Since perhaps the Medieval period, there has been the notion that death is the great leveller - all are equal in death. This is decidedly not the case. Skeletal analysis reveals that the inequalities of life leave their traces in the human skeleton, but because disease that affects the skeleton is in its chronic form, the epidemiological interpretation of these lesions is not as straightforward as equating lesions with ill health and imminent death. Individuals lacking lesions succumbed to illness due to low immune resistance, before the disease could elicit bone reactions. Although lacking lesions, these individuals were, in fact, less healthy. Those displaying inactive or healed lesions, then, were the ones whose resistance to disease was high (and whose frailty was low) and, as a consequence, survived the onset of disease. This perspective has been termed the ‘osteological paradox’, one that has had a major impact on the way that disease and health are interpreted from the study of human remains. The full significance of the paradox, however, cannot be fully exploited without considering that the morbid conditions of the past had deleterious social and personal consequences for those afflicted. One must also consider individual access to remedial and palliative care and cures that have been available since deep antiquity. As in today’s society, access to care is likely the key factor in the past, and this access was heavily conditioned by the social standing of the afflicted individual. Whatever the case, it is clear that one Cannot simply study the physiology of peoples without due consideration of their cultural, social, economic, and political context.
There are two means by which to reconstruct social standing or status from the archaeological record. A method traditionally employed by archaeologists equates the richness of grave goods, funerary architecture, and placement of the grave with respect to others with the social position of the individual during life. An alternative method relies on an osteological approach based on measurement of stature, body proportions (i. e., growth and development), and other biological indicators, such as nutrition, longevity, and health status that have been linked to social standing in living groups. A biocultural approach employs both of these approaches as complements (see Bioarchaeology; Osteological Methods).