Why Care: Complex Evolutionary History of Human Healthcare Networks

Abstract

One of the striking features of human social complexity is that we provide care to sick and contagious individuals, rather than avoiding them. Care-giving is a powerful strategy of disease control in human populations today; however, we are not the only species which provides care for the sick. Widespread reports occurring in distantly related species like cetaceans and insects suggest that the building blocks of care for the sick are older than the human lineage itself. This raises the question of what evolutionary processes drive the evolution of such care in animals, including humans. I synthesize data from the literature to evaluate the diversity of care-giving behaviors and conclude that across the animal kingdom there appear to be two distinct types of care-behaviors, both with separate evolutionary histories: (1) social care behaviors benefitting a sick individual by promoting healing and recovery and (2) community health behaviors that control pathogens in the environment and reduce transmission within the population. By synthesizing literature from psychology, anthropology, and biology, I develop a novel hypothesis (Hominin Pathogen Control Hypothesis) to explain how these two distinct sets of behaviors evolved independently then merged in the human lineage. The hypothesis suggests that social care evolved in association with offspring care systems whereas community health behaviors evolved as a type of niche construction. These two types of behaviors merged in humans to produce complex, multi-level healthcare networks in humans. Moreover, each type of care increases selection for the other, generating feedback loops that selected for increasing healthcare behaviors over time. Interestingly, domestication processes may have contributed to both social care and community health aspects of this process.

Compassion: From Its Evolution to a Psychotherapy

“…Care of offspring is not the only source for the evolution of caring. Kessler (2020) explores the evolution of what she calls "health-care, " caring for sick individuals, and highlights that many species care for their sick and injured. Kessler refers to the work of Frank et al (2018), who noted that termite hunting ants (Megaponera Analis) are prone to injury such as losing legs, but are often carried back to the nest by nest mates, where their chances of recovery are 80% compared to 10% of those who are not.…”

“…Undoubtedly, humans are prepared to make sacrifices of their own lives to save others, and even strangers, as witnessed in many situations of the rescue services or medical staff working on viral infections around the world including of course Ebola and COVID-19. It is not entirely clear, however, when that kind of altruistic behavior evolved (Kessler, 2020). Nor is it clear when we develop the capacity to make sacrifices of giving up our own resources at a cost to ourselves.…”

Antimicrobial wound care in an ant society

“…Infected wounds are a major mortality risk for animals ( 1, 2 ), but the identification and medicinal treatment of infected wounds is thus far considered a uniquely human behavior. While several mammals have been shown to lick wounds and apply saliva ( 1, 2 ), the efficacy of this behavior remains largely unknown and occurs indiscriminately of the state of the wound.…”

Creating a Compassionate World: Addressing the Conflicts Between Sharing and Caring Versus Controlling and Holding Evolved Strategies

“…Evidence suggests that humans adapted their physiological and cognitive systems for extended and extensive parent-infant caring (Hrdy, 2009) and these became a template for a range of social relationships, particularly in small groups. While caring and sharing in hunter-gatherer societies had a number of sources including conflict resolution and prevention, compassion as "the desire to intentionally help others in need and care for them" was certainly one of them (Spikins, 2015(Spikins, , 2017Kessler, 2020). The basis of this is partly because the same hormones and patterns in the autonomic system underpin all forms of caring.…”

“…So, this brings us back to the fact that compassion is the intentional desire to be “sensitive to suffering in self and others with a commitment to try to alleviate and prevent it” ( Gilbert, 2017a ). Many animals may care for their young or others, and ants may carry their injured colleagues back to the nest ( Kessler, 2020 ), but only humans as far as we know have this knowing intentional awareness and can develop deep wisdom of how to be helpful – can develop science and medicine or seek the politics of caring. This is profoundly important because it means that compassion is an intentional desire to bring caring into our relationships, into our world, into our politics, into our businesses, and we can use science and research of how best to do those.…”