Health inequality

Almost all studies irrespective of the methods applied find that health is a matter of related to social inequality. The study by Lyons et al. (2023) in the Lancet demonstrates the same basic findings. This study uses the concept of multimorbidity and time until first and subsequent diagnosis as the measures of health. Mortality between different socioeconomic groups in Wales (UK) is largely confirmed. It is not only men beyond 70 years of age that face this unequal health trajectories, but already in the age group of 10- 20 years old teenagers the time until first diagnosis is different between the poor and wealthy neighbourhoods.
Differential health trajectories have a very early onset and seem to widen throughout the live course. The longitudinal nation-wide study in Wales allows to determine the impact of socioeconomic deprivation on health. The conclusions imply a combination of health and social policies to address health inequality. Clinical practice alone is unlikely to reverse the trends as onset of disease in form of first or subsequent diagnoses start from a very early age onwards in deprived areas.
Health as part of the curriculum in education systems is an obvious conclusion as well. This needs to take preventative approaches more seriously to give children and adolescents a more equal start into adulthood and professional working life. Education systems have to be reformed to become part of the solution rather than creating unhealthy trajectories themselves due to stress and unrealistic, unhealthy goal setting. Walking or cycling to school, more healthy school meals and learning about nutrition as well as processes of metabolism in the body should complement a more active school life-style. The dangers of developing ill health early seem to be greater nowadays than before. That is probably the most worrying news of the study. Sedentary life-styles seem to be a result of deprived neighbourhoods with less areas for comfortable, healthy walking or outdoor exercise.
It is an accumulation of effects due to neighbourhoods, commuting patterns and work-related health risk. Counties within regions grow more distant from each other as well as regions within countries. Youth is well aware of these health and social differentials. Eventually they will claim their “lives” or “equal chances” back again. Sociology has provided many clous to address these issues: Segregation or discrimination of groups of society, gentrification of neighbourhoods, intersectionality of health and social issues, to name just a few.
In order to target at-risk populations better and intervene with prevention rather than curative, we have to integrate social and health approaches much more than we used to do. The way forward is to improve the targeted, preventive approaches in order to improve the equality of chances to education, health and work.
(DOI: LINK to study)

Unwinding violence

A common metaphor to describe rising or erupting violence is the “spiral of violence”. In exerting violence by one person or group, the response of the other person or group is even more violent and, potentially, the response to the response makes use again of more violence. The spiralling up of violence is hard to stop or to reverse. Law as well as its enforcement has to play a major role in this process. However, if the police violence is involved as part of the spiralling process the process gets even more complicated. Beware of the beginnings of such a process.
In France in July 2023 the debate about violence is wide open. Contributions to the debate in Le Monde deal with the discussion to claim equal treatment of violence from “fundamental ecologists” as well as extremist defendants of industrial agriculture (Stéphane Foucart). Both sides became more radical in their actions and threaten an escalation in case of governmental inaction. The “triangle of silence” is also a breeding spot with a potential for violent confrontations. Groups in society that have no voice in parliament or local governments frequently use violent actions to raise awareness to their concerns as politics and media tend to ignore “not so nice” images and reporting from areas with multiple disadvantages and social confrontations.
One of the proposed solutions by Marcel Marloie (published in LeMonde) proposes to rethink urban planning deviating from the path proposed originally by Le Corbusier. Instead of offering public parks that are cultivated (and policed) by the local government, entrust areas of collective gardening to the disadvantaged communities. The empowering role is, to master your own piece of happiness. The “bonheur à la Voltaire” is likely to increase attachment to your local and neighbouring community. Of course, this is not evolving without conflicts, but these are processes of accepting compromises and mediation rather than violent resolution of conflicts or aggression out of desperation.
Contrary to the belief that some big projects (Olympic games in Paris) should contribute to unite a nation(s), it might well lead to further segregation of persons who benefit from the games and those who are unable to enjoy some sort of participation in the event. Further gentrification of Paris is likely to be the result. Poorer or lower middle-class people will no longer be able to live in the renovated suburbs that have more public space being privatised and turned into for profit activities. The challenge is to build areas that enhance trust in people, trust in institutions and politics. Schools, associations, trade unions, political parties and social institutions have an important role to play in this respect. The way forward is with more communication and deliberation, not less, especially for and with the most distant groups of a societal consensus.