Assessing medical technologies.

Adapting to high altitudes: historical, evolutionary, and physiological perspectives The birth of civilization and society can be traced back to the flatlands near large river basins such as the Nile, Yellow, and Indus river valleys. These “River Valley Civilizations,” and their fates, have been debated to a large degree. High-altitude civilizations, on the other hand, have been largely overlooked. High altitude regions (highlands) might be defined as those at altitudes greater than 2,500 m. About a quarter of Earth’s area constitutes highlands, and 10% of Earth’s population lives in these regions. The most prominent highland societies are those that have settled in the Andes, Tibet/Himalayas, and Ethiopia where all indigenous residents have been non-Caucasians. Each of these regions is populated by a few million people, and traces of mankind can be found that date back to prehistoric times. Living in the highlands requires genetic adaptations to low oxygen, or hypoxia. Moreover, each highland civilization has developed strategies for domesticating crops and livestock that are specifically tailored to different altitude conditions (e.g., frigid climate and arid soil). While being isolated from the outside world, highland societies have maintained strategic commerce with lowland regions. On the mental level, religion among highland populations serves as a symbol of unity and the will of the people to overcome the harsh living conditions. Although highland societies share many similarities, including hypoxic adaptation and environmental utilization, particularly notable are their diverse features. Moreover, while the lifestyles of highland populations have been maintained over thousands of years, this is beginning to change with the spread of globalism. In this report, we trace the process of adaptation to high-altitude environments. In particular, we focus on the physiological and cultural adaptations of highlanders to these environments, and how highland cultures came into existence.