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FB Livingstone Textbook
Frequencies of Hemoglobin Variants 1985
Image: "Frequencies of Hemoglobin Variants" text book by Frank Livingstone
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Frank B Livingstone (1985) Frequencies of Hemoglobin Variants: Thalassemia, The Glucose-6-
Phosphate Dehydrogenase Deficiency, G6PD Variants, and Ovalocytosis in Human Populations (New
York: Oxford University Press). ISBN: 0-19-503634-4.
In this work, the anthropologist Frank B Livingstone demonstrated that there are clines (gradients) of gene frequencies between populations measured at different territorial points at particular moments in time (Livingstone, 1985). For a sociologist, the importance of Livingstone's work is that in compiling such a global compendium, Livingstone retains the awareness that there is no primordial correspondence between genes in bodies and attachment to a particular territory (see Carter and Dyson, 2011). This is because Livingstone's classic work (Livingstone, 1958a&b) outlines how sickle cell gene frequencies in populations changed as a result of social practices (slash-and-
burn clearances of forested areas; the spread of yam cultivation; the denser concentration of human populations; the compacting of soil through agriculture: all leading to the creation of an ecological niche favouring reproduction of the malaria-carrying mosquitoes).
For the public health specialist, Livingstone's work illustrates the importance of micro-mapping in public health surveillance because gene frequencies can vary quite substantially across relatively short geographical distances. This is important information for a nation-state, or for a particular administrative region within a nation-state, that needs to be convinced, in health economics terms, that provision of screening and treatment services for sickle cell and thalassaemia should be funded by government. Since sickle cell disease and beta-thalassaemia major are genetic conditions it is often assumed, wrongly, that they cannot therefore be public health issues (but see Atrash and Parker, 2010; Ebrahim et al, 2010). To sample a few thousand people, say for sickle
cell trait in a sub-Saharan African country, and to extrapolate carrier rates for a whole country would be inappropriate. Livingstone's work ascribes carrier prevalence to particular populations, at particular moments, in particular places, sampled in particular ways. As such Livingstone's work reminds us of the ongoing need to improve the quality of epidemiological data we have on the haemoglobinopathies in order for countries currently less well resourced to plan the response of their health systems to sickle cell disease and to the thalassaemias.
Atrash H, Parker CS. (2010) The public health response to blood disorders American Journal of Preventive Medicine 38(4S):S451-S455.
Carter, R and Dyson, SM (2011) Territory, ancestry and descent: the politics of sickle cell disease Sociology 45(6):963-976.
Ebrahim SH, Khoja, TAM, Elachola, H, Atrash, HK, Memish, Z, Johnson, A. (2010) Children who come and go: The state of sickle cell disease in resource-poor countries American Journal of Preventive Medicine 38:(4S) S568-S570.
Livingstone, FB (1958a) Anthropological implications of sickle cell gene distribution in West Africa, American Anthropologist 60 (3): 533-562.
Livingstone, FB (1958b) The distribution of the sickle cell gene in Liberia, American Journal of Human Genetics 10 (1): 33-41.
Simon Dyson, February 2012