasmore about assimilation than crime.
“Let me step back and tell you that the vast majority of the people that move illegally into the United States are not bad people. They’re not criminals. They’re not MS-13. … But they’re also not people that would easily assimilate into the United States, into our modern society. They’re overwhelmingly rural people. In the countries they come from, fourth-, fifth-, sixth-grade educations are kind of the norm. They don’t speak English; obviously that’s a big thing. … They don’t integrate well; they don’t have skills. They’re not bad people. They’re coming here for a reason. And I sympathize with the reason. But the laws are the laws. … The big point is they elected to come illegally into the United States, and this is a technique that no one hopes will be used extensively or for very long.”
“Cruelty is the Point”
When John Kelly was asked about whether he thought it was cruel and heartless to take a mother away from her children, hereplied, “I wouldn’t put it quite that way. The children will be taken care of — put into foster care or whatever.” Kelly is an alumnus of UMass Boston, where I have taught since 2003. I think he is an intelligent person, but this seems to be feigned ignorance. All he would have to do is take a moment to imagine a young child being separated from their parents — perhaps imagining himself as a boy in Brighton, or thinking of his own children being taken away when they were young. I’m sure he would quickly conclude that this would be a difficult experience. Again contradicting each other, President Trump acknowledged this when he tweeted that the policy of separation was “horrible,” though he neglected to mention that he was reportedly dismayed that some subordinates “were resistinghis directionthat parents be separated from their children.”
Unbending rigor is the mate of death, And wielding softness the company of life Unbending soldiers get no victories; The stiffest tree is readiest for the axe. (Tao Te Ching: 76)
Early in life, our bodies are like unmolded clay, ready to be shaped by our experiences. For some of us, that matching process can create problems. If circumstances change, we could end up poorly adapted to our adult environment. A child born into harsh conditions, though, may have to take that risk in order to make it to adulthood at all.
TheHmong in French Guianamay be an example of this process. They are a fascinating population for many reasons, the most obvious being that they are there at all. A few dozen refugees from Laos first resettled in French Guiana in 1977, a few years after the Vietnam War, after they and the French government agreed that life in small, ethnically homogenous villages in a tropical environment was a better option than acculturating to the cities of Métropole France. The experiment paid off. Today, more than two thousand Hmong are farmers in the Amazonian jungle, producing most of the fruits and vegetables in the country. The result is a level of economic autonomy and cultural retention that is likely unique in the Southeast Asian refugee diaspora.
Scenes from Hmong villages in French Guiana. (Clockwise from top left: fields of Cacao, young men going on a hunting trip in Javouhey, swidden agriculture of Cacao, a street lined with farmers’ trucks in Javouhey.
Looking through the 5 most frequently read essays of 2017, I see few themes. They are mostly attempts to find reasons to be hopeful (even though that has been hard at times). Humans are adaptable and flexible, and we aren’t fated to any single behavioral way of being. That means we can always make a better world.Light up the darkness.
Cumulative learning. From
A variety of skin colors. From the Humanae Project, by Angelica Dass (source).
The Revolution of Giraffes by Matthieu Robert-Ortis
Who’d want to hurt Spiderman?
Plantain trees flattened by Hurricane Maria in Yabucoa, P.R. In a matter of hours, the storm destroyed about 80 percent of the crop value in Puerto Rico, the territory’s agriculture secretary said. Credit Victor J. Blue for The New York Times
1. The Conditions of the Game: It’s Not a “World of Eternal Struggle” (Sept 2)
This was by far the most read post on this site, which I wrote after the violent clashes in Charlottesville, Virginia. This was upon seeing a photo of a man with a t-shirt that quoted Hitler in which he wrote that ours is “a world of eternal struggle.” I found it disturbing, but also just wrong. In evolution, adaptations are context specific, and they depend on the conditions of the game. This is also true for cooperation and conflict.
“How we view the world matters. If we see it as zero-sum, as an eternal struggle against other people where only one party can win, then we will act accordingly. Norton and Sommers (2011) found that many white people see racial relations as a zero-sum game: that if other groups are making progress toward equality, that this progress comes at their expense. But remember that non-zero-sum relationships are widespread. With cooperation so prolific in nature (genes, cells, organisms, groups, human societies), it just seems odd to declare that life is solely a contest of struggle. Nor does it make sense to say that cooperation is impossible between groups. Or we can see it as a chance for coalitions, that the success and well-being of others around us does not require us to lose. We make a niche for the others around us, as they do for us, and we all decide whether the costs that come with building up our armor are worth it. They may be, depending on how we perceive the conditions of the game.
