Abstract
Contemporary Sociology 46(2):186–88. First published March 1, 2017.
In History of Infectious Disease Pandemics in Urban Societies, Mark D. Hardt has written a timely if at times unsystematic book on the relationship between humans and infectious disease. By the start of the twenty-first century, the world had experienced outbreaks of SARS, pandemic influenza, Ebola, and, most recently, Zika. These experiences have renewed scholars’ interest in the social aspects of infectious disease. Social scientists have examined both the contemporary impact globalization has had on facilitating the spread of infectious disease and how nation-states and international organizations like the WHO have mounted a coordinated response to these disease threats. Meanwhile, historians like Patrice Bourdelais and Peter Baldwin and historical sociologists like Owen Whooley have examined the historical development of medicine and disease control in western countries. Hardt’s book is located at the nexus between these two related fields of inquiry.
Using a demographic approach, Hardt covers the social aspects of the history and contemporary manifestations of infectious disease. Hardt, a self-proclaimed “generalist” sociologist at Montana State University-Billings, studies the shifting relationship between microbes (e.g., germs and bacteria) and “macrobes” (e.g., Homo erectus, Homo sapiens, and contemporary humans). Reviewing large swaths of human history, he argues that there have been a number of “orthogenic shifts”—a series of transitions in forms of ecological balance between microbes and human macrobes. Specifically, he examines how the move to a more sedentary mode of human existence that occurred with the development of cities and towns created an “urban death penalty”—an increased rate of mortality from infectious disease. By the nineteenth century, this penalty started to be converted into an “urban life advantage” as cities became cleaner and healthier places to live. Nevertheless, with the advent of globalization and the rise of antibiotic resistance, Hardt foresees the potential for another “orthogenic shift.” Instead of living in a “post-infectious disease world,” there is the distinct possibility of future pandemics. At times Hardt’s book is intriguing, and there is promise in the conceptualization of some of his concepts. However, the book is also undisciplined, and the full promise of his research is not fulfilled.
Hardt introduces the book by asserting that most social theories of disease have focused solely on the human component; a more nuanced view grasps the interdependent relationship between humans and microbes. He then reviews demographic transition theories that have examined how societies have moved through stages of shifting rates of mortality and fertility (e.g., moving from a premodern stage of high mortality and high fertility to a modern stage of low mortality and low fertility). Some of these theories assume a contemporary “hubristic stage” in which mortality rates would continue to fall as humans eradicate infectious diseases one by one. The twenty-first century has, Hardt claims, awakened us from this dream of a “post-infectious disease world.”
The main argument of Hardt’s first chapter is the claim that as humans moved from gatherer-hunter societies to communities that farmed and raised livestock, there was a corresponding shift in the ecological relationship between microbes and humans. The more sedentary lifestyle of these later societies, combined with increased population density, allowed for niche disease like tuberculosis and leprosy to flourish. In his second chapter, Hardt expands on this argument as he describes the origins of the “urban death penalty”—a situation in which, because of infectious disease, cities historically experienced higher rates of mortality than fertility. In Chapter Three, Hardt covers a range of topics including the comparative case of Japan and the social-psychological impact of urban pandemics.
Chapters Four, Five, and Six describe the medical response to infectious disease, beginning in Ancient Greece, Rome, and the Middle East, continuing into medieval Europe’s experience with the bubonic plague, and finally covering the nineteenth century with the development of the “Sanitarian Movement” in England and the rise of germ theory later in the century. Chapter Seven provides a description of the history of vaccination, a discussion of Thomas McKeown’s thesis of the reduction in mortality in the nineteenth century, and a brief review of the concept of risk. In his concluding chapter, Hardt returns to the concept of an urban death penalty. He notes that though in modern times urban environments have become healthier, we should not be so foolish as to believe that all infectious diseases can simply be eradicated one by one—what Hardt calls the “domino theory” of disease eradication. Instead, the contemporary experience of AIDS, globalization, and the increased urbanization and globalization of the world suggest the potential for a “perfect storm” where pandemics once more become a familiar experience. Hardt expands on this theme in his prologue with a brief discussion of SARS, MERS, and the increasing resistance of microbes to antibiotics.
There are a number of intriguing aspects to Hardt’s book. By focusing not just on the human component of disease, but also on the role of microbes, Hardt takes a unique approach. By developing the concept of “orthogenic shifts,” he is able to develop this line of argument. His best example of an “orthogenic shift” is his description of the process of urbanization. By showing how the emergence of cities and towns impacts humans’ relationship with infectious disease, Hardt is able to show how a change in social structure is able to alter the ecological balance between humans and microbes. Likewise, his related concepts of an “urban death penalty” and “urban life advantage” also are useful in understanding how long-term social changes can shape mortality patterns.
The value of these contributions is undercut by the undisciplined nature of Hardt’s book. His work is not clearly organized, and the reader is often required to work at making the theoretical connections that Hardt implies. Each chapter is split into many different sections, and sometimes the links between those sections are unclear. For example, in Chapter Two, “Origins of the Urban Death Penalty,” in twenty pages Hardt discusses topics ranging from the conceptualization of the urban death penalty, how the development of cities impacts rates of disease, the role culture plays in disease susceptibility, the role disease played in the conquest of the Americas, the Aztecs’ experience of cultural anomie after conquest, the experience of disease in seventeenth-century England, a comparison between the disease experiences of the West and Asia, an analysis of classical and contemporary social theories of urbanization, the “domino theory of disease eradication,” and, finally, an analysis of the impact of SARS and pandemic influenza. As each chapter tackles many different issues, some of those topics remain underdeveloped. Overall, Hardt’s book is intriguing and his approach is at times original, but its unsystematic style diminishes its full potential.