Tag: health

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Biased Results

The use of statistics in presenting results of research is common practice. Empirical studies are summarized using statistics and statistical methods based on samples of bigger populations are cost efficient. However, care needs to be exercised when interpreting results to guard against inappropriate conclusions derived from biased estimates. Since the topic has been highlighted and methods proposed to handle them, these methods were deemed worthy of a Nobel prize.  The basic problem of a bias due to a selective sample has been demonstrated by Stockwell et al. (2024). The authors investigate the old question, whether a little bit of alcohol consumption (per day) could be beneficial for our health. The statistical issue which needs careful examination is the construction of the control group against which the results are compared. Apparently many studies have biased control groups which included persons in the not drinking control group who had stopped drinking for bad health previously. Compared to those persons with other health conditions those drinking a little bit compared rather well. But of course such individuals should not be present in a control group. Of the control group is biased due to many persons with below average health the groups of interest consuming higher levels of alcohol do not perform so badly. Hence, interpretation of results from medical or social science studies has to consider carefully the actual or potential sources of bias. Not really a new results in statistics, but still not well known or understood by the public at large. Drug consumption as well as studies of this consumption could deserve the same sticker: handle with care. (Image: Extract from Tenier II David, Les fumeurs, also entitled Chanson à boire, 17th century, Paris Petit Palais).

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Intimate change

Society changes and with it so does intimacy. The major changes pass through the behavioral changes of persons and sooner or later the whole society adopts such changes as the new normal. Trends of individualization have moved over centuries as the exhibition in the Museum of decorative art (MAD) in Paris demonstrates. At the same time the changed individual approaches to intimacy have become more widely spread quickly over time. Social media have accelerated such new trends again. Social class is yet another intervening variable in this context which created different speeds of adjustment as well as sustaining differences in kind. 

Religious beliefs and practices have made claims about how individuals should handle intimate relationships and affairs. Legal issues are defined by each society to guide moral practices as well. Hence, the sociology of intimacy is a huge topic and comparing societies an interesting topic. The development of intimacy over a person’s life course, however, is given little attention due to a lack of adequate longitudinal data. From the exhibition we are encouraged to think about the relationship of hygiene and intimacy. Bathrooms accompany us throughout our lives and privacy was originally a bourgeois concept. Over the life course we move from dependency to independence and maybe dependency again in very old age. The images (below) from the MAD exhibition range from basics of bath tubs to a painting of Edgar Degas in the background. Instagramer or YouTuber share lots of images and stylized arrangements of bathrooms on social media. It seems that intimacy is moving further into the public domain. 

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Law and Witches

Medical and chemical authorities have been questioned for many centuries. As far back as Friedrich Spee (1591-1635) in the early 17th century there were even among the clergy men with enlightened views on what might be helpful ways to assist people on their journey to better health or simply pain relief. This did include many unhelpful or detrimental methods as well. Scientific rigor was not well established at that time, which opened up many doors for alternative diagnosis and treatment. From a historical and sociological perspective the closing procedures of professional organizations are interesting as well as opposition to them. Early moderators between hardliner positions are rare at the times of forceful and fierce competition between opinions and doctrines that characterized medieval history. In the absence of an independent judiciary earlier moderation could be influential in specific instances. A testimony for can be found in a documentation of the biography of Friedrich Spee and the society that promotes the memory of such exemplary behavior.

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Law and Legality

Some persons consider themselves to stand above the law or push all interpretations of regulations beyond usual understanding of it. Even after a person has been dealing with pharmaceuticals or drugs used also for doping purposes, the conviction of such a person may take several years if not decades. In France, Mr Bernard Sainz seems to be a good example of such a relentless case of practicing para-medical consultations to assist mainly cyclists in endeavors to win championships or professional status. Le Monde  and Cash investigation have raised awareness of the public for such dubious practices. The “French Federation du cyclisme” and medical doctors association fight a continued legal battle against this persons exercising illegally such doping assistance. 

With apparently 56 legal procedures in connection with this person, the legal system has to bear the majority of costs of such illegal practices.

