In the field of public health the screening paradoxon is a well-known feature of large scale programs to check for and contain the large increases in cancer among populations. A recent medical study underscores the necessity to curtail the screening paradox in Europe. The screening paradoxon is defined as “the underuse of screening by those with unhealthy lifestyles and high risks”. The opposite cases, “the overuse of screening by those with healthy lifestyles and low risks” only cause a problem for the costs of the health system as those unlikely of attaining a form of cancer make extensive use of screening. In terms of social inequality we have to be concerned about both ends of these distributions. The publicly available screening programs are skewed towards the higher educated with risk awareness as well as healthy life styles. More of them participate in screening. The other distribution of actual risks and detection of cancer is skewed towards the other end of the risk distribution. The 2 probability distributions overlap to an extent that is most likely co-determined by cultural factors like general attitudes towards prevention.
With the increase in cancer rates generally and due to demographic aging of societies, we shall need to target our resources devoted to health more precisely rather than spending too much on screening of people with very low risks. Increasing the duration between screenings might not impede detection rates of those with healthy lifestyles, but could allow to devote more resources to those people who are hard to reach by screening programs so far. Evaluations of such programs are necessary to judge the need for more targeted programs.(Image own representation inspired by Ola et al. 2024)
Personal Health
Most people would agree, health is a personal issue. From the onset of life, we have package of genes that predetermine a number of factors of our personal health. Epigenetics has taught us there are many factors to take into account additionally. Environmental factors have huge impacts as well. Improvements in the availability of medical devices in the hands of individuals as well as AI systems on portable devices like smartphones facilitate the monitoring of personal health. Several indicators of early-onset of illness can be retrieved from such devices. Dunn et al. (2024) show that prior to the onset of symptoms of Covid-19 or influenza portable devices can indicate the presence of infections through indicators of resting body temperature, heart rate/min, heart rate variability/millisecond or respiratory rate/min. Combined with the indicators of air quality, indoors as well as outdoors, the presence of allergens a much more personalized data set emerges which can easily be part of an AI-assisted diagnosis. More abundant personal health data and analytical power allows remote and digital health applications to inform patients, medical doctors and the public at large. Digital health technologies are only at the beginning to unfold their potential. Prevention becomes more feasible using such devices, medical professionals should be allowed to focus on interpretation of data and treatment rather than simple data gathering. Thinking about digital health technologies points in the direction of dealing with climate and environmental hazards as sickening causes more forcefully. Personal medicine and personal health are, after all, still heavily dependent on health and safety at work, commuting practices and all sorts of pollution. Personal health, however, is a good starting point to raise awareness of the potentials of digital health technologies to better our lives.
(Image: AI MS-Copilot: 2 robots run in a city. They sweat. The air is full of smog. 2 other robots rest near pool. All look at their wrist watch showing heart beats)
Flooding
Flooding after abundant rain fall is an almost worldwide phenomenon. This is why research has taken up the issue for some time now. 2 recently published papers hint at direct and indirect consequences of excessive rain and flooding which usually are not taken into account. The Lancet respiratory medicine has highlighted the second round effects of flooding which consists in the latent danger of mould creeping into buildings even after the immediate effect of the flood has vanished. It is the mould with its longer duration that causes major respiratory health and safety hazards on top of the instantaneous casualties and epidemic health risks (Link to study 2024).
The second study focuses on “the need for more systematic understanding of how societal structures and vulnerabilities moderate disaster risk” (Link to study). In wealthy countries the flood mortality is substantially lower than in comparatively poor countries. More sophisticated anticipation systems play a major role in reducing casualties. Flood-induced displacements remain hard to predict despite a reasonable explanatory power of the statistical model as the authors point out. Additionally it remains an important question to estimate the share of people who (want to) return after being displaced due to flooding. The frequency of flooding plays a role in combination with the severity of flooding. Climate change might be an additional hazard in the sense that more frequent flooding will change the propensity of people to permanently relocate rather than returning after displacement. Social networks, support and solidarity with the victims of flooding as well as reconstruction efforts will play a crucial role in dealing with these environmental hazards.
Building higher dikes is a worthwhile solution in regions that can afford them (Rotterdam example). It is hardly a solution for countries with little resources to invest in protection in face of an already suffering and displaced population. Dealing with mould after the flooding only adds yet another health hazard to an already difficult situation. 
Smart watch
Das Handgelenk hat noch viel Platz für elektronische Geräte. Vom preiswerten Schrittzähler bis zur smart watch und intelligenten Armreifen oder sogar Ringen gibt es dort viel Potential für Innovation. Jenseits der Schritte werden mittels vielfältiger Sensoren eine Fülle von Daten erfasst. Datenschützer erschaudern geradezu. Das Potential für medizinische und soziologische Auswertungen dieser Daten ist immens. Vergleichbar mit einer elektronischen Waage, die Knochenmasse, Wasser und Muskeln erfasst erlauben die smarten Uhren noch mit Ungenauigkeiten, aber stetig besser werdend, kardiologische Werte und Schlafrhythmus zu erfassen. 
