Studies of skeletal samples from Cahokia have found evidence of nutritional stress, infections, and other health problems that suggest the population was not uniformly well-nourished or healthy.

The stress markers evident in some samples suggest that a significant proportion of the population experienced periods of poor nutrition, which may reflect the unequal distribution of resources in a highly stratified society as well as the overall environmental pressures on the food system.

The weight of the evidence, taken together, suggests that Cahokia’s decline was not the result of a single catastrophic event — no invasion, no natural disaster, no plague appears in the record as a clear precipitating cause.

Instead, it looks like a long, slow process in which multiple pressures — climate, environmental degradation, political tension, health — combined to make the city less and less viable over a period of a century or more.