The reach of such dubious practices might be extended if the systems beyond doping, but for assisted euthanasia cannot be controlled effectively. Hence, the precursor cases of positive stimuli like doping pose similar challenges to the legal system as “negative stimuli” weakening persons as assistance to die. The end of a life course is not only a medical issue. Society-wide debates need to take place in order to organize a large consensus on the implications more liberal practices shall entail. 

(Image: Palais de Justice, Paris 2025)

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Suicide Prevention

The annual mortality statistics and special reports on suicidal tendencies are a tough reading. OECD Statistics give a at least an approximate, comparative perspective. Reporting routines and medical confirmation of a suicide or suicidal behavior still vary quite a bit between countries. Nevertheless, the usually reported incidents per 100.000 persons remain rather abstract.
Absolute numbers speak a clear language. For example in Germany there were about 10.300 recorded suicides in 2023, France had to mourn about 9200 in 2022. To put the size of the problem in perspective it is helpful to know that in Germany all other not aging related causes of death like traffic accidents, drugs or murder make up for around 7.000 deaths per year. The targeting of resources and prevention efforts on these vulnerable people seems inevitable. However, we see only limited additional efforts to curb the problem.
A more detailed analysis of the frequencies reveals the gender and age differences. More men commit suicides and older (very old) people have higher risks. The oldest age group of men is most at risk.
Since the Covid-19 pandemic young women show rising trends in many countries again of suicidal attempts and self-inflicted wounds. Despite a continuing effort of research (Links) there is no single cause to explain the occurrences.
As a working hypothesis, which awaits empirical tests, I would look into societal factors that stigmatize persons who are made to believe or feel like they are beyond the normal spectrum of society. The lack of acceptance of diversity concerning gender, age, ethnicity, body shapes or mental states like anxiety. Poverty might cause immense distress and suffering. Large shifts in wealth in both directions cause additional risks.
It seems as if our minds and society are constantly in a kind of „regression towards the mean“ posing challenges to those furthest away from the average or perceived norms. Percentile ranks or percentile scores are commonly used to express a person’s position in a frequency distribution. For example you are better/lower than 90% of persons of your age group. Such statements might cause further distress for persons. However, summarising across several (psychological) measurements, they may yield encouraging indications as well. Actual and perceived positions in such percentile ranks add another “social risk” as perceived positions may govern behavior.

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Defence Spending

As in research there are many dual use products, which can be part of defence spending. Robotics in production or rockets to launch satellites for telecommunication are such examples. Much less known to the public is the amount of military spending that goes into medical developments that benefit both the military as well as the civil population. Countries build a whole ecosystem round the provision of medical services for defence purposes , which consists not only of a sufficient number of qualified persons, but also companies that provide specialised products. Most of them have civil applications as well after minor adaptations.
Oxygen provision was a prominent example of a product that has civil and military uses in treatment of respiratory infections or contaminations. A mobile transportable operation table is another element of daily rescue services as well as potential use in situations of conflict, just like anesthesia machines. An increase in spending on such infrastructure and the necessary long-term training of persons operating and maintaining these medical applications take time and considerable financial resources.
The current debate in Europe and NATO neglects the considerable time delays in production and provision of the equipment. Research on “Skill Needs in OECD countries” has shown the substantial delays between sudden skill needs and the time to train high-skilled persons.
The International Review of the Armed forces Medical Services is a journal dedicated to publish up-to-date information on needs of medical products and persons trained to use them in special emergencies. The need to safe lives in extreme and dangerous conditions needs preparation of thousands of specialists. Of course we hope that such an incidence will not happen. The persons and material have an obvious potential to serve the civilian population in more peaceful times as well. The unfortunate “hog cycle” in skill provision is not a problem for dual use products or services.
(Image: edited extract of a mobile operation table)

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Obesity Revised

The scientific paper on a revised definition of obesity was produced by the special Commission on Obesity. It appeared in The Lancet Diabetes & Endocrinology in 2025-1. The previously common practice by medical doctors was to classify person in the obesity category based mainly on the simple calculation of the body mass index (BMI = weight/height²). A BMI  > 30 put persons into the obese category and stigma.
Since the Covid-19 society-wide testing experience, we are all familiar what it means if you get misclassified and have to live with the consequences (exclusion from work or events etc.). The simplifying and summarizing BMI calculation and classification has also produced many wrong classifications. For example, persons with a lot of muscles (just watch this at any fitness studio) will have a high weight relative to their body height², but they are likely to be more healthy than many other light weight, but seriously stressed persons.
In empirical test theory such cases are the so-called false positive cases, i.e. classified as obese, but not a medical problem at all. Medical doctors and health insurances should not finance special treatments for these persons, which foregoes treatment of other more needy persons.
With new expensive drugs on the market to treat obesity it is even more important to test with more precision the normal, pre-clinical and clinical status of obesity. Fatty tissue or muscles, that is the relevant question. Fatty tissue in muscles is the next level testing issue.