Mit Daten von tausenden bald Millionen Datenlieferanten lassen sich wichtige Studien zur Früherkennung von Gesundheitsrisiken durchführen. Plötzlicher Herzstillstand ist eines der immer noch wenig aufgeklärten Phänomene. Die Studie im LANCET digital health hat solche Daten ausgewertet und kommt zu der Schlussfolgerung, dass dyspnoea für Frauen und Männer der größten Risikofaktoren darstellt. Für Frauen wird Entwarnung gegeben für Diaphoresis, exzessives Schwitzen, aber nicht für Männer. Letztere sollten Schmerzen in der Brust ebenfalls ernst nehmen. Daten sammeln kann durchaus Leben retten. 
Dennoch droht dem Gesundheitswesen eventuell eine Welle an falsch positiven Selbsteinweisungen in der Notaufnahme der Krankenhäuser. Darauf sind wir noch wenig vorbereitet, inklusive der möglichen rechtlichen und finanziellen Konsequenzen. “Big brothers are smart watching you”. Müssen Ärzte die smarte Evidenz berücksichtigen, etwa so wie eine Patientenverfügung? Was wenn plötzlich der Notarzt unaufgefordert an der Tür klingelt? Wer hat meine Uhr gehackt, … , singt das Paulchen Panther jetzt.
Drowning
Drowning is a largely underestimated risk. 2.5 million people die of drowning in 10 years according to the WHO. low and middle income countries have the highest drowning rates. However, remedies like teaching how to swim and to assess drowning risks at an early age can make a huge difference. Flooding as natural disaster causes high numbers of casualties, but even in such extreme weather conditions survival strategies involve drowning prevention.
Even in the richest countries drowning is still a reality. Life guards cannot prevent the most irresponsible behavior like drinking alcohol, taking drugs and drowning risks. Overestimating one’s own swimming capabilities is yet another reason for drowning in wealthy countries. Try floating your body with as little movement as possible and you slowly enhance your capabilities to survive in dangerous water conditions. This increases your self-confidence to master tricky situations. Panic in water is surely not helpful. Learning how to help others in danger is for well-trained rescuers or professionals.
Healthy Brain
We’ve got only one brain. Hence, we better take good care of it. There is only a small community in Wales that has got more than one brain, they have got brains. For all others we should like to know what we can do to keep our brain healthy for as long as possible. Scientists try their best to find out for decades. The state of the art is well documented in a study published in The Lancet which followed 64 so-called superagers in the study and 55 in the control group. These superagers are 80 years old persons that have annual brain fitness tests and brain scans (MRIs) that show their brain has a functionality of a person 20+ years younger. Anxiety scores and depression levels seem to be major explanatory factors for reduced grey matter and decline in functionality of the brain in aging. Fewer glucose disorders and hypertension contribute to successful aging of the brain. An active lifestyle and any form of practicing music make you also more likely to be in the group of superagers. Motor control, balance and speed are important to take into account additionally. A good solution to successful aging is “singing in the rain” I would say. In terms of prevention of “brain loss” it seems important to highlight both the pure brain functionality and the importance of exercise to keep sufficient motor control. Get up and walk! That is the answer. Yes. Again. Trying to do it fast is a good way to preserve not only your body but also your brain. 
Schwalbe
Verzicht auf Spritzmittel wie Gluphosat in großen Mengen an Bahngleisen, Autobahnen und sonstigen Verkehrswegen kann schon viel helfen, dem Artensterben zu begegnen. Unkraut zupfen im Weinberg, Nutzgarten oder Ziergarten, statt die chemische Keule einzusetzen, beginnt Wirkung zu zeigen. Zarte Ansätze von Biodiversität sind beispielsweise die Rückkehr der Schwalben (Hirundinidae) in vielen städtischen Bereichen. Das freut sehr viele Menschen, die das Zwitschern der Schwalben lange vermisst haben. Die Schwalben ernähren sich hauptsächlich von Insekten. Genau diese Insekten werden aber mit den Spritzmitteln ebenfalls vernichtet. Das führt nicht nur vielfach zu erheblichen Gesundheitsschäden beim Menschen, sondern lässt sich an dem Vogelbestand bereits gut ablesen.
Daher ist es ein gutes Zeichen, dass die Schwalben zurückkommen. Wir bieten mehr Nahrung, Brutstätten und weniger Umweltgifte in den Innenstädten. Nebenbei braucht der Stadtneurotiker dann auch weniger in das Umland auszuschwärmen, um urwüchsigere Landschaft und Klangwelten zu erleben. Ein paar Singvögel leisten damit sogar einen Beitrag, die persönliche CO2-Bilanz aufzubessern.
Für alle, denen Vogelstimmen zum Wohlbefinden beitragen, hier noch ein Link auf die umfangreiche Hitliste der Stimmen der Mehlschwalben. Von dort lässt sich die Vielfalt weiter erkunden. Für Musikliebhabende lässt sich im Internet auch eine Webseite zu der Verwendung von Singvogelstimmen in der meist klassischen Musik und darüber hinaus, finden (BR-Klassik).
