combined with the destruction of the tra- trend. The progressive acquisition of life, imported food, and motorcycles, ditional culture modern degenerative diseases was docu- sugar and salt intakes nearly tripled, high mented by an eight-member team of blood pressure increased approximately DISEASES OF New Zealand medical specialists, an- ninefold, diabetes two-to threefold, and DEVELOPMENT thropologists, and nutritionists, whose heart disease doubled for men and more research was funded by the Medical Re- than quadrupled for women, while the Pe search Council of New Zealand and the number of grossly obese women in- lic health specialists to start talk World health Organization. These creased more than tenfold. among the ing about a new category of searchers investigated the health status New Zealand Maori, sugar intake was diseases.. Such diseases could be of a genetically related population at var- nearly eight times that of the Pukapu called the diseases of develop ious points along a continuum of increas- kans, gout in men was nearly double its nd would consist of those ng cash income, modernizing diet, and rate on Pukapuka, and diabetes in men pathological conditions which are urbanization. The extremes on this ac- was more than fivefold higher. while based on the usually unanticipated culturation continuum were represented heart disease in women had increased consequences of the implementa- by the relatively traditional Pukapukans more than sixfold. The Maori were,in tion of developmental schemes of the Cook Islands and the essentially fact, dying of"European"diseases at a Hughes Hunter, 1972: 93 Europeanized New Zealand Maori, eater rate than was the average New while the busily developing Raroton- Zealand European. Economic development increases the gans, also of the Cook Islands, occupied Government development policies disease rate of affected peoples in at least the intermediate position. In 1971, after designed to bring about changes in local three ways. First, to the extent that devel- eight years of work, the teams prelimi- hydrology, vegetation, and settlement populations suddenly become vulnerable c ry findings were summarized by Dr. patterns and to increase population mo- opment is successful, it makes developed an Prior, cardiologist and leader of the bility, and even programs aimed at re to all of the diseases suffered almost research as follows ducing certain diseases, have frequently exclusively by“ advanced” peoples led to dramatic increases in disease rates Among these are diabetes, obesity, hy We are beginning to observe that because of the unforeseen effects of dis- pertension, and a variety of circulator the more an islander takes on the urbing the preexisting order. problems. Second, development disturbs of the West, and Hunter(1972)publishe traditional environmental balances and he is to succumb to our degenera lent survey of cases in which may dramatically increase certain bacte tive diseases. In fact, it does not ment led directly to increased disease al and parasite diseases. Finally, when seem too much to say our evidence rates in Africa. They concluded that development goals prove unattainable, now shows that the farther the Pe hasty development intervention in an assortment of poverty diseases may atives move from the quiet, relatively balanced local cultures and appear in association with the crowded carefree life of their ancestors, the environments resulted in "a drastic dete- conditions of urban slums and the gen- closer they come to gout, diabetes, rioration in the social and economic con- eral breakdown in traditional socioeco- erosclerost.s. o ditions of life Traditional populations in general Outstanding examples of the first sit- Prior. 1971: 2 have presumably learned to live with the uation can be seen in the Pacific. here endemic pathogens of their environ- some of the most successfully developed In Pukapuka, where progress was ments, and in some cases they have native peoples are found In Micronesia, limited by the islands small size and its evolved genetic adaptations to specific where development has progressed more isolated location some 480 kilometers diseases, such as the sickle-cell trait rapidly than perhaps anywhere else, be- from the nearest port, the annual per cap- which provided an immunity to malaria tween 1958 and 1972 the population ita income was only about thirty-six Unfortunately, however, outside inter doubled, but the number of patients dollars and the economy remained es- vention has entirely changed this picture treated for heart disease in the local sentially at a subsistence level. Re- In the late 1960s, sleeping sickness sud hospitals nearly tripled, mental disorder sources were limited and the area was denly increased in many areas of Africa increased eightfold, and by 1972 hyper- visited by trading ships only three or four and even spread to areas where it did not tension and nutritional deficiencies be- times a year; thus, there was little oppor- formerly occur, due to the building of gan to make significant appearances for tunity for intensive economic develop- new roads and migratory labor, both of the first time(TTr, 1959, 1973, statisti- ment. Predictably, the population of which caused increased population cal tables) Pukapuka was characterized by rela- movement. Large-scale relocation some critics argue that the tively low levels of imported sugar and schemes, such as the Zande scheme, had Micronesian figures simply represent salt intake, and a presumably related low disastrous results when natives wer better monitoring due to eco- level of heart disease, high blood pres- moved from their traditional disease-free nomic progress, rigorously controlled sure, and diabetes. In Rarotonga, where refuges into infected areas. Dams and ir- data from Polynesia show a similar economic success was introducing town rigation developments inadvertently creArticle 35. The Price of Progress 2 combined with the destruction of the tra￾ditional culture. DISEASES OF DEVELOPMENT Perhaps it would be useful for pub￾lic health specialists to start talk￾ing about a new category of diseases.