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I'm trying to plan out a post-apocalyptic novel that takes place on earth centuries or thousands of years after the apocalypse. The circumstances surrounding the apocalypse are vague as society has regressed without access to technology and most reading material was lost or destroyed and hoarded by a small few. I was hoping to create a scenario in which there is a society (not the wider earth) that are sort of isolated and there is a select elite that are healthy(ish) while there are a subjugated group that are kept sickly and with hair falling out, maybe deformities. The sickly non-elite are dependent on the healthy elite or at least think they are. They think the healthy elite are superior to them because of their health. I was considering something to do with radiation although I know the plausibility of this is not ideal. As in, the elite are protected from radiation by structures while the rest are not, or the sick are eating food/water that's been contaminated. Maybe inter-breeding made things worse. Meanwhile there are areas that this society don't know about that have healthy people not affected by radiation.

My question is how can I establish people who are ill, deformed, etc. while others are protected? How can this be limited to a geographic area?

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    $\begingroup$ Radiation sickness that is severe enough to cause significant hair loss would be fatal too quickly for this to be a "normal" state of affairs; none of the poor people would survive infancy, and nobody would be healthy enough to have children. Better to go with something like lead poisoning or groundwater contaminated with fracking chemicals, etc. Chronic malnourishment might also work, although it can't be too severe or, again, no children. $\endgroup$
    – Tom
    Commented Jun 1 at 21:16
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    $\begingroup$ The plausibility of this is not ideal only because it's safe to exit the shelter after two weeks. 1k years after the apocalypse, that's the only thing you'd have to explain (why you're still in a vault 200y later).... I've Fallout 4 modded with green trees and overgrown grass, because 200y later, you wouldn't even know what happened until you found the one building still standing at ground zero (air bursts don't leave a crater). Genetics doesn't matter. Resource distribution is everything as always. Which can work both ways: rich people's teeth fall out, while poor people eat vegetables. $\endgroup$
    – Mazura
    Commented Jun 3 at 1:44
  • $\begingroup$ Healthcare like fitness time, nutriology, cancer treatments, genome manipulation and qualified personal medics are available only to wealthy/powerful. Education discrepancy further widens the gap. This was true in the past, is true in modern times, and will likely stay this way in future. $\endgroup$
    – Basilevs
    Commented Jun 3 at 21:48
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    $\begingroup$ Iodine. Available only to the rich people from a iodine-rich well $\endgroup$
    – syck
    Commented Jun 3 at 21:53

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The answer is simple: you can't get sick from radiations if you don't exposed to them.

The elite keep themselves sheltered while the non elite are forced to dwell in areas which are known to be still contaminated by radioactivity.

For example alpha emitters are not too dangerous, because alpha particles get easily shielded, unless they get inside the body, where it will be the body itself to absorb them and get damaged. So one person who works in an environment prone to have dust of alpha emitters will get way more radiation damage from dust inhalation than from a person who doesn't get to inhale that dust.

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  • $\begingroup$ Essentially, gas masks & hazmat suits for the elite. Makes sense, because I've heard they aren't cheap. $\endgroup$ Commented Jun 1 at 22:59
  • $\begingroup$ And don't forget all of the extra stuff the make sure the suits are still good. Like pressure testers. pksafety.com/… $\endgroup$
    – Fred
    Commented Jun 3 at 17:37
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Lead poisoning, perhaps?

Lead was used as a sweetener. You could hang a lead ball in cider or wine and make it taste like the more expensive stuff. Legionaries posted in Britain drank lead sweetened cheap wine, while their officers would have wine imported from Spain or elsewhere without lead. The effect was that rankers rarely lived to being 50 while officers could live to be 80. The effect on an individual may have been hard to see given all the other threats to life back then, but they would have skewed the statistics for reaching great age.

Lead lined vessels were also used to make sauerkraut. George III liked sauerkraut and sweet lemonade. Some of his problems may have come from lead poisoning. Some of Beethoven's health problems (though not his deafness) are also thought to have come from lead.

The cure was to take the waters in Bath or other spa towns. People excrete lead faster in weightlessness. The same effect seems to happen when sitting up to your neck on water. They believed that the water contained special curative agents, and should be cold to be really effective. Neither is true as far as we know. A poor person with lead poisoning could not go to a posh spa town, but they could have sat up to their necks in water anywhere.

Generally, this was seen as the rightful order of things. The wealthy were seen as a separate, superior race that lived longer, and were born to leadership. There are plenty of privileged people who still think like that today.