Schwalben schlagen zudem jede Wetterapp in der Kurzzeitvorhersage von Regenschauer im Sommer. Ein nahendes Tiefdruckgebiet mit Regenschauern zeigen die Schwalben bereits mit Tiefflug-Akrobatik an. Der richtige Indikator verbessert eben die Vorhersage. Das können Ökonomen und Meteorologen aus der Biodiversität lernen. Wir erfreuen uns einfach an dem Zischen der Schwalben im Flug und lassen uns inspirieren oder amüsieren uns an anderen Spielarten von Schwalben (Moped, Fußball, War and Diplomacy). 
Collective Violence 2
Summers and Markusen (1999) subsume state terrorism under the broader heading of collective violence. Even beyond non-governmental groups, states might apply collective violence against innocent people. Among the strategies governments use as a form of collective violence fall (1) arbitrary arrests, (2) imprisonment without trial, (3) torture and (4)a summary execution of members of alleged enemy groups. Particular outcries are caused by, for example, police or other para-military groupings of persons who jump from (1) to an execution of an innocent person or of several even seemingly unrelated murdered persons (4b).
Amnesty International attempts for decades to fight against such occurrences on an almost global scale. The need to complement the national legal systems through supra-national instances as well as NGOs in this domain is obvious. Even the most advanced democracies need to permanently check their systems for several forms of state terrorism or abuses of power to eliminate or intimidate opposition.
Staub (1999, pp.195) undertook an attempt to list elements that allow to predict and maybe prevent collective violence. The theory starts with “conditions of life” more generally like economic, social and political conflicts as well as rapid social change. Activation of basic needs in people, like several forms of security, challenges to a person’s self-concept, traditional values, simply the customary way of life (COVID-19) or new comprehension of (climate) realities, they all challenge old world views of people (superiority) and their place in the world (AI).
Claims for support by other people (government), missing connection to others (individualism) lead people to focus more on their own needs and isolated action. Rebellion as collective violence is directed against differences in status, power and (social) rights. Self-interest is becoming an overriding societal principle. Racism (p.200) and police violence (p.201) are part of Staub’s theoretical considerations. He argues in favour of training of situations in which a police officer is likely to become unnecessarily violent or to stop it if it occurs. At least a medium-term solution.
Framing of such training as preparation of good teamwork rather than betrayal is crucial in action teams, be they in the police or the military. The reader on “violence subie, violence agie” by Seron and Denis (2000) allows us to take a step back and reflect on the spirals and repercussions involved in violence from the perspective of the person who carries out an act of violence and the victim. A social-therapeutic approach aiming at reconciliation is worth trying, albeit a lot of obstacles. Collective dance rather than collective violence is the immediate as well as long-term solution (More on dance here). 
Medical Personal
Like in many other professions, medical doctors and nurses are in short supply. Labour markets in Europe have changed from high oversupply (unemployment) to shortages of mainly skilled persons. 20 years ago, such skill needs were already visible in projections. In 2023 the discussion of skill needs is spreading to more and more professions. The medical professions are no exception to this rule. Even the best paying jobs will not be filled in sufficient numbers. The German institute for the medical profession (www.zi.de) forecasts, in my opinion, a lower bound estimate of medical doctors for the year 2030. Their projection is based on an underestimation of the growth of the population (war in Ukraine), which they see as about constant until 2030. From the recent figures on the population of Germany there were 1.5 million persons moving to Germany and a loss of more deaths than births of 327.000. Migrants are on average much younger than the German population and, therefore, overall aging of the population is reduced. Tough news for those daring to do projections. Thanks to the immigration of younger persons there will be more persons contributing to health insurance and pay for the higher costs of a rapidly aging population.
Following the projections of the distribution of specialists needed, we shall need more urologists, eye specialists and substantially more psychotherapists. This originates in the aging of the population and the higher demand of younger persons (post Covid-19), as well as refugees, in need of psychotherapeutic assistance.
So-called hog-cycles tell us for the medical profession, with a “production time” of 10 years for a medical doctor, that we are already far behind schedule to address the future skill needs of the aging medical profession and population. This strengthens the need to get serious about prevention of avoidable diseases. Stop reading here, stand up and go for walk. It is the best-practice-solution taking account of the aging of the medical profession and the population as a whole. 
Shake Hands
Shaking Hands, like rubbing noses or kissing cheeks are social practices you will have to master depending on which society you live in. After the Covid-19 crisis we have become more careful to shake hands or exchanges of touching another person. The handshake has another medical function as well. If we are approaching eachother to shake hands, we prepare our handgrip mentally and physically.
It is exactly the strength of the handgrip, which serves as measure of another person’s health. Believe it or not, your handgrip is telling a lot about your general muscle strength. Of course, it is possible to conceal the true strength, but most people seem to have an intuitive handgrip with less mentally controlled strength of application. Medical studies mostly confirm the correlation of handgrip strength and frailty in older persons, predominantly for women. The conclusions of these studies lead us to a preventive approach of exercising your hand grip strength and other muscles in order to reduce frailty and to increase even life expectancy. After Covid-19 we should return to shaking hands more forcefully than ever before. Exercising by shaking hands with yourself or shaking your foot with your hand as alternative are fun exercises. The scientifically confounding effect of laughing while exercising might additionally cheer you up. Balance and joy are additional features of a healthy longevity. (Image: Extrait from Degas, copyright BnF, 2023)
Source: Santos S and Paúl C. Handgrip Strength and the Perceived Risk of Institutionalization, Hospitalization and Death. Journal of Fam Med. 2022; 9(4): 1302. 