… Such diseases could be called the “diseases of develop￾ment” and would consist of those pathological conditions which are based on the usually unanticipated consequences of the implementa￾tion of developmental schemes. Hughes & Hunter, 1972: 93 Economic development increases the disease rate of affected peoples in at least three ways. First, to the extent that devel￾opment is successful, it makes developed populations suddenly become vulnerable to all of the diseases suffered almost exclusively by “advanced” peoples. Among these are diabetes, obesity, hy￾pertension, and a variety of circulatory problems. Second, development disturbs traditional environmental balances and may dramatically increase certain bacte￾rial and parasite diseases. Finally, when development goals prove unattainable, an assortment of poverty diseases may appear in association with the crowded conditions of urban slums and the gen￾eral breakdown in traditional socioeco￾nomic systems. Outstanding examples of the first sit￾uation can be seen in the Pacific, where some of the most successfully developed native peoples are found. In Micronesia, where development has progressed more rapidly than perhaps anywhere else, be￾tween 1958 and 1972 the population doubled, but the number of patients treated for heart disease in the local hospitals nearly tripled, mental disorder increased eightfold, and by 1972 hyper￾tension and nutritional deficiencies be￾gan to make significant appearances for the first time (TTR, 1959, 1973, statisti￾cal tables). Although some critics argue that the Micronesian figures simply represent better health monitoring due to eco￾nomic progress, rigorously controlled data from Polynesia show a similar trend. The progressive acquisition of modern degenerative diseases was docu￾mented by an eight-member team of New Zealand medical specialists, an￾thropologists, and nutritionists, whose research was funded by the Medical Re￾search Council of New Zealand and the World Health Organization. These re￾searchers investigated the health status of a genetically related population at var￾ious points along a continuum of increas￾ing cash income, modernizing diet, and urbanization. The extremes on this ac￾culturation continuum were represented by the relatively traditional Pukapukans of the Cook Islands and the essentially Europeanized New Zealand Maori, while the busily developing Raroton￾gans, also of the Cook Islands, occupied the intermediate position. In 1971, after eight years of work, the team’s prelimi￾nary findings were summarized by Dr. Ian Prior, cardiologist and leader of the research, as follows: We are beginning to observe that the more an islander takes on the ways of the West, the more prone he is to succumb to our degenera￾tive diseases. In fact, it does not seem too much to say our evidence now shows that the farther the Pa￾cific natives move from the quiet, carefree life of their ancestors, the closer they come to gout, diabetes, atherosclerosis, obesity, and hy￾pertension. Prior, 1971: 2 In Pukapuka, where progress was limited by the island’s small size and its isolated location some 480 kilometers from the nearest port, the annual per cap￾ita income was only about thirty-six dollars and the economy remained es￾sentially at a subsistence level. Re￾sources were limited and the area was visited by trading ships only three or four times a year; thus, there was little oppor￾tunity for intensive economic develop￾ment. Predictably, the population of Pukapuka was characterized by rela￾tively low levels of imported sugar and salt intake, and a presumably related low level of heart disease, high blood pres￾sure, and diabetes. In Rarotonga, where economic success was introducing town life, imported food, and motorcycles, sugar and salt intakes nearly tripled, high blood pressure increased approximately ninefold, diabetes two- to threefold, and heart disease doubled for men and more than quadrupled for women, while the number of grossly obese women in￾creased more than tenfold. Among the New Zealand Maori, sugar intake was nearly eight times that of the Pukapu￾kans, gout in men was nearly double its rate on Pukapuka, and diabetes in men was more than fivefold higher, while heart disease in women had increased more than sixfold. The Maori were, in fact, dying of “European” diseases at a greater rate than was the average New Zealand European. Government development policies designed to bring about changes in local hydrology, vegetation, and settlement patterns and to increase population mo￾bility, and even programs aimed at re￾ducing certain diseases, have frequently led to dramatic increases in disease rates because of the unforeseen effects of dis￾turbing the preexisting order. Hughes and Hunter (1972) published an excel￾lent survey of cases in which develop￾ment led directly to increased disease rates in Africa. They concluded that hasty development intervention in relatively balanced local cultures and environments resulted in “a drastic dete￾rioration in the social and economic con￾ditions of life.” Traditional populations in general have presumably learned to live with the endemic pathogens of their environ￾ments, and in some cases they have evolved genetic adaptations to specific diseases, such as the sickle-cell trait, which provided an immunity to malaria. Unfortunately, however, outside inter￾vention has entirely changed this picture. In the late 1960s, sleeping sickness sud￾denly increased in many areas of Africa and even spread to areas where it did not formerly occur, due to the building of new roads and migratory labor, both of which caused increased population movement. Large-scale relocation schemes, such as the Zande Scheme, had disastrous results when natives were moved from their traditional disease-free refuges into infected areas. Dams and ir￾rigation developments inadvertently cre-