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.
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. 
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) 
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) 
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)
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. 
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) 
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).
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. 
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) 
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.
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.
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).
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)
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)
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)
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.
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.
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) 
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)
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)
Paris Experiment
The Olympic Games 2024 were prepared years ago. Already the application procedures to prepare “un dossier” has to bring in lots of ideas and imagination what is desirable and feasible. Paris opted for a celebration of sustainability in a city proud of its medieval heritage and the Haussmann tradition of radical transformations of a city with large boulevards and representative buildings. From the “Arc de Triomphe” the major axes of communication between “arrondissements” become visible. 100 years ago the city had already been transformed according to this master plan. At that time sanitation of a city meant different things than today. The invasion of inner cities by Diesel-driven cars made life unhealthy again. Now, the Olympics gave reasons to restrict cars and lorries passing the inner city and the great boulevards. More tourists need more space and shall keep a much better memory of how pleasant Paris was during the Olympic Games. This could be a game changer for urban development in general. The proportion of pedestrians versus cars has to be shifted in favor of the walking population for many reasons. Tourists will flock to the city, if the overall and shopping experiences are great. Back to the future sounds crazy, but it has an interesting flavor to it for urban renewal and residents as well. (Image Paris 2024-8, b/w color filter applied, enlarge to see vasque)
Olympic Virus
We tend to believe or want to believe that the horrible SARS Covid-19 crisis is completely behind us. However, science signals that we need to stay alert with respect to the mutations of the virus. International events like the Paris 2024 Olympics bring together athletes and spectators from all continents and some of them still seem to carry the virus with or without symptoms. A report in the LANCET Respiratory Health mentioned that dozens of athletes were tested positive for the virus and a largely unaccounted number of spectators had carried the virus FLiRT variants. As tracking is difficult with more or less absent testing strategies the tests rely on waste water analyses and reports from health care institutions. The Olympic Games are over but the virus still lives on and variants keep popping up. Games during the summer months should be much saver than winter games as the time spent outside is much longer. Traveling in crowded transport, however, remains a potential health hazard. Huge crowds at Olympics are inevitable. After all, birds of the same feather flock together.
Olympic Prevention
In the streets near the Stade de France at Seine Saint Denis the team of street workers addressed spectators with little presents. Each of these little items served the purpose to remind people of the prevention of disease or later consequences of the Olympic atmospheres in PARIS 2024. Sex, booze and drugs, but also noise were the topics of the prevention patrol around popular venues. Great way to bring home a message for visitors and the local population as well. Health and Olympic Games is a huge topic with many facets to it. Not only athletes are concerned, but also spectators. The team agreed to pose for media coverage as this is their reason of existence. Reaching big crowds is essential especially if big sugar is among the big sponsors of the games. It is another kind of competition with rather unequal starting conditions. You might loose some fights against yourself, but trying to overcome alcohol addiction or sugar overdose is worth a repeated game. Prevention is key.
Swimming Pool
Summer time is the time to enjoy outdoors. Hiking, biking, climbing as well as swimming are high on the agenda. With the Olympic games 2024 around the corner we rise to the challenge and get started again with more sports activities. Swimming has many health advantages. Most people think of cardiovascular training and relieve of back pain. Exercise without carrying your body weight is great for your joints and ligaments. The benefits for psychological wellbeing have long been underestimated. Diving into silence under water even if it is only for some seconds or a minute calms your spirit. The water pressure holds you tight without restricting your movements. Breath control is an almost meditative experience. Everyone can do it, again and again. Childhood memories, good and bad, are associated with swimming. Choose your style, costume and pool. The summer break is an ideal occasion to test the marvelous experience again of cold or warm water. The cold water bucket challenge of everyday life takes a break. Time to find your pool again. (Image extract from Susanne Hay, Swimming Pool II, 1996 in private collection, exhibition in Yerres, summer 2023)
Live longer
It is an old dream of mankind to live longer and longer. The Covid-19 pandemic has taught us many lessons that there are powerfully viruses and their continued mutations which threaten this. Life expectancy declined slightly during the pandemic and we learned that long Covid is yet another threat to our life expectancy. Scientists have found other sources that are crucial for survival. Like sepsis, it is the constant inflammation processes in our bodies. Long working times, stressful commute to work and interrupted or shortened vacations all contribute to keep inflammation at higher levels than is healthy from a longevity perspective. The research note published in Nature on the inflammation enhancing protein IL-11 highlights the chain reaction process of inflammation causing cancer and autoimmune disorders and diseases. Hence, it is essential to watch the biomarkers of inflammation and probably adjust our lifestyles accordingly. The sources of inflammation are manifold, but the potential rewards to address the issue are huge as well. Among the easy to address sources is nutrition, exercise and working life. Changing just a little bit here and there can make already a change. Monitoring how you feel about such changes puts you on a learning curve for your own inflammation levels. Vacation times are also perfect for adaptive behavioral changes. We just need to keep trying.