In the nineteenth century medical dogma held that there were only four essential nutritional factors: proteins, carbohydrates, fats, and minerals. Everything else was caused by germs. The outbreaks of scurvy on isolated ships lead to the recognition that there were some other essential parts of the diet. Clinicians recognised scurvy, beriberi, rickets, pellagra, and xerophthalmia as specific vitamin deficiencies. Slow lead poisoning did not fit into this model as it was the slow addition of something rather than the lack of it.

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Hmm, this doesn't seem like a hard problem. The elite protect themselves from exposure to the disease while the peasants are exposed, and/or the elite have access to medicine that the peasants don't.

Like, during the Industrial Revolution, the working class had to work in harsh conditions, exposed to dangerous machinery and dangerous chemicals, while the elite lived in comfortable estates.

Reminds me, I don't have the citation on this, but I once read that while the life expectancy of the average American has gone up dramatically in the last 200 years, the life expectancy of a US senator has not changed. Presumably because senators are mostly drawn from the upper classes, and they always had access to good food and medical care. Advancing technology helped more people to have access to these things, but the rich always did.

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  • $\begingroup$ I expect it had gone up a bit for senators, just because of improved medicine, but not as much as the poor. Although with the USA opioids problem it may be going down again. I live in the countryside and I was amazed by the ages on the 1800 gravestones $\endgroup$
    – WendyG
    Commented Jun 4 at 9:28
  • $\begingroup$ @WendyG Senators today are also exposed to a lot more bad stuff than they were 200 years ago. So, whatever advancements in medical technology there have been are being offset by things like food additives, increased atmospheric toxicity, etc. $\endgroup$
    – Nosajimiki
    Commented Jun 4 at 16:08
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Your situation isn’t awfully far-fetched! In many pre-modern societies, many of the poor were generationally malnourished and lived hard lives, while the elite were well-fed and relatively well medically attended — so the elites were healthier, taller, and (often, depending on customs) stronger, while the poor were much more likely to be smaller, weaker, more hard-beaten, afflicted with some chronic illness or injury or deformity… These were all very visible, and one of the many ways such elites maintained their legitimacy and status.

Other answers offer suggestions for the medical causes of the divergence — but for the psychology and sociology of how it could be perceived and used by the elites, look to history. Medieval Europe is one period where this health difference was often very clear, and which is very well-supplied with both accessible non-fiction history literature, and a wealth of well-informed and accurate fiction, which can be very helpful for getting a feel of how people in the time thought about such things.

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To expand on L.Dutch's answer (and a comment is to short), you could add that the elite has a genetical anomaly to absorb carbon, potassium or something else. In general, we got trace amounts of radioactiv elements incorporated into our body, bones, tissues etc. Chemically equal to the non-radiative counterparts, like carbon-14 or potassium-40, they could accumulate those elements into their body and stay sick, caused by the higher conentration of radioactive elements.

The elite could eat the same food and live in the same region, without accumulating this radiation into their body, because their body have difficulties absorbing these elements. That way they would stay 'healthier' for a longer time, but could still die to accute radiaton posioning.

The advantage of this would be that they would likely develop other sickness associated with the lack of potassium or carbon or whatever, but could be countered or at least alleviated by medicin only they can get.

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Replace radiation with a crippling microbial disease.
I believe radiation as an aeon-old plague is too egalitarian. The OP seems to equate the sick condition with damage to the ADN of the individual; however, in real life we have more traditional, time-honored ways to make wretchedness hereditary.

The usual way to visit a sectarian group with endemic sickness is by ways of contagious diseases. The disease is usually deadly, e. g. bubonic plague, however it can also cripple the victims, e. g. leper and poliomyelitis or cripple their offspring, e. g. German measles.

Our traditional way to selectively protect an elite subgroup is by proclaiming them holy and to prescribe cleansing rituals for the unworthy underlings before they may approach their persons or touch their food. Additional cleansing rituals must be obeyed by the holy ones in case they came in sacrilegious contact unawares with the unworthy.

The classical example is the set of Biblical prescriptions to preserve and restore the ritual cleanliness of Israel's children: many of them would classify as rules of hygiene to-day, specially the Levites being prohibited from touching dead flesh and unclean animals (among which, rats and mice). See Leviticus 11-26 for details.

Against cholera-like germs, you may want to bless water to be drunk by the holy ones with a drop of silver chloride. Blessing their table salt with a wee bit of it might help them fight mercury poisoning. For good measure, bless their bath salts and their soap with hypochlorite. Consider making the exact recipe for blessing salt and water a secret of the holy ones: this will increase the chance trespassers, out of ignorance, try to consume pure bleach and meet a suitable retribution for their sacrilege.