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Investment Disinvestment

Asume we live in a world of fixed amounts of investments. The option to invest in a new project or product will automatically reduce the amount of investment in another product. The investment decision, therefore, is subject to opportunity costs. A recent study by Naci et al. (2025) applies this rationale to the investment in new drugs compared to financing other traditional treatments. The results for the U.K between 2000 and 2020 revealed that the „quality-adjusted life-years (QALYs)“ is not in favor of the investment in new drugs. The relatively small numbers of beneficiaries of the new drugs is compared to the many other persons who could have benefited from the less costly previous treatment. Investment in one new drug causes disinvestment in other ones. The overall balance for the UK turned out to be negative. Particularly the disinvestment in prevention of diseases appears to have very detrimental effects in view of the results based on this study. Preventative measures are relatively cheap compared to the estimated 20.000 pounds for one additional quality adjusted year of life for a new drug. The message is: choose your health investments wisely to avoid ever rising health costs and health insurance. (Image: rest room Belgium)

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No tobacco Sweden

Sweden is the forerunner as country with the lowest number of smokers across Europe and probably even the world with only 5% of the population 16 years and older. The success of these public health policies is due to banning smoking not only form pubs and restaurants, but also outside in the surroundings of public spaces like schools, playgrounds, train stations and sports facilities. These policies work quite well and the effects of discouraging smoking in public is reduced to a minimum rather than the normal encounter.
Health of the other persons and children passing through these areas is not the only goal. A new estimate of lost days or years due to smoking based on a study from England shows that “each cigarette smoked reduces the smoker’s life by about 20 minutes (17 for men, 22 for women, LINK to study). Of course, there is a huge variance and other work and life conditions that play an important role as well, but the broad average estimate is a nice way of talking about statistics. The basis of the estimate is for those who stop smoking and not those reducing their tobacco intake by some percentage or replacement product.
In the Belgian football stadium (image below 2024) in Brussels the No tobacco sign is well placed to make parents of children and youth understand the challenge ahead. Good resolutions are assisted by gentle regular reminders as well.

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Health Tech

Health technology assessment (HTA) is an interesting scientific field. The new digital opportunities allow people to participate in medical and medication trials in their homes or even in bed. Their health data and the administration of medication is also encouraged and sometimes supported through digital devices. The pharma and health industries have many devices ready to go. The differences to the traditional forms of medical trials, however, is an issue as we want to compare the results from both kinds of trials. Participants of trials, might prefer or struggle with these novel kinds of study designs. In any case the results will be impacted in several forms (Study Link). In the best of all worlds for the researcher the effects will cancel out each other, but is rather unlikely. Some participants will reach more positive effects with the use of digital tools, whereas others are challenged and might even abandon during the trial. Monitoring during the study (for example through digital inhalors) is another advantage of such distributed trials. Rather than taking adherence to a trial medication for granted, digital tools allow a more precise monitoring of subgroups as well. Data and effort invested in the trial is preserved through the easier access to person’s information, assuming continuous readiness to stay on in the trial.
Our own smartphones are still underexploited in terms of health monitoring and use in research designs. The possibilities to link data to other external data sources shall further advance the research potentials in many interesting ways. Data protection and data security become even more important with the ever smarter phones and connected devices.

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Health data

2025 will be a crucial year for health data across the EU. Germany introduced the electronic patient card, which can store basic information to then access data in the health insurance cloud for medical doctors, hospitals and other related health services. Potentially this is a great step ahead as some tests do not have to be repeated if they had been completed recently before already.