Waldbrände
Waldbrände sind leider jenseits vom Süden Europas auch im Zentrum von Europa ein Bestandteil der täglichen Gefahren geworden. Vor 50 Jahren waren die seltenen heißen Sommer die große Gefahr. Seit einiger Zeit bemerken wir öfter heiße Sommerwochen, die die Wälder austrocknen und leicht entzündlich machen. Jetzt haben wir die noch frühere Sommersaison nicht nur im Süden, sondern auch im mittleren Europa. Neben den Bränden in der Lausitz in Deutschland, kämpfen Feuerwehrleute öfter in den französischen nördlicheren Waldregionen mit Bränden. Eine Nachricht, wie die zum Brand Anfang Juni im „Forêt Fontainebleau“, sollte uns klar machen, da brennt unserer europäisches ökologisches und kulturelles Erbe. Jeder hat die brennende Kathedrale „Notre Dame de Paris“ noch in Erinnerung. Da war Klimawandel nicht die Ursache. Bei den Waldbränden sieht das anders aus. Das Ergebnis ist das gleiche. Die Vernichtung unseres kulturellen Erbes schreitet voran ohne Prävention. Das ist eine zentrale Aufgabe. Nicht erst in der Zukunft. Prävention verlangt Handeln, Planen und Implementieren schon heute. Das ist ein riesiges Qualifizierungsprogramm nötig. Es umfasst die Sensibilisierung für die allgegenwärtigen Gefahren genauso, wie das Schulen allfälliger Einsätze von professionellen und freiwilligen Helfenden. Gefahr erkannt, heißt leider nicht schon Gefahr gebannt. Da gibt es viele Zwischenschritte, die geprobt sein wollen, damit ein effektiver Einsatz gelingen kann. Es bleibt viel zu tun, packen wir’s endlich an. (Artikel in La Marne 7.6.2023 S.6) 
Corruption EP
Corruption is a severe crime. Not only in administrations, organisations and enterprises, but primarily in democracies it is discrediting political systems. Autocracies rely on corruption as a major tool to be able to persist over time. They are used to such practices. Democracies rely on meritocratic systems, where ideas, effort and winning elections should be the major ingredient of achieving higher positions in organisations, enterprises, political parties and democracies. This is not easy to ensure. The European parliament has a tough time to get rid of an enemy of the democratic Europe. Rather than stepping aside for the time of the legal procedure, Eva Kaili, accused, but not yet convicted of corruption is willing to destroy the European project as much as she can. If money can buy political decisions, the European project will no longer find wide-spread support. Big interests will always have a strategic advantage, however, the ethical principles on which democracies are found have to guard against corrupt misbehaviour. The same applies to the business world. Even low corruption countries like Sweden still face a risk of adverse effects of corruption like the negative impact on entrepreneurship on the local level. It is another context, but the same conclusion.
Additionally, it is part of the strategy of corrupt persons to portray themselves as victims of other persons’ wrong-doing. The major function of this strategy is to remind other persons in the corrupt network that the network has still some clout on its members as well as outside the inner circle. Hey, we are still alive and in powerful positions, they proclaim.
Therefore, the fight against corruption is a long and persistent one. Reducing the guards against early onsets usually is very lengthy to fight later on. Always a painful lesson for believers in democracy and the European project. (image Jacques Jordaens before 1678 “The King Drinks! Musées royaux des beaux arts, Brussels). 
2P2R
2 Pinot 2 Riesling. That could be the long version of 2P2R. However, this far from (politically) correct. The not-joking scientific medical journal “The Lancet” (Vol.401 Nr 10391) has next to the article on “Laughter is the best medicine” coping with trauma, the serious matter of how best to deal with pandemics. Remember 2P2R as the important lesson from the pandemic. Prevention, preparedness, response, and recovery (2P2R) are key. And don’t forget about primary health care or essential (medical and other) workers. This is, in short, the message from Arush Lal and Nina Schwalbe (Paper Link). Lots of social topics involved in this correspondence from the authors. Prevention is a big issue and, as in the health system, fighting continuously for sufficient resources. Prevention is in most cases less costly than curing a disease. Preparedness has direct costs. Masks and ventilators need to be produced, stored and monitored in their functionalities. Response has to be immediate, masks in China a important but do not allow us to respond fast to local emergencies. Recovery can be long and costly as well, just as we learn from Long-COVID patients.
Now we need to define properly what is included in primary health care. Medical doctors, nurses and technicians of hospitals have to reach patients and hospitals in pandemics or need child care, food etc. and, maybe, also laughter to avoid trauma. Remember 2P2R, but best in company with your loved ones, but not on your own. 
