Why Are People in the South Less Healthy? It's Always Been the Case

A new scholarly study documenting the poor health of southern military recruits has been much in the news of late ( Newsweek , January 11, 2018).

In the study, published online in the Journal of Public Health Management & Practice last week, a team of researchers organized under the auspices of The Citadel in Charleston, South Carolina, found that male and female army recruits from ten southern states were significantly less fit and much more likely to become injured while on duty than male and female recruits from other parts of the country.

The authors of this careful study, based on data drawn from 170,000 recruits, suggest that the overall poor state of public health in the South shows up clearly in the data on military recruits from the region, and that, as a result, the public health burden in the South is impairing U.S. military readiness and national security.

There is no reason to challenge the study's overall findings, however depressing, but adding a bit of historical context might allow us better to interpret them.

First and foremost, it is important to note that the study's findings will not surprise any student of southern history. The South has long been a public health disaster area, with the region's population topping the charts in statistics relating to morbidity, mortality, and various and sundry indices of parlous health outcomes for a century and a half.

The region's dubious rankings in these regards are closely related to--indeed, inter-correlated with-- similar rankings regarding per capita income/wealth, poverty, educational achievement, and other socio-economic indicators.

When President Franklin D. Roosevelt, writing in 1938, called the South "the Nation's No. 1 economic problem," he knew whereof he spoke. The below average level of per capita income, high level of poverty, and poor state of public health in the region over the last one hundred fifty years have "presented" in myriad ways, including in high rates of rejection for military service in the Spanish-American War, World War I, and World War II. In each of these cases the primary reason for rejection was related to weight.

There is a big difference, however, in the way regional poverty and impaired health "presented" on southern military recruits in the past and the way they do today. Whereas the principal reason for rejecting southern males for military service in 1898, in World War I, and in World War II was failure to meet minimum weight requirements, the authors of the new study emphasize obesity .

One of the most dramatic changes in the relationship between nutrition and income in the U.S. in recent decades has been the reversal of the historical relationship between income/wealth and weight.

Until quite recently, poor people everywhere in the world have weighed less than people in wealthier groups. In the U.S. and other developed countries today, this situation has often been reversed, with obesity levels higher, generally speaking, among members of lower-income groups.

Basically, poor people buy cheap, high- caloric foods in order to survive and don't have the time or resources to burn off the fat.

Since the lead researchers in the recent study work out of The Citadel, it seems appropriate briefly to mention some historical research done on Citadel cadets themselves, the findings from which underscore the principal points above.

In two papers published in the 1990s, economist John Komlos and I used data from the archives of The Citadel on the height and weight of cadets between c. 1880 to c. 1940 to analyze biometric trends in the region. The most striking findings from our study—based on biometric data on 6550 cadets born between the 1860s and the 1930s—were related to their slight stature as reflected in weight and BMI (body mass index).

The average 18-year old male cadet at The Citadel in the cohorts born in the 1870s, 1880s, 1890s, and 1900s—over 77 percent of whom resided in the South -- ranged between 129.8 pounds and 134.9 pounds, and the average BMI between a tiny 19.9 and a slight 20.5. And, almost certainly, Citadel cadets came from families that on average were wealthier than the regional mean.

By way of contrast, U.S. military recruits in World War I averaged about 145 pounds, fully 10 pounds higher than Citadel men.

There were many reasons for the meager stature historically of southerners, including Citadel cadets, whose families were generally not well off, but seldom impoverished.

Historians generally point to the region's high rate of poverty and to its high disease burden—to malaria, pellagra, and hookworm in particular. These diseases were largely eradicated from the region in the first half of the twentieth century, but the region is still considerably poorer than the U.S. as a whole.

Today, however, the region's economic problems find physical expression in obesity rather than stunting, as the authors of the new study demonstrate.

Peter A. Coclanis is Albert R. Newsome Distinguished Professor of History and Director of the Global Research Institute at UNC-Chapel Hill.