Huguys as a species have been around for about 200,000 years. For 99. 9% of this period, our average life expectancy is about 30 years. As recently as 1865, a man in Stockholm lived an average of 25 years, while women lived an average of 31 years.
Since that time, massive economic, social and technological advances have fundamentally reshaped society, resulting in major advances in the public physical state. Children born in Stockholm in 2018 are now expected to live to 81 and women to 85. All this is reported in the Folkhälsorapport 2019 (Public Health Report 2019) of the Center for Epidemiology and Community Medicine (CES). The report also provides many descriptions of how fitness is unevenly distributed in Stockholm County. I like it:
Gisela Nyberg, a researcher affiliated with the Department of Global Public Health at Karolinska Institutet and the Swedish School of Sport and Health Sciences, is among the researchers seeking to perceive how the fitness of socioeconomically disadvantaged groups is involved.
It measured physical activity levels among young people across Sweden, based on the age, gender and educational level of the parents. According to their findings, women exercise less than children, activity levels decrease as children get older, and children of less educated parents have less physical activity. active.
“We conducted this study to shed light on the situation,” Nyberg says. “It’s the very basis for starting the projects I’m now involved in. “
One of the assignments Nyberg has worked with is called A Healthy School Start. The goal of this allocation is to save obesity and obesity among young people living in socioeconomically disadvantaged areas. Parents of young people entering kindergarten won a booklet with nutritional recommendations and two Motivational Interviewing Sessions aimed at turning circles of family habits. Children also received instruction and tasks similar to nutrition and physical activity in schools. The task A Healthy School Start has been evaluated several times, the highest recently in a thesis that was presented in June 2022. One of the studies showed that young people had acquired greater eating and exercise habits, but there was no effect on the prevalence of obesity and obesity.
Another task Gisela Nyberg is involved in, A Healthy Generation, targets entire families with at least one child in the current year of number one school, also in socioeconomically disadvantaged areas. Families were invited to participate in two activities consistent with the week. , such as ice skating, basketball or football, all without a fee and without the need for equipment. After the activities, fruit or a healthy dinner were served and a debate led to positioning the food on other facets of physical activity, nutrition and health. Topics include the importance of doing things together such as a circle of family members or how to dress for a forest outing.
Evaluations of this task show that study participants have not only become more active, but also achieved lower blood sugar levels and better quality of life, especially among those who described poor quality of life at the start of the study. Qualitative studies interviewing participants were also conducted. These show that allocation has reduced social isolation. In particular, moms in the domain were introduced to others, which contributed to a sense of security and made it less difficult for them to go out and exercise. he still didn’t dare to play sports in school he also had the courage to participate after having the possibility to see other activities.
“These are difficult things to measure, but they are also very vital parameters for an individual’s health,” Nyberg says. “I think it’s a smart project. I don’t know of any other that engages and strengthens entire families in vulnerable areas. “
Modest effects
In a 3rd project, the recently presented Brain Health in School 2, the extended school day in 3 hours for 8th graders. Up to 60 schools throughout the country will be included, in spaces with other degrees of socioeconomic vulnerability. During those 3 hours, students will be physically active, receive assistance with classroom work, and walk around with an audiobook. Students will be followed up with tests that measure things like fitness, intellectual health, memory, etc.
Gisela Nyberg is also an advisor to Generation Pep, which aims to be a grassroots movement where individuals, nonprofits, the public sector and businesses can care about the health of young people and young people.
So how did these projects develop?
Yes, they have. But they are modest and short-term.
Gisela Nyberg talks about the difficulties in demonstrating the effects of projects that are intuitively experienced as very valuable. Getting control equipment to work properly, for example, can be tricky. Participants in the monitoring organization would likely have titles that require them to be referred to a fitness clinic to help, for example, in the early stages of type 2 diabetes.
“Then we did an intervention in the organization even before the study started,” he says. “Another challenge would be for study participants to simply retire if they end up in the organization, because they need a lot to be part of the organization. “Projects that we will be offering in the intervention organization. That’s why we decided to offer the intervention to the organization also after the exam era ended, but we can’t meet the timing with the organization. “
“Sometimes it’s useless”
Nyberg describes the apparent context of some of the projects: It is well established that obesity and overweight are more common in socioeconomically vulnerable teams and it is also well known that physical activity and nutritional recommendation can save obesity and overweight in young people and young people. Spreading healthy behaviors in teams where there are barriers to implementation is highly desirable.
But how should projects be organized so that they have an effect on: to prevent obesity and obesity in children and youth at risk? And how can we get evidence of what works when projects are difficult to evaluate?
“Sometimes it’s useless,” says Nyberg. I think things are moving too slowly. We want many more people to work in those areas, and we want to place projects that succeed in those who want them most. But it’s hard. If we create an initiative that succeeds among those already active, then we have failed. For example, data campaigns, we do not succeed in the poorest through a data campaign. We don’t know what to do and there are very pocos. de us. But doing nothing isn’t a smart concept either. “
We can put together a long list of health-related threat points that are no more unusual in socioeconomically vulnerable groups. For example, smoking, drug use, fruit and vegetable consumption, physical activity, high BMI, and impaired kidney function, to name a few.