Gewaltmonopol
Für Demokratien ist die Frage des Gewaltmonopols eine sehr entscheidende Frage. In gleichem Atemzug muss dabei die demokratische Kontrolle dieses Monopols gewährleistet sein. Verfassungsrecht in Demokratien ist darin eindeutig. Lediglich die Praxis des Rechts gestaltet sich oft schwierig und durchaus wechselhaft. Die Studie von Laila Abdul-Rahman, Hannah Espin Grau, Luise Klaus und Tobias Singelnstein (2023 bei Campus kostenlos downloadbar) greift das wichtige Thema mit einer repräsentativen Studie von 3300 Opfern polizeilicher Gewalt in Deutschland auf (Zusammenfassung). Anders als im amerikanischen Raum fehlt bei uns bisher die Berücksichtigung von Rassismus und räumlicher Verortung in der wissenschaftlichen Aufarbeitung des Geschehens. Das Interaktionsgeschehen oder Eskalationsstufen (S. 31) bieten einen weiteren Ansatzpunkt zukunftsweisend präventiv tätig zu werden. Die Aussetzung der Strafverfahren gegen Polizeibedienstete wegen Gewaltausübung (Körperverletzung) ist mit 93% aller Fälle außerordentlich hoch. Das Kapitel 8 (S. 307ff.) über die strafjustizielle Aufarbeitung offenbart die Randbedingungen der justiziellen Verfahrensweisen.
Das Gewaltmonopol darf nicht in Frage gestellt werden, aber sobald Gewalt des Monopolisten unverhältnismäßig und rechtsstaatlich ungenügend kontrolliert wird, kommt eine politische Gewaltenteilung langsam ins Wanken. Die wehrhafte Demokratie braucht Polizeigewalt, um beispielsweise das Demonstrationsrecht durchzusetzen oder öffentliche Veranstaltungen zu sichern. Aber die Exzesse polizeilicher Gewalt müssen geahndet werden. Solche Anklagen finden wir in England anlässlich der Krönungsfeier, in Frankreich bei Streiks oder Fußballspielen oder in Belgien bei Gipfeltreffen oder Räumungen von Flüchtlingslagern. Das ist keine Randnotiz. Friedlicher Protest ist wesentlicher Bestandteil von Demokratien. Einschüchterung durch Gewaltanwendung ist Teil der dunkelsten Kapitel und muss entschieden unterbunden werden im Friedensprojekt Europa. 
Crises
Crises, yes crises, we have seen a few in recent years. After the first financial crisis, 2009, the COVID-19 crisis and now the energy crisis, , they all have cost us respectively 1.6%, 2.5% and lately a whopping 7.8% of GDP loss according to Tom Krebs (Uni Mannheim and FNE) in his assessment of lessons from these crises. Also Philip Lane (ECB) showed the lower GDP growth rates due to the crises.
We lost out on the wealth of our nations and face mounting difficulties for the distribution of this wealth. As firms cashed in on profit margins lately, workers risk even more to fall behind significantly. At the same time, it is high time to prepare for the next winter season now, to ensure the same risks as the dependency on energy resources from outside Europe, especially Russia, can be maintained. The conference of the Forum New Economy from the 8th of May 2023 discussed several ways forward to learn our lessons from these crises. Strategic independence needs to be properly defined for Europe as a whole, not just in each individual state. Implementation has to be rapid as well. Geopolitical challenges will not wait for us to finish discussions. Germany and minister Robert Habeck has received some acclaim from the economists for a fast and rather successful reaction to safe us from an energy crisis last winter. Massive increases in renewables (+20% solar energy) has helped a lot to ensure sufficent energy supply when France suffered heavy reductions from its nuclear energy power plants. “Let the sun shine … in”, I would sing. However, we have to think even further ahead build our resilience based on improved energy efficiency and may rethink the risks and vulnerabilities of our economic model of production and consumption. Diversifying imports from Russia with imports from other countries and other (green) forms energy is part of the solution. A heavy reliance on China as buyer of our products is good for trade balance, but some sectors (automotive) are nowadays critically dependent on selling in China. Some of our partners are very anxious about this new dependency on Asia for our economic growth model (see figure below from conference). Market based economies suffer more openly from huge economic swings than more secret-based autocratic economies. Our state agencies have to keep that in mind and state intervention seems to become more likely options in future as we have already witnessed in the past crises. We had to rely on running higher state deficits to cover the losses incurred from the crises. The EU, the larger Europe in combination with the transatlantic and pacific alliances has a lot of resources to address these strategic interdependencies. Being prepared, in strategic thinking and potential implementation procedures is a major part of building capacities that ensure resilience and strategic independence. As in a game of chess, you have to think ahead a couple of steps to frighten off some potentially dangerous moves of other players.
In terms of a planetary concern we still have to address the major climate crisis and the last 3 crises have largely contributed to reduce the resources we have available to address climate change. Smart crisis management succeded to ask for emission reductions in return for subsidies from firms and private households. This might be the “best practice examples” worthy to learn from. There are still huge evaluation tasks for analysts of these crises. 