In pseudomised form, research may draw samples from such databases to enhance our science based understanding of disease. The evaluation of public health interventions becomes easier and medium and long term efficiency of measures can be assessed in many instances.
The Belgian research using health data has met to discuss the potential and limitations to link health data to other data sources to allow more complete and more complex analyses of health and disease processes. Another extensive data source sits on our smartphone. Collection of steps walked, sleep patterns or heart beats give valuable insights into a person’s own contribution and care about personal health. Although data are frequently incomplete, researchers are used to estimate missing data on the basis of existing or comparable person’s data. The basis for improving health for all are quite promising, data handling and linking them will be a challenge to the competence of all stakeholders and everyone involved in better health. It will be stressful before it becomes a routine.

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Shorter is better

Contrary to a lot of received previous recommendations, the shorter duration of antibiotics prescription and use (3-5) days is overall better than the prolonged use of durations between 7-14 days (JAMA Link).  A so-called narrative review of medical studies (Lee et al.2023) reports more precise results separate for medical indications (pneumonia, sinusitis etc.), which tend to go in the same direction for the majority of indications. In view of the serious issue of antimicrobial resistance, a consequence of overconsumption and too widespread use of antibiotics (also in animal health and food production), the slogan of shorter is better should receive serious attention.
It is not only a medical, pharmaceutical or public health issue. The topic has become an issue of nutrition as well. The food chain contains largely unknown amounts of antibiotics as well, especially if larger amounts of animal or fish products are part of it.
The knowledge from these sciences has still to filter through to the broader public. This means it has become a social science topic as well. The transmission of knowledge and patient expectations on prescriptions, which is also linked to regulations concerning sick leave, make it more difficult to shorten prescriptions of antibiotics. There is a steep challenge to change behaviour according to the new mantra “shorter is better” with respect to antibiotics, even if we know that it is better for all of us in the medium or long term.
(Image: Jan Harmensz. Muller, De keuze van de rechte levensweg 1571-1628, MRBAB, Brussels)

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On Intersectionality

Society deals with individualization or individualism in various forms. One way is to take each social group as a specific singular case. This is reasonable and justified in many instances. There are cases where this form of dealing with specific social groups comes to limits. Following the rationale of plurality and individualism it has become common practice to address each target group in a specific manner. Intersectionality, however, acknowledges the overlapping of target groups, which necessitates a more specialized approach to intersecting (social) phenomena. Gender might not be the single most important factor to describe a person, just as age is a concept of various intersections. Chronological age versus age defined through biomarkers demonstrate the variety and potential for intersectionality. The Paralympics 2024 in Paris gave another positive example of intersectionality as extraordinary persons achieved previously unimaginable world records in specicialized disciplines. Individualization and classification is only a first step in the scientific endeavour, the analysis of intersectionality is an additional step to consider in a broad range of fields beyond the social sciences.
(Image: Exposition Isa Genzken 75/75 in Neue Nationalgalerie 2023)

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Bi-directional Sleep

For most of us bi-directional sleep is a question of sleeping on the left or right side, or on our back or front, head left or right. In immunology bi-directionality of sleep has another meaning. The immune system is linked to sleep in a bi-directional manner. Good sleep enhances the immune response of cells (direction 1) and infected blood cells for example send a signal to the brain to extend sleep. The study by Huynh et al. (2024) in Nature has demonstrated this bi-directional mechanism. It allowed mice who slept well after an imposed heart attack to recover in a better way than those whose sleep got interrupted during the experiment. The most natural response to a heart attack or acute coronary syndrome is more sleep. This is induced by an inflammatory reaction in the brain, which « orders » your body to increase deep sleep. 😴 Sleep is more than just rest, it may be part of healing. ❤️‍🩹 (people looking at Caspar David Friedrich „Infinite Landscapes“, exhibition Alte Nationalgalerie Berlin 2024)