To keep the underlings in the comfortably sick condition they deserve, make it taboo for them to consume, even touch blessed stuff. Decree it is arrogance for them to wash their hands on their return from the privy, when it is mandatory for the holy ones to do so.
Bonus points if microbicides are hard to come by and their production is easy to monitor, e. g. state-owned or can be made a commercial secret, e. g. by requiring advanced technology (electricity). An other useful secret is the recipe for the redox indicator (methylene blue) whose discoloration proves bleaching activity is ongoing.

To make holiness hereditary, have special hygiene rules for sexual activity and for giving birth among the elite, disguised as cleansing rituals; make it mandatory for the offspring of the elite to observe the same hygienic rituals as themselves. Again, see Leviticus for details.

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(TOXIC) POISON!

It could be that the environment has some kind of toxins present nearly everywhere that cause the conditions you described. It could be present in the water source, or some similar vector. The Elite would be insulated against this through a special solution that counteracts the effects which only they know how to make, leaving them relatively healthy, while the others without the knowledge of how to make the antidote are left sickly.

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Invaders from another land

If the apocalyptic event was nuclear war, there could be geographically isolated regions (such as Oceania) that got far less radiation and as a result had far fewer genetic issues introduced into their populations.

Fast forward through a few thousand years. The nuclear fallout has effectively completed its decay, so the population effects are the ones left over from the initial irradiation. The people of Europe, Asia, and Africa had enough harmful mutated alleles that these have spread out through the population. There's enough evolutionary time to filter out the fatal mutated alleles, but not enough to filter out the mutated alleles that just cause health problems or quality of life reductions. Such health problems are now ubiquitous within these populations, where everyone has at least a handful of them. Meanwhile, the populations in Oceania still look genetically like pre-collapse humans.

Then, a group from Oceania invade into Asia (such as the Saxon Invasion of Britain). You now have a robust healthy group ruling a group sick with radiation-style illnesses.

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One explanation is that the elite are eating better food, which is the main reason why the real world elite today are more healthy than the general population. To be more specific, maybe the elite in your story grow their food hydroponically - which is still relatively low tech.

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We're all giving you basically the same answer, but to be more specific...

Use L. Ron Hubbard's Solution

In Battlefield Earth in order to create a crisis for the story, Hubbard placed the village from which the protagonist hails near a nuclear mine field.

You see, radiation isn't an illness and it's not contagious. You're in danger when exposed to a source. You're not when you are not exposed. Thank goodness for the Van Allen Radiation Belts!

Anyway, Johnny Goodboy Tyler's Psychlo-driven education led him to realize what the problem could be and a map he found at a defense base showing the location of the mine field, then he used Psychlo breathe-gas (which is violently reactive to radiation) and his horse to run back-and-forth and identify the exact locations of the mines. After marking them, he proceeded (with all due narrative nonsense) to relocate his kith and kin someplace safe.

Thus, your one and only option is to use something radioactive — like radioactive land mines — to rationalize the presence of radiation which affects the geographically-unfortunate population.

Why does everyone want to do this 500-1000 years after the fact?

The more you rely on physics, the more this isn't going to work. Radioactive substances have a half-life, meaning that each time the time period expires, half the strength of the radiation remains. If the half-life is 100 years then 100 years after the apocalypse the radiation is at 50% of strength. Another hundred years and it's at 25%, then 12.5%, then 5.75%... After 1,000 years there's so little radiation that there won't be any radiation poisoning. But this is looking at an enormously worst-case solution that doesn't explain why Hiroshima and Nagasaki are inhabitable today. So why are they? I found a good explanation on Quora:

First, the bomb core was about 20% U-238 which is the same stuff as in the granite countertops in my kitchen. Radiologically speaking, such materials are nearly harmless, as the vast energy stored in their nuclei is being released over an equally vast period of time, and in the form mostly of alpha particles, which are utterly harmless unless inhaled or swallowed.

In fact, the potassium-40 in your bones is much more dangerous—radiologically—than natural uranium, and about as dangerous as the enriched U-235 used to make the bomb. Worse yet, it’s inside you (and inside every living thing on Earth). Which should tell you something.

Every minute of your life, potassium-40 inside your body undergoes a few hundred thousand atomic disintegrates. All of these emit radiation which can kill or damage nearby cells. A few of these even emit photons of gamma energy, which are even worse. Yet, we’ve gotten this far.

