The health of Native Americans was in trouble long before Columbus came. Archeologists think the rise of agriculture is the reason, because farming encouraged people to settle in larger communities, where disease was more easily spread.

Researcher Richard Steckel analyzed more than 12,500 skeletons excavated from 65 sites in North and South America that ranged from 5,000 BC to the late 19th century, looking for signs of chronic health problems. He found the healthiest people were Indians living along the coast of Brazil about 1,200 years ago. The Zuni Indians of Hawikku, New Mexico were the worst. The skeletons at this site died before coming into contact with European settlers, so imported disease could not have been the reason. Six other sites in the least-healthy category existed at least 500 years before Columbus.

Many of the healthiest groups lived along the coast. Others lived in the interior of the United States, where they hunted and gathered food. The healthiest sites were the oldest ones, predating the arrival of Columbus by thousands of years. However, nomads who traveled on horses, which were brought to the Americas from Europe, were also among the healthiest groups in the study. People living in rural areas had less evidence of negative health than skeletons excavated from large settlements. Infections increased as people began moving to cities, and the worldwide spread of disease began by the 1400s, with increased trade between Europe and the Americas.

Archeologists also studied skeletons of slaves buried at Philadelphias African Church in the 1800s and found they were in the top half of the health index, with health that was superior than small-town, middle-class whites. This shows it was possible for a socially disadvantaged group to stay healthy in an early 19th-century city. However, plantation slaves buried in a South Carolina site ranked third to last on the health index, probably because their living conditions were worse than the first group.

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