Polypharmacy
Each specialist treats a person or patient in her/his field of competence to the best of current knowledge. Well, marketing of pharmaceutical products is also a field of special competence. Medical doctors and pharmacists are largely competent intermediaries between the world of medical and pharmaceutical research, commercial interests and patients. As persons age, so-called multimorbidity is creeping into the daily life of many persons. After a certain age (75+), depending on country of residence to some extent, we all become patients. Although the basic problem has been known since the phenomenal rise of the pharmaceutical industry, little research is devoted to patients receiving multiple treatments with medical prescriptions from several specialists. In addition, we know there is a rather severe issue with compliance to prescriptions, for example, taking antibiotics for the whole prescribed period, to name just one. The interactions between several prescriptions and molecules administered to patients are very difficult to monitor and scientific tests of those are expensive and no pharmaceutical company really has an interest in such studies that might further add to the already long list of potential side effects. However, the study published by Daunt et al. (2023) reiterates the warnings that treatment of multimorbidity can have unwanted side-effects we do not really know about. General practitioners will have to take on the role for medical stewardship for their patients. Monitoring a patient’s digestion of a combination of medications becomes a prime role as of the age of 75, the paper specifies. Whereas a common believe tells us, taking more, will help more, the “daunting” truth might be, less can be more. (Source: Daunt, R., Curtin, D., & O’Mahony, D. (2023). Polypharmacy stewardship: A novel approach to tackle a major public health crisis. The Lancet Healthy Longevity. https://doi.org/10.1016/S2666-7568(23)00036-3. 
Immune system
A brief review of the press on the coronavirus 3 years after its first appearance shows that we have learned to live with it. Everyone has found the personal way to balance exposure to risk and protection against infection. Long-term consequences are severe for pupils. Many lost friendships, were lonely at home and accumulated missing out on peer advice or effective teaching.
Overall, strengthening of the immune system is another more complex issue. Some people swear by masks and others keep washing hands, or both. More rare is the vaccination approach against COVID-19. The evolving virus seems to adapt to a seasonal pattern as the influenza had done decades ago. The term seasonal greetings nowadays has an additional flavor to it. We have come out of the 3rd year of the pandemic reasonably well. Preparing for the next winter is left to the scientists to study the ever new variants arising, probably in parts of the world where winter is just beginning. Working on our immune system’s strength, however, is up to us. Happy Walking and cold Showering. 
2 real newspapers, 3rd one “Pastiche” exposé à la BnF, Paris April 2023.
Feuer im Wald
Das sogenannte grüne Lunge kann immer öfter ihre wichtige Funktion der Klimaregulation nicht mehr wahrnehmen. Waldbrände begleiten den Klimawandel. Bereits 2018 gab es ein großes Feuer im Wald bei Paris. Im “forêt de Sénart” in der Nähe der Städte Montgeron, Yerres und Brunoy (nahe Paris) hat sich der Wald seit dem Feuer im Hitzejahr 2018 noch nicht erholt. Geld für Reparatur der Schäden fehlt und so lässt die notwendige Aufforstung auf sich warten. Der Verlust der Biodiversität durch den Brand lässt sich schwer bemessen. Brandrodung, gängige Praxis im Amazonasgebiet, hinterlässt auch bei uns mehrere ungewollte Folgewirkungen. Die Bewirtschaftung des Waldes hat die Schäden abgeschrieben, aber Zukunftsinvestitionen lassen auf sich warten. So heizt sich die Region Ile de France eben weiter auf und Millionen Käufer von Klimaanlagen. Die befördern in naher Zukunft das Wirtschaftswachstum, aber beschleunigen den Klimawandel. Wir wissen, dass es so nicht weitergehen darf. Nur der Wille, wirklich etwas daran zu ändern, fehlt an vielen Orten. Weiterso, wenn es kein Weiterso geben darf, ist die Schizophrenie unseres und des letzten Jahrhunderts. Lernen im und vom Wald ist nötig. Das ist unsere Lebensgrundlage. 
Pressure
Pressure or stress, in most humans, contributes to higher blood pressure. Sources for pressure are manifold and that is the basic problem. As it is hard to identify the major sources of high blood pressure, we often use a summary term “life style” in order to avoid shaming particular substances, (tabaco, red meat, alcohol to name just a few). Among life style elements is the daily rush to work and back home or bringing children to school and home again. Work itself is a major contributor as well. Leisure activities are not free of pressure in order to perform at a person’s best. As in many health topics, the balance does the trick. This is common knowledge beyond the Asian world as in their health philosophy of Yin and Yang. The Western world is proud to have the best and highest availability of medical treatment and hospitals for their populations, accepting some inequality in access nevertheless. For countries with less means for curative practices they have no choice and have to focus on preventive strategies (Lancet Study Link). Rural China, therefore, is a good case to study access and willingness to apply western medical type treatment of high blood pressure is too expensive and just not available in sufficient numbers. The good news is, with a preventive programme based on nurses rather than medical doctors the prevention of high blood pressure works reasonably well. Community health workers are therefore a cost-effective alternative in reducing blood pressure. Sitting is the new smoking, and driving around in a car rather than walking or cycling are health risks, even if the car or the chair is a very nice one.
