- Email: [email protected]
Seeking refuge
Perspectives
are entirely caused by 100 different factors, each twice as common among the poor as among the rich. The result would be a two-fold difference in rates of premature death. If a welfare state then succeeded in removing half of those contributions to inequalities in premature deaths, we would still be left with a two-fold difference in death rates from the remaining causes. Now, imagine that there are, in addition, some causes of premature death that act equally in all classes, which are also reduced by stronger welfare systems. The result would then be that better welfare states would be left with larger relative differences in mortality. So although good welfare systems in Nordic countries may not have led to much smaller health inequalities, that does not mean that they are not the source of the lower death rates
enjoyed by their populations, or of the fact that Sweden has achieved the lowest mortality for manual workers in Europe. It would be naive to dismiss the effect of welfare systems on health. In addition, these more egalitarian societies have higher rates of social mobility: reductions in health inequalities might be partly masked by selective mobility. The most important thing that the better welfare states do is to redistribute income. Only Japan has better health than the Nordic countries. That it has a weaker welfare system is offset by the fact that incomes before taxes and benefits start out less unequal. The same pattern can be seen in the USA: the states with the best health tend to be those that have better welfare systems. Once again, the only states that do equally
well without good welfare systems are those, like New Hampshire, which are relatively egalitarian to start with. The overwhelming advantage of improving health by tackling the underlying socioeconomic inequalities is that the benefits extend well beyond health. Reduce relative deprivation and most of the problems of relative deprivation decline. More equal countries not only have better health, they also have lower levels of violence, better educational performance of school children, lower teenage birth rates, lower prison populations, and higher social capital. Rather than a political nettle to be grasped, this is more like an attractive shop window.
Richard Wilkinson [email protected]
In brief Exhibition Seeking refuge
A Refugee Camp in The City An exhibition by Médecins Sans Frontières USA on show at Centennial Park, Nashville, TN, USA, until Oct 8, 2006, and then throughout the USA. For more information about the exhibition see http://www. doctorswithoutborders.org/ education/refugeecamp/ index.cfm
1230
More than 8000 people stood in long lines in New York City recently, not in anticipation of a concert or a ticket to a hot Broadway show, but to imagine themselves as refugees. In Central Park and Prospect Park, Brooklyn, Médecins Sans Frontières (MSF) USA set up A Refugee Camp in the Heart of the City, an interactive, educational exhibit composed of photographs and stations that represent a typical refugee camp, with real field materials used by MSF. The tents and other temporary shelters show the challenges of safety and simple survival for those displaced by war and conflict: how to get clean water (4–19 L per day, instead of the 380 L used daily by most Americans), food, and treatment for the diseases that are all too common in such environments. Visitors, many of them school children, were shown different types of shelters and latrines, tasted a high-protein emergency
ration biscuit, and learned about cholera outbreaks, mass vaccination programmes, and ways to identify and prevent malnutrition. Spectators also had to negotiate models of landmines, representing some of the 45 million landmines that threaten
the lives and limbs of innocent people in more than 80 countries. Some 33 million people around the world, in such places as Chechnya, Colombia, and Sudan, have been forced to flee their homes because of violence and persecution. Two-thirds of those displaced by war have not been able to return to their homes or to a new country. Nicolas de Torrenté, Executive Director of MSF-USA, said this display can’t begin to recreate the uncertainty, insecurity, and vulnerability to violence and disease that marks the life of a refugee, but is instead “a means to try to start a conversation”. Judging by crowds at the New York installations, the conversation looks to be off to an energetic start. The exhibit, which was first shown in France in 1995, moves on to Nashville, and then westward throughout the USA.
Faith McLellan [email protected]
www.thelancet.com Vol 368 October 7, 2006
are entirely caused by 100 different factors, each twice as common among the poor as among the rich. The result would be a two-fold difference in rates of premature death. If a welfare state then succeeded in removing half of those contributions to inequalities in premature deaths, we would still be left with a two-fold difference in death rates from the remaining causes. Now, imagine that there are, in addition, some causes of premature death that act equally in all classes, which are also reduced by stronger welfare systems. The result would then be that better welfare states would be left with larger relative differences in mortality. So although good welfare systems in Nordic countries may not have led to much smaller health inequalities, that does not mean that they are not the source of the lower death rates
enjoyed by their populations, or of the fact that Sweden has achieved the lowest mortality for manual workers in Europe. It would be naive to dismiss the effect of welfare systems on health. In addition, these more egalitarian societies have higher rates of social mobility: reductions in health inequalities might be partly masked by selective mobility. The most important thing that the better welfare states do is to redistribute income. Only Japan has better health than the Nordic countries. That it has a weaker welfare system is offset by the fact that incomes before taxes and benefits start out less unequal. The same pattern can be seen in the USA: the states with the best health tend to be those that have better welfare systems. Once again, the only states that do equally
well without good welfare systems are those, like New Hampshire, which are relatively egalitarian to start with. The overwhelming advantage of improving health by tackling the underlying socioeconomic inequalities is that the benefits extend well beyond health. Reduce relative deprivation and most of the problems of relative deprivation decline. More equal countries not only have better health, they also have lower levels of violence, better educational performance of school children, lower teenage birth rates, lower prison populations, and higher social capital. Rather than a political nettle to be grasped, this is more like an attractive shop window.
Richard Wilkinson [email protected]
In brief Exhibition Seeking refuge
A Refugee Camp in The City An exhibition by Médecins Sans Frontières USA on show at Centennial Park, Nashville, TN, USA, until Oct 8, 2006, and then throughout the USA. For more information about the exhibition see http://www. doctorswithoutborders.org/ education/refugeecamp/ index.cfm
1230
More than 8000 people stood in long lines in New York City recently, not in anticipation of a concert or a ticket to a hot Broadway show, but to imagine themselves as refugees. In Central Park and Prospect Park, Brooklyn, Médecins Sans Frontières (MSF) USA set up A Refugee Camp in the Heart of the City, an interactive, educational exhibit composed of photographs and stations that represent a typical refugee camp, with real field materials used by MSF. The tents and other temporary shelters show the challenges of safety and simple survival for those displaced by war and conflict: how to get clean water (4–19 L per day, instead of the 380 L used daily by most Americans), food, and treatment for the diseases that are all too common in such environments. Visitors, many of them school children, were shown different types of shelters and latrines, tasted a high-protein emergency
ration biscuit, and learned about cholera outbreaks, mass vaccination programmes, and ways to identify and prevent malnutrition. Spectators also had to negotiate models of landmines, representing some of the 45 million landmines that threaten
the lives and limbs of innocent people in more than 80 countries. Some 33 million people around the world, in such places as Chechnya, Colombia, and Sudan, have been forced to flee their homes because of violence and persecution. Two-thirds of those displaced by war have not been able to return to their homes or to a new country. Nicolas de Torrenté, Executive Director of MSF-USA, said this display can’t begin to recreate the uncertainty, insecurity, and vulnerability to violence and disease that marks the life of a refugee, but is instead “a means to try to start a conversation”. Judging by crowds at the New York installations, the conversation looks to be off to an energetic start. The exhibit, which was first shown in France in 1995, moves on to Nashville, and then westward throughout the USA.
Faith McLellan [email protected]
www.thelancet.com Vol 368 October 7, 2006