Tobacco and Tuberculosis in the Past, Present, and Future: a Bioarchaeology of People, Products, and Pathogens

Through the lens of tobacco use, Part 1 of this fellowship demonstrates the value of Bioarchaeology for current health debates. Later, part 2 expands on this approach and explores human tuberculosis co-evolution. Tobacco, mostly commodified to generate wealth for governments and elites in the post-medieval period (16th-19th centuries), is known today to significantly alter the patterns and prevalence of socially significant diseases. Yet, tobacco use is not considered in social histories of health. This misses a chance to examine less direct dictators of health in the past, e.g. sociopolitics and commodification of tobacco, and for Bioarchaeology to contribute to one of today's most pressing public health issues.

Bone constantly adapts in life, chemically and physically, reflecting consumed products, environment, and disease. Thus, research on the remains of past people reveal how changes, including new behaviours and social priorities, impact us. Part 1 of this fellowship uses skeletal remains in a comparative approach to examine how disease patterns changed after the arrival of tobacco in three different post-medieval societies. It examines important diseases of the period (tuberculosis, vitamin D deficiency, dental disease, and cancer) all known to be exacerbated by tobacco use today. By contextualising disease patterns with historical sources on tobacco use and commodification, we can assess how commodification impacted health. Additionally, in using pre-modern individuals (pre 1900s) we can begin to disentangle the role of tobacco from other modern life variables (pollution, domestic smoke, and antibiotics) in disease causation and expression.

Based at the School of Archaeology and Ancient History (University of Leicester (UoL)), this project uses 900 skeletons from three regions of differing tobacco history: England, major tobacco producers and mainly pipe smoking; the Netherlands, importers of English tobacco and mainly pipe smokers; and Spain, importers and users of snuff, cigars and cigarettes. Working with the UoL's Department of Genetics and Genome Biology and the Institute of Genomics at the University of Tartu, biomolecular methods, including genetic and proteomic (proteins), will complement macroscopic methods for disease analysis (palaeopathology) to conceptualise disease patterns. A novel biomolecular approach using metabolomics will be developed with the UoL's Precision Medical Diagnostic Institute to improve detection of tobacco use and exposure in past individuals. Metabolomics is a biochemical method that studies all small molecules in a biological sample. Analysis of these molecules permits researchers to identify distinctive indicators (biomarkers) of drug use or disease in biological material, including bone and teeth. Its development and application here would be the first on archaeological bone, and sets up the foundations for research in part 2 where we aim to provide insight into changing TB dynamics.

Due to tremendous public interest in archaeology, an exhibition, podcasts, and an online teaching resource will improve understandings of the role of tobacco in developing chronic diseases less well known to be exacerbated by smoking. Such initiatives are valuable in preventing the uptake of smoking, a priority for many health agencies, and improving people's life quality. An interdisciplinary working group focusing centred on archaeological remains will be formed and information disseminated through open access publication and conference presentation. Overall, in exploring how tobacco commodification altered disease in past groups, and how TB patterns change overtime, this fellowship will demonstrate Bioarchaeology's power to provide unique insights into the complex dynamics between people, cultural behaviours and health in the past, and feed into contemporary health debates of significance today.

Today tobacco use remains the leading cause of preventable death and disability globally. Aggressive marketing strategies by tobacco companies in countries with low or no tobacco control exacerbates this issue, while new ways of using tobacco whose long-term effects are not known, are spreading across communities. As Part 1 of this Fellowship assesses the relationship between disease and tobacco use, the information generated has the potential to both directly and indirectly impact on the health of the British and wider public through its acquisition of knowledge on factors that influence individual and population health, and through its ability to inform the public about the risks of tobacco use. Information generated in Part 2, which will explore changing patterns of tuberculosis with human behaviour, would also generate significant impact. Part 1 research is of benefit to:

Wider public (directly and indirectly)
Public Health researchers, charities, and NGOs
Policy makers

This research will demonstrate the long-lasting implications of socio-political and economic decisions taken in the late 16th and 17th centuries on health, especially in relation to tobacco. This is a key priority for NGOs (e.g. the WHO, National Institutes for Health) who aim to prevent disease by understanding how existing and emerging products, combined with the current socio-political climate may impact us in the future. Furthermore, as one of the first truly global products, this research is particularly pertinent to one area: globalisation and its associated processes are one of the biggest challenges facing modern health as its effects are multiscalar and have variable effects on societies (The WHO). To plan for future outcomes in all societies, a greater understanding of this variation is needed, something we address by exploring three different places. This is highly relevant today as tobacco companies move into regions with limited restrictions on tobacco use and marketing. Revealing long-term effects will be informative for policy making in these areas. We will produce a short report on our findings that can be provided to those involved in policy making (e.g. the Commons Select Committee on Health and Social Care, MP's dealing with related issues, NGO's etc), which has the potential to meet UKRI goals on a global health challenge. Research will be disseminated at conferences of the UK Nicotine and Cessation, Public Health England and the World Conference on Tobacco or Health. Given the relationship between early tobacco use and medicine, a public exhibition where we also invite representatives from charities, NGO's and policy makers etc will be proposed to the Wellcome Trust. This will cover the history of tobacco use in the UK, and its long term implications for health.

Bioarchaeology has tremendous public interest in Britain. People are fascinated with skeletal research as everyone has a skeleton and has experienced pain, trauma, toothache, illness etc, which makes the research relatable. A big public health priority is preventing people starting smoking, especially in the young and/or lower socioeconomic groups (CDC, Nuffield Health). Bioarchaeology can improve public knowledge on the risks of tobacco use and its long-term implications through public engagement, which would serve to improve public health. While events, e.g. workshops and talks would be primarily targeted at young people, museums and other relevant community groups would be targeted, including schools in regions surrounding Leicester and London with higher numbers of disadvantaged children where the uptake of smoking is still common. We also plan to produce a free online digital teaching resource for teachers. To get a global audience social media will be used. It is anticipated that this can benefit the health of people by discouraging tobacco use, which will benefit people today, and given the cost of tobacco-related illness and death, society in the future.