How? Because we are evolved to handle it. Our bodies routinely repair such tiny insults from radiation, and from field studies we know that living things—including people—can safely accommodate much, much higher exposures that that. We set exposure limits in industry low because someone is ultimately responsible for it, but nature has set its limits much higher—because it has to.

The main danger from the uranium in the bomb was that it is a chemically toxic metal, but blasted to hell and spread to the winds, it quickly reacted with other chemicals in the environment or joined the millions of tons of natural uranium already dissolved in the Earth oceans. It’s harmless. Forget about it.

No, the danger from a fission bomb comes from the flash, the blast, the instantaneous burst of radiation at the moment of fission. At Hiroshima, that burst of radiation was in the form of x-rays and neutrons. The x-rays were all absorbed by the air to create the fireball, as the weapon exploded nineteen hundred feet above the ground. The neutrons, however, could reach the ground and there crack atomic nuclei, but mostly they had that effect on the bomb components, rendering some small amount of mass intensely radioactive.

This material, in the form of extremely short-lived isotopes, then went on breaking down and releasing large amounts of dangerous radiation until, within a week it was essentially all gone. After that, there were a few isotopes remaining with intermediate half-lives, some of which were dangerous to humans. In particular, radioactive iodine was a threat mostly because it can be concentrated in the thyroid and cause cancer, though this won’t happen to people who already get plenty of iodine in their diet (and most Japanese do). Next was strontium-90 which can be taken up in the bones and cause leukemia, as it is a chemical analog to calcium.

But the Hiroshima bomb barely worked. It fissioned less than 2% of its bomb core, producing relatively little radiation. All the hot stuff was gone within days. The iodine was effectively gone within months. The strontium was effectively gone in a few years. And today, there’s functionally nothing left.

Hiroshima is still radioactive, but so is New York. And so are you. Essentially all of the Earth is radioactive if you’re willing to set the bar low enough, but we can take it. We evolved here, and radiation is not magic death cooties. Meanwhile, most human exposure to unnatural radiation is from radon released by coal fired power plants, and pollution from such plants kills tens of thousands of people per year. (Source)

And that's why I say use the L. Ron Hubbard solution

Forget reality. Reality is boring. In a real nuclear apocalypse the vast majority of the Earth will be completely inhabitable again in 7-12 years and we need just enough people to survive those 7-12 years and we're in good shape... for having been stupid enough to elect governing officials who are, themselves, stupid enough to launch nuclear weapons. But I digress....

Come up with something clever, like nuclear land mines... something that supports your story and helps you with your narrative, and use that window dressing to rationalize the rule for your world that you already have: radiation is still harming people based on geographic location after 500-1,000 years.

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All the fallout has settled deep into the soil

After over 1000 years, the radioactive fallout is no longer in the air, topsoil, or water supply in any significant concentrations because its been slowly swept out to sea by precipitation and broken down into more stable isotopes, and all that is left is what has settled deeper into the soil. Because of this, people who dig in the ground for a living like miners, quarriers, construction workers, farmers, etc. are at the greatest risk... who also just so happen to represent most of your lower class. You middle-class tradesmen like carpenters and blacksmiths are at a medium risk because they may work with contaminated materials now and again, but they are by in large less exposed to them. Your upper-class has very little contact with deep soil or its products; so, they tend to be exposed to far less fallout.

Also, they may enjoy a diet more rich in shallow rooted vegetables. Plants with deep root systems like Cucumbers, Tomatoes, Lima Beans, Pumpkins, Wheat, etc. may still able to absorb the remaining fallout that has settled deep underground whereas crops with shallow roots like Lettuce, Strawberries, Potatoes, Onions, and Corn could be the staple foods of the rich.

They also eat a lot more meat. Since most of the fallow crops that grazing animals eat have relatively shallow roots, meat should be relatively low in fallout as well.

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There already exists a large range in radiation resistance within humans. The difference in lethal dose that kills 50% of humans (LD50) and 100% of humans (LD100) is 2x as per the CDC Acute Radiation Syndrome Fact Sheet. Which is to say that assuming your group of elites have naturally higher radioresistance, they can naturally withstand over twice the dosage of the common folk.

Your elite are elite because they have a naturally high radioresistance. Furthermore radioresistance seems to be genetic, so your elite stay healthy from generation to generation.

So long as the average radiation exposure in your world is between 4.5 and 10 Gy, we would naturally expect some people to be much more healthy than others. This natural health allows them to accrue wealth more easily and drives them to want to have children with other radiation resistant elite.

TLDR; Resistance to radiation is naturally occurring and has a large variation within a population. The elite in the real world are at least partially the elite because of good genes. This would apply to a post apocalyptic world as well.

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