I don’t know about you, but I think my life would be better if I was surrounded by healthy, fulfilled, cooperative people over those who feel distrustful, held back, and resentful. Of course, some people may feel differently. There are many strategies one can use. But don’t argue that nature gave us only one hand to play.”
Darieliz Michelle Lopez, her 20-month-old son and three-year-old daughter sit on a sofa where her apartment stood in San Isidro on Sept. 28. (Andres Kudacki for TIME)
In 2013, Orlando Sotomayor, a professor of economics at the University of Puerto Rico-Mayagüez, looked into whether two hurricanes in 1928 and 1932 impacted the long-term health of the people of the island. He specifically explored whether people exposed to the hurricanes prenatally had higher rates of various chronic diseases and lower education levels decades later.
He framed this within what used to be referred to as the fetal origins of disease hypothesis, but is now usually called the DOHaD (developmental origins of health and disease), acknowledging the importance of development beyond the fetal period. In a nutshell, the DOHaD is based on decades of evidence that various biological insults (malnutrition, maternal psychological stress, pollution) in the prenatal and early postnatal stages of life may predispose individuals to chronic diseases later in life. This has been linked to type 2 diabetes, coronary heart disease, and hypertension (Barker 1994), schizophrenia (Wahlbeck et al 2001), osteoporosis (Cooper et al 2009), and possibly cancer (Walker and Ho, 2012).
In one of the best-known examples, women who were pregnant during the Dutch “hunger winter” in World War 2 had offspring who had a higher risk of various conditions by the time they reached middle age, including a doubled rate of coronary heart disease, obesity, and diabetes in adulthood (Rooseboom et al 2011). They also had an increased chance of having schizophrenia and depression, and did worse on cognitive tasks. While famine conditions are not necessary to have such impacts (poverty and deprivation operate in a dose-like fashion), the well-defined period of the “hunger winter” provided a way to compare exposed and unexposed persons.
The 1928 and 1932 Hurricanes
Professor Sotomayor viewed the decades-old hurricanes in Puerto Rico as akin to something like the Nazi-imposed famine in the Netherlands. There are differences, obviously. Disasters resulting from intentional, anthropogenic (human-generated) disasters like war usually end up leading to protracted humanitarian crises (Schultz et al 2014). While natural disasters are often devastating, they are usually short-lived and can be ameliorated by humanitarian aid, whereas unsafe conditions during war often makes such assistance logistically difficult. Of course, aid following natural disasters depends on the scale of destruction, a country’s pre-disaster wealth and access to resources, and the political willingness of neighboring countries to assist.
Hurricane San Felipe (1928) and hurricane San Ciprian (1932) both had devastating effects on the agrarian economy of Puerto Rico, with damages estimated to be about one-third and 20% of national income, respectively (Sotomayor, 2013: 282-3). Coffee, citrus, and sugar cane crops were particularly affected. Using data from the CDC Behavioral Risk Factor Surveillance System surveys, Sotomayor looked at people born between 1920 and 1940, and defined those individuals born in the years immediately following the hurricanes (1929 and 1933) as having been exposed to difficult early life conditions. Unfortunately, month of birth was not available in the dataset, so year of birth had to suffice.
Plantain trees flattened by Hurricane Maria in Yabucoa, P.R. In a matter of hours, the storm destroyed about 80 percent of the crop value in Puerto Rico, the territory’s agriculture secretary said. Credit Victor J. Blue for The New York Times
In all, the sample comprised 11,990 individuals, with 1,197 defined as being exposed to the effects of the hurricanes in early life. Overall, he found that exposed individuals were more likely to be diagnosed with hypertension, high cholesterol, and diabetes, as well as be more likely to have no formal schooling. This latter outcome variable was interpreted as possibly being a “cognition shock,” suggesting that exposed individuals may have had some decline in mental faculties resulting from poor early neurological development.
Incidence (and 95% confidence intervals) of chronic diseases and lack of schooling in Puerto Rico by year of birth. People born in 1929 and 1933 were viewed as being exposed to the effects of a hurricane in early life (Sotomayor 2013).