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Water Quality

Obviously, water is not just an issue of quantity, but also quality. The availability of sufficient quantities of water in a region depends on rain, its storage, and the use of these water resources. The quality of water is a subsidiary issue, as lack of inflow causes concentrations of nuisance in water to rise. Global warming will most likely intensity the concern for not only the quantity, but also the quality of water.
Public services are in charge to sample and monitor levels of water quality for consumers. Independent of public, private or public private partnerships in this field there is a need to check from time to time the quality of water. Public institutions do a great job in monitoring water quality, but as science progresses there are new sources of pollution that enter the already complex analysis of water quality. New chemicals and remains of medical or pharmaceutical analyses have been retrieved from water and, sometimes, they have reached critical or unhealthy levels.
More detailed monitoring is necessary and new digital tools allow to improve just this type of monitoring to inform policy makers on shifting patterns.
A project of that type “Urban Green Eye”, for example, allows to monitor the artificialization of previous vegetation to show up on satellite images of Germany. Independent groups, citizens or communities might find it useful to use their own sampling and testing to guard against abuses or dysfunctional public monitoring systems. Start-ups like “Hydroguard” offer services to support activists, communities or public services in their own efforts to ensure water quality.

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Public health info

Public services have a premordial role to play in providing reliable and up-to-date information on health issues. It is no longer only in charge of collecting this information, for example on infectious diseases, but public services are in charge of timely disemination of that info as well. This is, of course, were online services and AI come into play. Getting out this info is crucial, but in the age of fake news and the wide disemination of news on social media, public services need to check also what becomes of the news they have published. The Covid-19 pandemic has been a worthwhile experience in this respect. It is important that reliable information is transmitted via trustworthy channels, which have already been established prior to the “next” health crisis. Many innovative tools were presented at the SCCON 2024 and maybe trustworthy video calls with a medical doctor or your pharmacist may constitute a solution to many infectious pandemics. However, trust in the technology is important as well as equipment and identification systems to be sure that your medical doctor you meet online is actually a medical doctor or only a savy pretender. The issue is as old as medical assistance. The RKI in Germany is the reference information for coordinated information on many public health issues like infectious diseases.
(Image: Extract of David Ryckart d.J. 1612-61, Der Dorfchirurg, SPK Gemäldegalerie Berlin)

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Science Fraud

It is a big issue if publications in science in high reputation journals have managed to pass a rather lengthy and thorough peer review process and still contain evidence based on fraudulent data. The worst case scenario that based on this wrong evidence tests of useless drugs are performed on patients in hope of an honest concern for their health. In fact the financial rewards and even academic rewards have been achieved only through the successful publication of a bias introduced into the data and/or analyses of the data. The fraudulent researcher became subsequently Director of the institute of agingwhoch is part of the American National Institute of Health (NIH) and an academic reference in health sciences far beyond the USA. It is the merit of Charles Piller and his team to persist in challenging the treatment recommendations which were concerning Alzheimer and Parkinson diseases. The checks and balances in the academic research have failed and a serious reconsideration of the procedures should follow, not just business as usual. The reputation of scientific research is at stake beyond the natural sciences and medicine, although the normal way of proceeding is just to qualify such events as singularity and specific to a single discipline. Aging is also not just treated by one single discipline. Hence, there is a need to review the review process and publication practices. The Boeing airplane control failures were also indicating that reviews of technology are subject to high risks. Independent checks and control are hard to ensure in advanced subject matters, but sufficient time and resources have to be devoted to the process. (Image Repair Lab Deutsches Technikmuseum DTM2024).

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Happy Runner

The happy runner is a nice example of how hard it maybe to experience happiness through running. The so-called runner’s high is available to everybody, if you manage to run long enough already. Most predictions put the threshold distance at about a 1 hour run. The reward for this effort is a special feeling that exceeds the pain or it makes you forget or supress the pain at least temporarily. Special reinforcements can be achieved through the big city runs in exciting places with thousands of people cheering you on. This has become a big business as well. Training for such an event might raise your feeling of happiness substantially. The chemistry of the endogenous production of stimulants of happiness in our body has been enlightened substantially in recent years (partly as doping control). Most of the brain active drugs our body can produce itself, although this involves a lot of physical and mental effort. The rewards are pretty healthy for most runners contributing to their basic level of happiness. Running outside, has contributed more to happiness for me more than the same exercise on a treadmil. Maybe, the environment is part of the happy runner’s high effect.