Greening Brussels
We tend to believe that inner cities have lost the fight against traffic jams and climate change. However, the number of projects that stem the tide is growing and some have gained visibility beyond their immediate neighborhood. This is the case of an urban planning project in Brussels that has taken back space from urban traffic to the citizens living there. Planting new trees and a gardening space reserved for flowers changed the street into a pleasant environment where people meet and greet again rather than hold their breath and disappear as quickly as possible. Parking of cars has been reduced on the street and instead bicycle parking has become a hint towards more sustainable mobility in inner cities. Walking the city, staying and shopping nearby will allow behavioral change for healthier lifestyles. It needs a lot of persuasion to accomplish this impact and years of reaching majorities for such projects and the ability to raise sufficient resources to implement them. The additional challenge is the need to take care of the green spaces that only works with the support of neighborhoods assisting in the care and protection of the urban lungs. As the awareness to act against inner city heat and pollution increases the number of persons willing to act and devote resources as well as time for such projects increases as well. It is a long way to improve inner city health again, but these signs of exemplary projects will convince many other people that urban renewal can work to the benefit of people.
Back pain
Most people know some form of back pain. This is understandable as an ever increasing share of people work in seated positions and spend additional leisure time in a similar position (gaming). Recurrent back pain is a frequent diagnosis. An Australien study has found a rather simple remedy for the widespread pain. The WalkBack experiment succeeded to significantly reduce recurrent lower back pain in study participants. Individualized and progressive walking accompanied by an education program did the trick. Keep on walking and try to extend the range of the exercise. It’s amazing to witness how the human body adapts to being challenged. Learning about the mechanics at work like the release of own personal “pain killers” hormones helps to trust in your body’s positive response to each dose of the challenge to pain. Do not walk too quickly too far. Stretching is a must and not an option. Go for it. Modern technology (in any smartphone) supports your efforts with counting your steps and measuring distances. Keeping track of a “pain diary” might give you guidance not to overdo the exercise and pause activities. Join a group of friends or people who are like-minded and get adequate shoes and clothes to feel comfortable while walking and afterwards as well.
Smoke Gamble
Smoking is like a gamble. Your input is your health and money. This is not including those who might rely on you or family relationships that might suffer one way or another. The other link has gambling at its source and smoking goes along with the continuous risk taking or the belief to be able to master the risks involved with both forms of potential addictions. Research has accumulated evidence that in fact both smoking and gambling occur frequently in combination with each other. Taking risks against the odds of suffering losses, maybe only in the medium or longer run perspectives like for health seems acceptable for those people. Society has put rather high taxes on both activities to discourage people and invests in prevention of addictions. However, it does not have substantial effects on people as smoking remains around the same level and gambling (poker online) or betting on sports (Euro 2024) are rising rapidly. Vaping and internet gaming have broadened the spectrum of addictive behaviors mostly for younger persons and young adults. The risks are manifold and increasing in their addictive potential since the smartphone is always in some pocket just like the smoking device. The behavioral turn in the social sciences has been well understood by the industries as well. The stakes for human development are high in this endeavor to offer young people equal opportunities at entry into adulthood.
Cannabis Alcohol
The use of cannabis and/or alcohol is yet another question where we are used to ask questions in the form of: either the or the other? Over generations we have gotten used to no longer ask for each do you or don’t you. With the controlled liberalization or legalization of cannabis in some Western European states the framing of the question is more like you do the one or the other, particularly for many younger persons.
Decriminalization of both drugs in small quantities is apparently reducing crimes link to drug use and drug dealing. On the other hand, the thresholds for doing drugs are lower than they used to be. In inner cities it is therefore no longer a surprise to find both kinds of drugs with addictive potential next to each other (see image below). We know that it is a slippery road from regular drug use to uncontrolled dependency and personal disaster. For cannabis a study published in the Lancet (Petrilli et al. 2022) added the importance of the potency of tetrahydrocannabinol to the estimate of risks. This is similar to the studies that differentiate the level of alcohol in drinks consumed. The higher the concentration, the higher the risks. A simple proportional relationship prevails in both drugs. The cumulative effects of consuming both together might have quite surprising non-linear effects.
The big issue is the risks of mental health related to these drugs. However, the causal direction is not easy to detect. Drugs induce mental health problems, but also mental health issues lead to drug abuse. This remains quite a puzzle for scientists to disentangle.
Additionally, the link to smoking and addiction to nicotine is a frequently observed corollary. Studying just one single source of health problems and addiction might be too restrictive to learn about the whole set of causal effects and casualties. For the time being we seem to jump from one field of attention to the next one ignoring the multiple interrelated factors at hand. 