After Hurricane Maria
We can speculate whether something similar might result from hurricane Maria, which made landfall on Puerto Rico on September 20 of this year. As aCategory 5 hurricane, it was among the most powerful ever recorded and its devastating effects likely won’t be resolved anytime soon. It has been estimated that more than1,000 people diedas a result of Maria, while a substantial proportion of the population still remains without electricity, months later.
Similarly to Hurricanes San Felipe and San Ciprian, Mariadestroyedup to 80% of Puerto Rico’s agriculture, and rates offood insecurityhave increased (rates were already high before the hurricane).Reportsindicated that following the hurricane, many people on the island had to skip meals and waited in lines for hours waiting for emergency food supplies, as relief supplies were below standards that were available in other recent hurricanes that hit Texas and Florida (even though all are American citizens). According toCBS News, more than 215,000 people left Puerto Rico for Florida between October 3 and December 5, and it’s been projected that perhaps more than 470,000 people will leave in the next two years (and up to750,000 peopleover the next four). Proportionally, this is a staggering loss of population on an island that had 3.4 million people in 2016.
A combination of NOAA satellite images taken at night shows Puerto Rico in July, top, and on Sept. 24, 2017, after Hurricane Maria knocked out the island’s power grid. NASA/NOAA/Handout/Reuters
All of this suggests that there is the potential that Maria could have long-term effects on health, growth, and development similar to San Felipe and San Ciprian. Early life is a particularly vulnerable period, and there are an estimated175,000 childrenunder the age of to 4 years old on the island. Growth rates are fastest in this stage, and the potential for long-term effects on health should factored into Maria’s costs beyond the effects on mortality, damaged infrastructure, destroyed crops, economic losses, and displaced population. It also hints at the urgent need to summon the political will to respond rapidly and sufficiently to minimize the effects of natural disasters like this. Otherwise, the costs will have to be paid later in terms of loss of health, premature death, and possibly diminished cognitive capacity (and all of its concomitant costs to education and economic potential). As Professor Sotomayor wrote (2013: 291):
“Evidence therefore suggests that in absence of preventive measure, effects of events like Bay of Bengal cyclones, Caribbean Sea storms like hurricane Mitch, or the great Haitian earthquake may not be over for a long time.”
References
Barker DJP. Mothers, Babies, and Disease in Later Life. BMJ Publishing; 1994.
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Birth weight is often used as a rough gauge for the quality of the prenatal environment. A newborn who weighs 2500g or less (about 5.5 pounds) is considered to be “low birth weight” (LBW). At the individual level, weight alone is an imperfect measure because of confounders such as gestational length (it’s axiomatic that the less time spent in the womb, the less time there is to grow). However, at the population level, if average birth weight fluctuates, then it is an indication that something in the environment probably has changed.
Sometimes, stressful changes can be low-intensity and chronic; at other times, they can be abrupt and dramatic. Biologists, psychologists, and bioanthropologists might call these changes “stressors” or “insults.” Economists might use the term “shocks.” They’re both getting at the same idea: to what extent can harmful environmental factors affect growth and health outcomes?
In the case of a natural disaster, the harm done can be substantial. Florencia Torche (2011) found that rates of LBW increased following the 2005 Tarapaca earthquake in northern Chile. Despite the magnitude of the earthquake (7.9 on the Richter scale), the amount of destruction was relatively limited: eleven people died, and 0.035% of the population had to temporarily relocate to shelters. This was attributed to the low population density of the region as well as Chilean preparedness and building codes to withstand earthquakes. Although the damage was not as severe as it could have been, Torche reasoned that the earthquake likely caused acute maternal stress, which in turn could affect prenatal development.
Looking at over half a million births, Torche used maternal county of residence as an estimate of the earthquake’s intensity across different trimesters of exposure. She found that mothers who were lived in the most intensely affected regions during the first trimester were the most affected. The probability of LBW increased from 4.7% to 6.5%, while rates of pre-term births also increased from 5.2% to 8.0%. Later periods of gestation were not substantially affected, and for infants who were conceived after the earthquake, the probability of LBW returned to baseline.
Again, these outcomes seemed to result primarily from acute psychological stress stemming from the earthquake. Torche reasoned that – given the relatively low amount of damage to infrastructure – the increases in LBW and pre-term births were unlikely to have resulted from other factors such as malnutrition, infection, stress resulting from deprivation, strenuous workloads, or exposure to environmental toxins. In reality, it’s not possible to control for all of these variables entirely, but overall it seems plausible that maternal psychological stress played a substantial role in birth outcomes.
Patrick F. Clarkin, Ph.D. 