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Happy Biology

At first glance happiness from a biological perspective is easy to understand. Its hormones, stupid, that regulates it all. Only problem, there are many of them that interact and, apparently, a lot depends on the right dosis and duration of exposure or deficiency. Oxytocin deficiency seems to be a corollary of anxiety and lack of pro-social behavior, potentially making people less happy – to put it bluntly. There are other complex interactions between hormones not only in the circadian circle of humans like for cortisol, but also related to differential reactions to stress. Genetics and epigenetics are involved as well stress regulation and early exposition to stress during the life course has longer lasting consequences later on. How much stress is good for you? Climbing Mountains induces physical stress, but most people report lasting happiness referring back to such singular events. Hormones seem to play tricks with us as well.
Some time after the novel “Klara and the Sun“, endocrinologists have documented the positive effect of a robot on oxytocin levels in humans. Improvements to mental health and well-being are apparently easy considering that oxytocin is a driver of feeling happy as well. Maybe we should take our depressors and drivers of oxytocin more seriously to be “biologically” happy.
(Image: Extrait Frans Hals 1660, Catharina Hooft and her nurse. Exhibition Gemäldegalerie Berlin 2024)

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Own Insulin

People who suffer from type 1 diabetes do not produce enough insulin themselves. The World Health organization estimated that „in 2017 there were 9 million people with type 1 diabetes; the majority of them live in high-income countries“ (WHO 2023). The report on successful reprogramming of stem cells of a person to produce insulin again and subsequently transplanting these cells into the same person allowed to produce own insulin again for that same person (Mallapaty, 2024). The hope for millions of people with type 1 diabetes is high that eventually there will be a cure to the disease. Scientists caution that there are no data yet for how long the transplanted own stem cells will produce insulin. Hence, the hope is driving research forward on a promising way forward. The case of type 2 diabetes is very different as additionally the absorption of insulin in the body causes problems. We keep walking and building muscles to facilitate the insulin absorption in the body to guard against the onset of type 2 diabetes. Interaction of diabetes and aging is another topic that needs our attention as rapidly aging societies are at higher risks to face many more people with various forms of diabetes.

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Buzzing free

It is always a chance to be in a city that bans cars for some time from streets and bicycles and pedestrians can walk freely in the city. On September 22nd 2024 this is the case in Brussels. In addition, the public transport system allows people to buzz around the city free of charge. Of course this is an invitation to get to know areas of the city where you normally don’t take the time to visit or mix with people. The police used the time to teach children how to cycle in a city in all security and respecting basic rules despite the enthusiasm for speed or going round in circles. Unfortunately, this happens only one Sunday out of 52 in a year. It is just amazing how the feeling of safety on the road changes again. The level of noise and pollution drops to levels of the countryside. Buses and trams pass the city easily and most people get around faster than they do on other days of the year. It is a bit like a coordinated health intervention for the stressed urban survivors. This experience is a modest reminder of how nice it was in Paris during the Olympic Games 2024 when prioritizing mobility beyond cars haa been effectively implemented for several weeks.

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Waiting time

A new report by Darzi, a former cancer surgeon and past minister of health in the UK, paints a dismal picture of the British health service (NHS) over the last 15 years under conservative rule. The public service has seen no increase in its budget accounting for population growth and the aging of the population. The service is no longer able “to give patients the timely care they need” (The Guardian 2024-9-12 title page). Increased waiting times lead to an estimated 14.000 premature deaths per year. Darzi presents data that show 300.000 persons had to wait longer than one year for a treatment that should have been performed within 18 weeks.

The staff seems desperate for changes as well as they have to spend more time on management of waiting times, time which is lost for real treatment. The quality of care is another issue which awaits urgent attention. Health cannot wait for most patients, but the neglect of investment in hospitals and people is expensive in the longer run. Even the reform efforts should not wait any longer. Time is a precious good and each life matters. (Image back cover of exhibition catalogue Käthe Kollwitz at MOMA 2024).