20th Century
The 20th century has told us many lessons. History does not repeat itself, but it appears that new variants of old themes keep coming back. Slowly passing the century like a movie in decades instead of episodes, we witness socio-emotional tides. The first decade, the 00s intensify the beginning of urban planning and social revolutions. The 10s show the arousal and subsequent extinction of masses of people in trenches. The 20s were described as the Carefree Twenties. In the 30s we observed the rising tides of fascist organisations followed shortly afterwards by the disastrous 40s. After the Shoah and the World War the 50s were fabulous viewed from the U.S. and Western Europe. The 60s propagated sex, drugs and rock n’ roll spreading across continents. The wild 70s became almost inescapable through the continued rise of mass media. The 80s were depicted as the colourful 80s as the 2 previous decades had set the scene for psychedelic colours. The 1990s have been coined as the gay 90s by some. Coming out as a gay person became easier and Western societies more sensitive and open to diversity. The back cover of the recent publication by Aurélien Bellanger “Le vingtième siècle” (The 20th century) speaks of the book as “roman polyphonique virtuose”. I look back on the 20th century as “polyphone” in many respects. It would be an illusion to believe we can only keep the nice sounding harmonies without the tensions or dissonances. 
10s
The 1910s have been eclipsed completely by “the Great War” between 1914 to 1918. The 1st world war certainly was the most horrific period of the decade of revolutions and mass arousal. From a global history perspective the years preceding and shortly after the humanitarian disasters deserve more attention, if we were to derive lessons for prevention of other world encompassing wars of imperialist states. The numbers 1st, 2nd, … 3rd (?) world war suggest an unescapable numbering of events. We no longer can think in this trivialising logic of war or historical determinism. Empires go to war more easily than democracies. This was the social scientists’ consensus after the Great War. It took several years for many European states to turn more democratic, allowing women to vote, or introduce more robust health and social security systems. Powerful aristocracies would not cede power easily, only the widespread poverty after the Great War and the human losses discredited many aristocratic regimes throughout Europe. The imperialist dominance of the beginning of the 1910s produced a spirit of ruthless conquest and exploitation of colonies around the world. It took another global war and almost half a century to dismantle these regimes. To understand global alliances and impediments of wars in the 21st century, the early 1910s are instructive as they inform the restitution of artefacts debate in the 2020s. In the history of ideas, the 1910s are probably best characterised as the period of attempting to turn “grand ideas” into political facts on the globe. The rise of Marxist ideology, liberal and fascist counter movements started to take powerful roots at the end of the 1910s. All these ideas and factual changes of the maps of power still seem to govern a lot of international politics even today. 
Fukushima 12
12 Jahre nach der Kernschmelze im Atomkraftwerk der technologiebegeisterten Japaner stellt sich immer noch die Frage nach der Entsorgung der verstrahlten Reste und Kühlwassers. Laut eines Berichts und den veröffentlichten Bildern zu dem Kernkraftwerk Fukushima staunen wir über das weite verseuchte Umfeld und die riesigen Lagerstätten für den verstrahlten Abfall. Geothermie, Wasserkraft, Windkraft und Solarenergie könnten auf der Fläche sicherlich riesige Mengen von nachhaltigem Strom produzieren. Das hatte bis vor 13 Jahren niemand denken oder aussprechen dürfen. Heute nach 18.000 Toten und vielen Folgeschäden durch Krebs und geschädigtes Erbgut wird der Unsinn weitergehen. Da sind sehr starke Interessen am Werk, denen es nicht um Menschenleben geht. Atomkraft, koste es was es wolle. Die Einleitung eines Teils des verseuchten Wassers ins Meer ist wohl bereits erfolgt. Noch mehr wird folgen müssen. Über die Fische als Teil der Nahrungskette werden Menschen dann mehr Radioaktivität aufnehmen. Das war schon so mit den Pilzen nach Tschernobyl. Fukushima bleibt ein abschreckendes Beispiel weltweit, da helfen jetzt zum 12. Jahrestag ein paar Solarzellen als Trostpflaster wenig. (Bilder aus ARD Tagesschau 11.3.2023. Auch bei uns ist es leider schmal Glück gewesen, dass nichts Schlimmeres passiert ist (Link Radiobeitrag DLF 2023-4-17)
Alkoholismus
Alkohol ist eine Droge, da Alkohol abhängig machen kann. Die Bewusstseinsveränderungen können beachtliche bis extreme Ausmaße erreichen. Das wissen wir alle und zwar seit Jahrhunderten. Mäßigung bei Rauschmitteln ist nötig, aber schwer erlernbar. Etwas Genuss ist gesellschaftlich nicht nur toleriert, sondern gewollt zur Förderung der Geselligkeit. Zu viel Genuss beeinträchtigt meistens andere und wird dann zu einer schwierigen Problematik. Ärztinnen, Psychologinnen und andere Heilberufe stehen oft hilflos, wie auch das nahe familiäre Umfeld, vor dieser Situation. Selbst neuere Studien weisen darauf hin, dass die Versorgung dieser Patienten (UK), bestenfalls in der Hälfte der Fälle als gut einzustufen ist. Die Studie zu Großbritannien beschreibt gleichfalls die Krankheitsgeschichte und -versorgung als „eskalierende Tragödie“. Für die meisten anderen Länder liegen keine wirklich guten Daten vor, die weder einen Handlungsbedarf noch auf einen gesellschaftlichen Gestaltungswillen hindeuten würden.
