Even without any conscious effort on our part, death is always present in Christmas BMJs. Maybe people write about what's really on their minds when freed from the constraints of traditional scientific communication.

This year's Christmas issue contains more on death and dying than most. Its first two papers, traditional enough in form and content, examine some of the social factors that are relevant to the mortality experience of large populations. Along with other papers in this section, they report that inequalities in life are followed by inequalities in death. By accident of birth or behavioural choice, some of us seem destined to live lives that are less poor, nasty, brutish, and short than those of others.

None of this is news. So why hasn't an awareness of more than a century of such research found its way into modern Western cultural forms? This question is asked by Johan Mackenbach in the preceding article. Representations of the dance of death, which were popular in the late middle ages and early renaissance, often contained criticisms of social inequality. Yet such social critique has largely disappeared from modern versions. "Developing a cultural means of conveying the moral message which follows from research into socioeconomic inequalities in health could be instrumental in raising public awareness," says Mackenbach. "But where is the artist prepared to face this challenge?"

We threw down Mackenbach's gauntlet to the Scottish artist Adrian Wiszniewski. Unexpectedly, he took as his starting point Poussin's Et in Arcadia Ego (left), painted in the early 17th century but depicting a much earlier time. It shows shepherds discovering a tomb, with an inscription that is still argued over. It could mean "I, who am now dead, also lived once in Arcadia," or "Even in Arcadia, there am I [Death]." However it is read, the whole picture seems to embody a warning about the inevitability of death.

The contemplative life costs money

Wiszniewski has retained the shepherds but has introduced a modern well off family on the left, whose son looks with concern at the less well off family in the shadow of the tomb. He's holding out a coin; does he recognise his common humanity with his "brothers" who seem headed for an earlier grave than he? A more subtle message that the artist conveys is that while the better off have the luxury to contemplate life the poor must confront the more immediate question of survival.

Aware that the image was destined for the cover of a doctors' journal rather than a street poster Wiszniewski said that he was trying for something more allegorical and symbolic than a political manifesto. He resisted our suggestion to emphasise further the differences between the haves and the have nots, eschewing "the kind of painting which depicts the underclass as trolls." Nor would he be happy portraying people as upper class twits: "That would be-well-just rude." He said that the history of art was littered with caricatures of class. "By not giving in to that style of representation you're actively fighting class distinctions."

BMJ,
London WC1H 9JR

Tony Delamothe,
deputy editor