The future up in smoke: The effects of tobacco use on population health in England and the Netherlands in the 16th-19th centuries

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This project aims to assess the impact of tobacco use on population health in the past. Specifically, the following main research question will be posed in this PhD:What has been the impact of tobacco use on population health - and more specifically, foetal and maternal health as represented by changes in congenital abnormalities and growth delay - in England and the Netherlands between the 16th and 19th centuries?AimsThis issue will be addressed by 1) reviewing historic literature on tobacco use demographics, combined with biomolecular evidence from individual skeletons gathered by the Tobacco, Health and History (THH) project at the University of Leicester, identifying the 'who', 'when' and 'how much' of tobacco use. Additionally, 2) macroscopic analysis of human skeletal remains will provide data on the prevalence of signs of developmental delay and congenital abnormalities. The remains used for this purpose derive from five archaeological sites in the Netherlands and England. The collected data will be assessed in two ways: a) Comparatively: analysis of trends in biological data for skeletal collections from different locations, different time periods, and different social strata; b) Longitudinally: the theoretical framework of the life-course approach will highlight the influence of early-life developmental issues on adult-life health consequences. By using congenital abnormalities in archaeological human skeletal remains as a proxy at the individual level, we can infer early-life circumstances and correlate them to population-wide health outcomes.BackgroundIn the post-medieval period, we see a decline in population health in Europe during which infectious disease is gradually replaced by chronic disease as the main cause of death. During the same period, tobacco is introduced and gains in popularity in England and the Netherlands. Despite the known ill health effects of tobacco use today, the link between commodification of tobacco and the emergence of chronic disease has never been thoroughly investigated.Aside from the disease and death caused by tobacco use directly, maternal exposure to tobacco during pregnancy can have a profound influence on the developing foetus. It has long been known that smoking during the early stages of pregnancy can adversely influence foetal health. Maternal tobacco exposure during early pregnancy (especially during organogenesis) can cause a wide variety of complications, including congenital disease and anomalies. Significantly, detrimental effects of tobacco exposure during the foetal stage do not end in early infancy. Those that are not fatal in infancy may cause health problems in later life. If the development of an individual is delayed during the foetal stage, no catch-up growth is evident until at least the age of 11 years. Chronic disease develops slowly, and the more risk factors are encountered in life, the higher susceptibility to disease associated with affluence becomes. Adversity in early life can thus significantly impact health in adult life, and therefore population health. Some congenital anomalies are already routinely documented during osteological assessment as 'non-metric traits', morphological deviations from the physiological 'norm', recorded as different phenotypic expressions. The aetiology of these traits is largely unknown, but may develop as a result of environmental influences during early foetal development (i.e. epigenetics). Non-metric traits are expected to not have had a direct influence on health but might be indicative of early-life ill health. Therefore, different prevalence rates before and after the introduction of tobacco - and between users and non-users - can identify exposure to tobacco as a potential causative agent. The results of this project will provide valuable insight into the long-term effects of tobacco on population health, which will shed light on current tobacco use, the world's leading cause of preventable disease