Die Radiosendung zum Thema „Umgang mit Alkoholkranken“ und die Initiative von Sänger Max Mutzke, „Kindern suchtkranker Eltern eine Stimme geben“ beschreibt eindrücklich die generationsübergreifende Bedeutung von Alkoholkrankheit. Alkohol ist eben nicht nur das Problem der betroffenen Person. Ein ganzes Umfeld ist betroffen. Das Problem wächst sich meistens aus zu einer Problematik für das weitere familiäre Umfeld, Freundeskreise und ArbeitskollegInnen. Es ist erstaunlich, dass wir seit Jahrhunderten keinen anderen Umgang mit alkoholbasierten Rauschmitteln gefunden haben, als alles erlaubt oder alles verboten, außer der Altersbegrenzung für Kinder und beim Autofahren. Der Maler Bruegel sah das wohl ähnlich. Den St. Martinswein kann sich heute jeder im Laden um die Ecke selbst kaufen. Mäßigung im Umgang mit Drogen ist nach wie vor ein schwieriger Lernprozess, für Einzelne (Jordaens – Der König drinkt!), wie für die Gesellschaft. ( fast betrunkenes Video Alko VLC Bruegel MRBA Bruxelles.jpg zur Bildexploration).
W for War
In Europe many people were lucky to live without the existential threat of war for a long time now. Putin has stopped this with his land-grabbing in Ukraine. We wonder why, what, when and where? War is back in our minds again. Members of the birth cohorts of the 1920s, 30s or early 40s have direct experience our traumatic memories related to war times. Some later born cohorts suffered from various forms of deprivation . Economic reconstruction or even so-called miracles may follow and can soften the traumatic experience, often by way of focusing attention on repair and new investments.
The work by James Hillman “A terrible love of war” has been a difficult read. To acknowledge that “war is normal” and our mindsets should take this into account, is hard to accept. Hillman cites Susan Sontag to state that “we cannot imagine how terrible war is – and how normal war can become”. We need a leap of imagination (p. 9) to grasp the mythical element about war which seems to be beyond the rational understanding of it. Greek tragedies told us, all along for more than 2000 years. The Romans exceled in it and German perfectionism and cold-bloodedness added the most horrible recent experience of war for millions of people. Memory and historical knowledge are important to activate recall for older and learning for younger generations. (short Video clip on war and UKR)
Gewalt
Die Betrachtung von Krieg und Kriegsverbrechen im weiteren Kontext als Anwendung von kollektiver Gewalt erlaubt das Einbeziehen eines breiteren Spektrums an sozialwissenschaftlichen Theorien. Auf Putins Nachttisch liegt direkt neben dem Buch von Machiavelli Il Principe, das Buch mit dem Titel Dell’arte della guerra. Ein Satz daraus besagt, lass keine Chance verstreichen, die fast keine Kosten hat (Jakobsen S. 24). Also rein in die Ukraine bevor das Land und Leute zu stark werden. Tor Jakobsen (Hrsg.) hat das in dem Band zu Krieg, Theorien und Forschung gut herausgearbeitet. Die Einleitung listet die Gründe für Krieg. Den Soziologen interessiert besonders die Erwähnung von gesellschaftlichen Strukturen, auf Russland bezogen würde das den Einfluss von Militär auf und Status innerhalb von Gesellschaften einschließen. Besteuerung für die Unabhängigkeit der USA sowie die Bedeutung von grenzüberschreitendem Handel gehören zu diesen Themen. Neben diesen liberalen Thesen für oder zur Vermeidung von Krieg existieren die sogenannten radikalen Argumente, wie Ungleichheit, ausländische Investitionen und Imperialismus, die zu erhöhten Risiken für Krieg führen (S. xii.). Tilly 2003 The politics of collective violence erweist sich als wichtige Lektüre. Kreieren einer Identität zusammen mit political entrepreneurship schaffen gemeinsam Voraussetzungen für kollektive Gewalt. S. 25. Im Konflikt der Ukraine spielen ethnische, sprachliche und kulturelle Ursachen ebenfalls eine Rolle. Auch lässt sich die ökonomische Erklärung von Krieg mit Zugewinn- und Verlustkategorien errechnen für alle beteiligten und sogar scheinbar unbeteiligte Parteien. Kosten-Nutzen-Analyse lässt grüßen mit all ihren Unwägbarkeiten und potenziellen oder faktischen Fehleinschätzungen. Für den derzeitigen Krieg in Europa lässt sich die deprived actor Theorie auf das russische Militär beziehen während die ukrainische Strategie versucht dem rational actor Modell folgt. So stehen sich neben den Heeren auch Theorien gegenüber. Mir gefielen die Sandkastenspiele bei denen nicht wirklich geschossen wurde am besten. Vielleicht ist ja doch noch was in dem Spruch: Putin will wieder Krieg, aber keiner geht mehr hin.