In Disease and Discrimination, Hutchinson describes the forces—biological, social, and environmental—that shaped health in the Colonial Atlantic, focusing in particular on exploring why certain subpopulations faced elevated risks of malnutrition and disease. Hutchinson considers the circumstances of colonists, Native Americans, slaves of African and Native American descent, indentured servants, and the rural and urban poor across the sixteenth to nineteenth centuries in a region that includes the Northeast, New England, Chesapeake, and Carolina. The book opens with a description of the fourteenth-century Black Death and closes with the 1918 influenza pandemic, arguably two of the most important infectious disease pandemics in human history. Hutchinson uses these diseases, both of which killed extraordinarily large numbers of people and with which all readers will certainly have at least a passing familiarity, to illustrate a point he returns to repeatedly throughout the book, that “diseases are processes, not things, and they exist within an ecological and social context” (p. xxvii). The book in general is organized topically, rather than strictly geographically or chronologically, though in Parts II–IV Hutchinson explores spatiotemporal patterns at multiple scales with respect to each overarching topic. Part I provides brief overviews of disease ecology, “virgin soil” epidemics, the evolution of virulence, and the Columbian exchange. Part II describes initial colonization with an emphasis on the effects of contact on native populations of the Northeast and New England (Chapter 4), the growing fur and deerskin trade throughout the Atlantic (Chapter 5), and the intersection of conflict, famine, and disease (Chapter 6). Part III describes the establishment and expansion of farming and the plantation system, and Part IV details the emergence of and increase in urbanization.

Throughout the book, Hutchinson implicitly and explicitly reveals how crucial context is in the production of variable health outcomes in human populations. One particularly effective example of this is his description of the intersection of warfare, famine, and disease during the French and Indian War (pp. 85–95). Though Hutchinson does not use the term syndemic (the synergistic interactions, often in the context of disparate social conditions, of multiple diseases or health problems that exacerbate their negative outcomes), he frequently describes phenomena that arguably are examples thereof; he thereby demonstrates the historical relevance of a concept that is increasingly informing our understanding of disease outcomes in living populations (Singer, Virulence 1:10–18). Hutchinson also emphasizes the importance of bringing multiple lines of evidence to bear on questions of anthropological and historical significance. Using case studies from the context of the Colonial Atlantic, he describes the historical, archaeological, and bioarchaeological evidence (including assessments of the strengths and weaknesses of each body of evidence) that contribute to our understanding of health in the past. These two things—recognizing the importance of context and using multiple sources of information—are inseparable and, as Hutchinson makes clear from the beginning, characteristic of anthropological inquiry. This book therefore provides an excellent example of the holistic nature of anthropology and how it produces a richer understanding of phenomena than is possible if we attend only to each individual contributing factor in isolation.

Hutchinson writes clearly and succinctly, and because he is occasionally present as a narrator, injecting personal observations and experiences, this is not a dry, strictly formal scholarly text. He clearly defines terms and concepts that might be unfamiliar to the nonexpert reader, and he provides enough detail to paint a clear picture of life in the Colonial Atlantic. But, this book is lean—neatly focused on illustrative examples and trimmed of excessive details that might overwhelm (bore) readers not already deeply interested in that particular time or place. Though Hutchinson focuses on the Colonial Atlantic, there is much in the book to educate and interest readers whose research or teaching focuses on different regions or time periods. This book is well suited to serve as a text for an advanced undergraduate or graduate seminar and will complement literature that delves more deeply into life history theory, the developmental origins of health and disease (DoHAD), paleopathology, paleoepidemiology, the evolution of virulence, syndemics, intersectionality, and other topics mentioned or alluded to therein. Disease and Discrimination is engaging, accessible, and would be ideal for anyone interested in the variable factors that shape health in human populations.