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Health GDP

A report by the WHO and the World Bank (2023) on universal health coverage and financial hardship has emphasized the difficulties to reach the goals defined by the strategic development goals (SDGs) by 2030 in this policy field. Moreover, the paper by Mazzucato and Ghebreyesus (2024) invites us to reconsider the importance of health in the overall assessment of development and progress. The authors ask us to “rethink the narrow focus on growth in gross domestic product (GDP) that typically dominates economic decision making”. There is of course a long debate on the status of health, GDP or wellbeing as major policy issues or even foundations of the a state’s major objective. For economists the question has been answered for decades to favor GDP growth and more or less the other objectives can be achieved with a time delay. Recently social scientists have highlighted the overall importance of wellbeing or happiness rather than GDP as stated in some constitutions. Health as an overall objective is another challenge to the existing economic framing of societies. In a traditional economic perspective the health sector is part of the GDP increasing public and private sector of the economy with insurers, equipment and persons contributing to it. On the other hand, health enters into the distribution or consumption part of the economy. Each country strikes its own balance between production and consumption. Put simply, in form of an equation where production equals consumption, health enters on both sides of the equation in each country. On the global, scale the distribution between costs and benefits of health have not narrowed over the past. The challenge for the world population remains steep. Considering unequal population growth across continents, the situation might get worse before it hopefully gets better. We still have to continue huge efforts to increase overall health on earth for example through large scale vaccination programs. (Image The tombstone of Molière in Paris 2024)

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Desertification

Since 2018 we have evidence of the progression of desertification into some Member States of the European Union. The mediterranean countries are concerned as well as regions of Bulgaria and Romania near the Black Sea. There are multiple sources of desertification. The 3 main reasons of desertification are soil erosion, loss of soil fertility and loss of natural and desirable vegetation besides wind or water erosion and salinization. We also know that man-made climate change is at the root of the past and recent problems. The statistical indicators of land degradation are collected by the European Joint Research Centre and these data show a dismal picture of land degradation in general and desertification as part of this process. A study by Ilea et al. published in Nature 2024 projects an intensification of extreme weather in the coming years. Higher temperatures will most likely enhance desertification and more frequent flooding will contribute to more soil erosion as well. It is a rather strange process that we know we are creating severe problems for some regions which endanger the roots of their existence and yet we do not act upon those undeniable facts (United Nations SDGs list). The amount and dynamics of land deterioration put the global South under severe pressure, but also the wealthy parts of the Mediterranean basin will be affected. It about time to acknowledge that we are all part of the global changes and challenges. (Image palm tree in Paris, Jardin du Luxembourg, 2024)

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Heat Stress

Heat causes cardiovascular and pulmonary stress. This has been well-known for a long time. A newly published epidemiological study for Germany reiterates this finding and adds more details to the picture of who is affected most by heat stress and heat-related mortality. Old age and being female increase the heat-related deaths in Germany according to the study by Zhang et al. (2024) published in the Lancet Regional Health. Our body’s thermoregular responses to heat stress like vasodilation or hyperventilation cause additional stress to our cardiovascular and pulmonary system. Excessive sweating and dehydration, possibly increased through medication, amplify heat-related risks. The study corrects the estimates by using fine particulate matter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) data on the district level in the analysis. High concentrations of PM2.5 and NO2 increase heat stress and related deaths as well. Inner cities are, therefore, not the best place to be during the hot season. Most southern European inhabitants of big cities are aware of these health hazards and act accordingly. In Germany it is much less a habit to quit inner cities during the hot days in summer, but climate change will make this a major concern. Greening inner cities is an urgent necessity, which is not just nice to have, but saves lives. (Image Berlin Bears, Berlin City Center 2023)

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Olympic Nature

Nature and its biodiversity can teach us many lessons. This is made very explicit in the small exhibition in the “Jardin des Plantes” in Paris. The treasures of (lost) biodiversity are exposed in the adjacent “Muséum National d’Histoire Naturelle”. In a pleasant environment within Paris you can stroll along rare flowers and trees to pass the posters that demonstrate the astonishing achievements of some species (Les champions of nature). For example ants would surpass us in weightlifting in relationship to own weight. A marathon of 42 km is a very short distance for birds flying across continents with rest. High jump or long jump is rather easy for frogs, but we struggle already to jump a little bit higher than our own body length. Lots of other examples are shown the exhibition and should make us a bit more humble concerning the sport accomplishments of humans. Beyond Darwin and Mendel there is a lot to see and experience in the Great Gallery of Evolution. After the question remains whether we are really at the top of the evolutionary ladder. In terms of marketing our successes irrespective of many species disappearing with rapid speed, we still appear rather unique in the evolution. Learning from other species as in bionics is a powerful strategy which is also quite effective to empower humans compared to other species.

