Editorial: Understanding past communal health: social responses to communal health in the past

Bioarchaeological research has long foregrounded the biological impacts of disease, stress, diet, and violence (e.g., Martin and Harrod, 2012; Reitsema and McIlvaine, 2014; Roberts and Buikstra, 2025). More recent research has provided increasingly sophisticated reconstructions of past health at both individual and population levels, exploring who was vulnerable to ill health within wider sociocultural settings (e.g., Bohling et al., 2022; DeWitte and Wissler, 2021; Mant et al., 2021. Yet the ways in which communities responded to these health conditions—socially, culturally, and institutionally—remain comparatively underexplored, with the exception of the bioarchaeology of care (e.g. Schrenk and Tremblay, 2022; Tilley, 2015; Tilley and Schrenk, 2017). This Research Topic addresses that gap by shifting analytical attention from patterns of health markers to the frameworks of care, management, and adaptation to communal health. As we define it, “care” involves providing support to those individuals with injuries, illnesses, or other conditions that affect their well-being. The contributions assembled here emphasise the embeddedness of and responses to health in social structures, belief systems, and institutional practices. Together, these studies demonstrate that responses to communal health are not only a matter of exposure to disease but also of access to care, social belonging, and culturally mediated responses to vulnerability.

A central theme emerging from this Research Topic is the variability of care practices within past communities. The study of medieval Danish cemeteries offers a compelling example (Kelmelis et al.). By integrating paleoepidemiological approaches with spatial analysis, the authors investigate whether individuals affected by leprosy or tuberculosis were treated differently at the time of death. Their findings challenge assumptions of systematic exclusion or segregation, as there was no clear evidence for differential burial treatment for individuals with leprosy in rural cemeteries, while urban cemeteries lacked leprotic individuals if a leprosaria and associated cemetery were present. Likewise, despite its prevalence, tuberculosis appears to have elicited no distinct mortuary response. Instead, social status emerges as a more consistent determinant of variation in survivorship and burial. This case highlights the complexity of medieval responses to disease, where institutional frameworks, rather than stigma alone, shaped the lived and post-mortem experiences of those who were ill.

The importance of social organisation in mediating health outcomes is further developed in the analysis of early modern Dutch populations (Schrader et al.). By combining historical documentation with bioarchaeological data, this study demonstrates that systems of care—whether community-based or institutional—had measurable effects on longevity and quality of life. Notably, rural individuals, despite exhibiting higher frequencies of pathological conditions, appear to have lived longer than their urban counterparts. This paradox underscores the effectiveness of localised, kin-based care networks, in contrast to more formalised but potentially less personalised urban institutions. The findings also reinforce the role of socioeconomic inequality, with lower-status individuals in urban settings experiencing reduced life expectancy. Here, communal health is revealed as a negotiated outcome shaped by access to resources, social cohesion, and the structure of welfare systems.

The contribution on castrates (Reusch) shifts the scale of analysis to a socially and biologically distinct group, offering a powerful lens on marginality, exploitation, and self-organised care. Castrates occupied paradoxical positions across different cultural contexts (e.g., Ottoman, Chinese, Persian): valued for specific roles—whether as elite guards or singers—yet often subjected to bodily modification with significant health risks and limited medical support. The study demonstrates that, in many cases, care structures were not imposed from above but emerged within castrate communities themselves. These networks facilitated mutual support, ensured proper burial, and, in some cases, enabled access to institutional protection through religious endowments. Importantly, the article also traces the broader medical legacy of castrates, whose bodies contributed to the development of endocrinology and modern understandings of hormonal function. This dual perspective—highlighting both neglect and contribution—underscores the asymmetrical distribution of care and recognition in past societies.

Religious and cultural frameworks further complicate interpretations of communal health, as illustrated by the study of medieval Portuguese dental pathology (Trombley et al.). By comparing Muslim and Christian communities within the same geographic context, the authors reveal how faith-based practices influenced both the prevalence of disease and approaches to care. Differences in dental pathology are interpreted not only through dietary variation but also through religiously informed hygiene practices, where oral cleanliness held both physical and spiritual significance. This study exemplifies how health behaviours are embedded within broader systems of meaning, and how these systems can produce measurable biological outcomes. It also demonstrates the value of integrating bioarchaeological data with ethnohistoric evidence to reconstruct culturally specific models of care.

Taken together, the contributions in this Research Topic highlight three key insights. First, communal health and responses to it must be understood as a relational phenomenon, shaped by interactions among individuals, institutions, and cultural norms. Second, care is neither uniform nor universally accessible; it is structured by social hierarchies, economic resources, and levels of marginalisation. Third, responses to health and disease are deeply contextual, shaped by local practices, belief systems, and historical contingencies. Importantly, these studies also highlight the methodological potential of integrating diverse lines of evidence—from spatial analysis and survival modelling to historical documentation and cultural interpretation. Such interdisciplinary approaches allow for a more nuanced understanding of how past communities navigated the challenges of disease and vulnerability.

This collection contributes to a growing body of research that situates health within its broader social and environmental contexts. It invites bioarchaeologists to consider not only who was sick but also who was cared for, how, and why. In doing so, it opens new avenues for exploring the dynamics of resilience, inequality, and social responsibility in the past. Ultimately, the study of responses to communal health offers more than a retrospective lens; it provides critical insights into the long-term interplay between biology, culture, and care. At a time when global health challenges continue to expose disparities in access and support, these historical perspectives remind us that responses to disease are as much social as they are biological—and that the structures of care we build—or fail to build—leave enduring traces in both bodies and communities.

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Footnotes

Edited and Reviewed by: Pamela L. Geller, University of Miami, United States