Every week I buy eggs that come from no-cage farms, they are more
expensive because thy are organic. Chickens in those farms are supposed to
be happier than chickens living in cages. There is no mention about
neither morbidity or mortality rates of these chickens. It is about
chickens’ dignity.
What does mean self-esteem? Likely, the answers will plentifully come
from clinical psychologists or other mental health experts focused on
individualistic symptoms of sickness and health. Marmot is brave enough to
use a language that permits confusion between the sociological point of
view of the solution (exposures) and the individualistic sight of both the
pathway (intermediate factors or mechanisms) and the consequences
(outcomes). As with typhoid fever, if the consequences are individual...
the self-protective status-quo of our society will utilize individualistic
solutions acting over individualistic risk factors. Specific problems are
solved in this way and inequalities persist. Those who enjoy the social
gradient because are at the top would not like to be affected by
decreasing the beneficial health effect of being “far the best”.
If the causative associations between self-esteem and premature both
death or disabilities were strongly supported by evidence, the consequence
would not be necessarily a social reengineering to decrease social
inequality. Likely, a pill with “aspirin, a statin, three blood pressure
lowering agents in half dose, and folic acid” could reduce cardiovascular
deaths in high risk population(1). Therefore, I would expect the same kind
of approach, an immediate and effective solution very close to the outcome
and focused at the individual level. Maybe a combination of the previously
mentioned pill with the addition of a sedative antidepressant.
Both morbidity and mortality rates caused by frequent diseases do not
still have enough political power to be utilized as the final argument to
change our society. They are important values, but they are not so broad.
Undoubtedly, Marmot (and Richard Sennett) put us closer to social
solutions than we have usually been. Also undoubtedly, human dignity
should be measured using factors closer to human dignity than just the
morbidity and mortality rates that our farmer probably use and the
chickens’ farmer does not.
1) Anthony Rodgers Editorial BMJ 2003;326:1407-1408 (28 June) about
Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than
80%. BMJ 2003;326: 1419-23
Competing interests:
None declared
Competing interests:
No competing interests
14 September 2003
Manuel Cifuentes
Epidemiology in Occupational Health
Work Environment Department University of Massachusetts Lowell USA
Rapid Response:
Human dignity or health?
Every week I buy eggs that come from no-cage farms, they are more
expensive because thy are organic. Chickens in those farms are supposed to
be happier than chickens living in cages. There is no mention about
neither morbidity or mortality rates of these chickens. It is about
chickens’ dignity.
What does mean self-esteem? Likely, the answers will plentifully come
from clinical psychologists or other mental health experts focused on
individualistic symptoms of sickness and health. Marmot is brave enough to
use a language that permits confusion between the sociological point of
view of the solution (exposures) and the individualistic sight of both the
pathway (intermediate factors or mechanisms) and the consequences
(outcomes). As with typhoid fever, if the consequences are individual...
the self-protective status-quo of our society will utilize individualistic
solutions acting over individualistic risk factors. Specific problems are
solved in this way and inequalities persist. Those who enjoy the social
gradient because are at the top would not like to be affected by
decreasing the beneficial health effect of being “far the best”.
If the causative associations between self-esteem and premature both
death or disabilities were strongly supported by evidence, the consequence
would not be necessarily a social reengineering to decrease social
inequality. Likely, a pill with “aspirin, a statin, three blood pressure
lowering agents in half dose, and folic acid” could reduce cardiovascular
deaths in high risk population(1). Therefore, I would expect the same kind
of approach, an immediate and effective solution very close to the outcome
and focused at the individual level. Maybe a combination of the previously
mentioned pill with the addition of a sedative antidepressant.
Both morbidity and mortality rates caused by frequent diseases do not
still have enough political power to be utilized as the final argument to
change our society. They are important values, but they are not so broad.
Undoubtedly, Marmot (and Richard Sennett) put us closer to social
solutions than we have usually been. Also undoubtedly, human dignity
should be measured using factors closer to human dignity than just the
morbidity and mortality rates that our farmer probably use and the
chickens’ farmer does not.
1) Anthony Rodgers Editorial BMJ 2003;326:1407-1408 (28 June) about
Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than
80%. BMJ 2003;326: 1419-23
Competing interests:
None declared
Competing interests: No competing interests