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Olympics for All

The Paris 2024 Olympic Games and the Paralympic Games have demonstrated the extraordinary competence, professionalism and competitiveness of all athletes. The television spectators and live participants in the events have been involved to a great deal.
After all this hype around sports let us consider the probability of getting involved in physical activities and sports. Additionally, it is of interest, whether people are encouraged to continue sports, maybe at higher ages as well through these sports events like Olympia.
High level athletes are most likely to continue their sports activities. In many countries the extraordinary athletes of the Paralympics faced tough challenges to pursue their sport interests and passion.
However, the public health challenge is the big unresolved issue of how to best raise an awareness for the pleasures and benefits of sport for the masses. (bibliography by BNF “Santé et activité physique). It is not only a matter of suitable infrastructure, but also the question of sports in your neighbourhood. This issue has implications for urban and rural communities and how they organize the practice of sports in an inclusive way. Each step may be a stepping stone into sports for all ages and pathologies.
The pleasure and benefit to walk or something simple as walking to or walking after work, are part of the solution to many public health issues.
The visitors of the Paris Olympics walked a lot.
This fun experience in an enthusiastic city will encourage many to continue the simple exercise without thinking about exercise. This will do the trick. Just do it, without thinking to much about it.

BNF Paris 2024-8
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Burden of Disease

For the planning of health and care systems it is important to measure the so-called burden of disease within societies or related to specific diseases or social groups. A large-scale analysis of several longitudinal data bases of the populations 50 years of age and older shows that we have underestimated the burden of disease to societies of psychiatric disorders, like depression, in most societies.
A meta-study and overview of previous studies showed already that depression (age 60+) is more common in lower-income countries (between 25 and 33% of 60+population age group). High income countries, studied by Wang et al. 2024 in The Lancet Healthy Longevity, have rates of depression well below these levels, but a link to socioeconomic status, inactivity and loneliness is still evidenced. A five-year follow-up of persons aged 50+ years shows that the probability to develop a depression (hazard rate) is twice as high for persons with low socioeconomic status, who were socially
inactive and lonely than for socially active, high socioeconomic status and did not feel lonely at the beginning of measurement. The conclusion of the research highlights the need to develop and implement integrated and simultaneous initiatives to addressed the growing burden of disease related to depression in older persons. (Image, Jules Desbois, “Misery” 1887-89, Musée Rodin, Paris)

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Stress Ageing

The relationship between stress and aging is a complex one. Stress is known to accelerate aging and aging caused different reactions to stress. In short causality does not run only in one direction. Additionally new research published in Nature Medicine 2024 demonstrates that different genetic preconditions determine different response patterns to stress and subsequent brain aging. From anecdotal experience we are well aware of different persons coping very differently with stressful situations. Mastering of various coping mechanisms may attenuate the stress experience but the impact on preserving our brain remains an open question. Various other forms of lifestyle conditions like drugs and smoking cause specific forms of brain damage as well. 2 separate forms of dementia can be identified from brain MRI-images as well. The brain is no longer the black box of missing information about what is going on in humans. Put to the right purposes this is good news. (Image: break dance shooting Paris St Denis 2024)

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Alzheimer Research

Alzheimer disease has reached unprecedented levels in line with population aging. The study by Martino-Adami et al. 2024 has raised the hope that more people can receive an early diagnosis of Alzheimer and potentially start treatments. The study used plasma biomarkers rather than much more expensive and rare MRI scans for diagnosis. The rather exceptional results allow even to test for severity of Alzheimer according to established evaluation measures. Additionally, the probability of an Alzheimer trajectory on a time scale is feasible. The authors suggest that the data and statistical methods applied allow to identify Alzheimer before the outbreak of impairments. The data sample stems from “patients of advanced age visiting primary care”. This remains a limitation for generalizations, but the hope that other studies test the same approach with samples from younger populations will spur additional investments into such research. The list of institutions and foundations that contributed to make this study possible is really long. Thanks go to all involved, researchers, donors as well as the reviewers and editors of the journal. (Image Paris Metro Help Column 2024)