Johan Fritzell, professor of Social Gerontology at the Karolinska Institutet’s Center for Research on Aging, describes two other techniques for research on equity in fitness. One is about the study of the link between other threat points and teams in society. of smoking, alcohol or drug use, or poor eating behavior among other teams in society, as well as in other socioeconomic teams. The other technique is to check to perceive why these and other points of threat are more common or less common in socioeconomically disadvantaged teams – to check to locate the “causes of the causes,” as it is now called.
“The way you look at equity in the physical state,” Fritzell says, “it’s not just about people’s possible choices and lifestyles, but also about social inequality, about life situations in society at large. “
One term used to describe this for an individual is “socioeconomic position” or, in short, “social position. “This is measured through occupation, education or income, but will most likely include a number of points that appear to be around a person’s life, Fritzell says.
According to this reasoning, differences in social position would possibly be similar to differences in physical form in all societies, fashionable and historical, and within other groups. Americans with another kind of life in Kenya, or with high or low wages in a Swedish workplace.
But how does an inferior social position lead to poor health?Or, put another way, why does a superior position offer protection?
Here, the studies become less clear, Fritzell explains. But one way to look for it is that it’s about resource allocation, seen from a broad perspective. Money, knowledge, networks, and intellectual and physical power are examples of resources that give a greater individual opportunity for their own lives. More resources allow for greater freedom in housing and food choices. More resources can also decrease stress, for example, because you care less about unforeseen expenses.
“Researchers who read about the reasons in this way argue that it is not imaginable to get rid of structural differences in fitness without equalizing the clothes and social situations of society,” he says.
Health gaps will need to be filled within a generation.
The Swedish government has set a new public fitness policy target in 2018. Under this new goal, fitness gaps that may be influenced will close within a generation, or more precisely, until 2048. The way forward will be charted by creating social conditions. Eight target spaces were identified, adding education, income, painting environment and housing.
Johan Fritzell, however, does not believe that the purpose will be achieved.
“No, I don’t think we can eliminate structural differences in fitness in about 25 years,” he says. “But it’s a smart purpose to try to reduce them, because there’s no smart argument as to why they deserve to stay. Early in my research, I studied economic poverty and income source distribution, and there are clever arguments as to why this would be a bad thing. The concept of absolutely equalizing other people’s source of income. As far as fitness is concerned, it is difficult to find such arguments. There is no rational justification for why certain equipment deserves to have a higher burden of disease or a shorter life expectancy for purely structural reasons. Because we all have other biological and genetic situations. However, other people from other social categories have no other biological and genetic situations for intelligent fitness, but the differences are structural.
The social gradient is maintained
His own specialty domain deals with the physical fitness of the elderly. Part of his studies have focused on a complicated clinical question: does fitness equality increase or minimize throughout life?? Or is it that as we age, biological and genetic points become more vital, which means that social and structural differences are minimized?
“We’ve come precisely to space science,” Fritzell says. We see in our studies that first there is an accumulation, but that it expires in life, after 90 years, the biological and genetic points take control. “
He and his colleagues chose to show the relative and absolute differences between other socioeconomic organizations. An example that can highlight this is infant mortality in England and Wales in other social categories. in the highest privileged categories. In 2001, the proportion was practically the same: twice as many young people died in the most disadvantaged organization. The relative difference remained unchanged. The number of infant deaths in the most private organization was more than 150 in 1911, but less than ten in 2001. This is compared to the estimated 75 infant deaths in the most privileged organization in 1911, a number that dropped to fewer than five in 2011.
“In this example, the relative differences remain,” says Fritzell. But it would be a mistake to call it a failure because many more young people survived in 2001 than in 1911. It can be argued that we deserve to concentrate on cutting differences in absolute numbers than in relative numbers. This is all that counts when formulating goals and statements of intent. “
COVID-19 a transparent example of inequality
One disease that has obviously unfairly affected the Swedish population is COVID-19. In 2020, the disease was the third leading cause of death in Sweden, according to a report by the National Board of Health and Welfare. Nearly another 9500 people in total died from COVID-19 in Sweden’s first year of infection, with the maximum dying in the first wave in the spring. Nine out of ten people who died in 2020 were over the age of 70, so age played a role in the threat of dying from the disease. But the country of birth also played a role. Among Somalia-born men who died in 2020, COVID-19 was the cause of death in part of the cases. The corresponding figure for men born in Sweden 10%, according to the report of the National Health and Welfare Council.
“COVID-19 is affecting the population in the same way as many other diseases,” says Bo Burström, a professor of social medicine in the Department of Global Public Health at Karolinska Institutet. “This is a very transparent example of the social gradient in health. It is almost ironic that wealthy ski tourists brought the house of infection to Sweden, however, when the disease entered society, it was other teams that were more severely affected, teams that were more exposed to the infection and had a greater vulnerability to the disease itself. Smoking and being overweight, for example, are not unusual in socioeconomically disadvantaged teams. These are points of threat for the emergence of severe COVID-19.
It describes the findings of a new report that interviewed 36 citizens of Järvafältet, one of the spaces hardest hit by the first wave of COVID-19. to follow the recommendations of the public. This is due not only to the fact that many of the interviewees work in service occupations and therefore cannot work from home, but also because buses and public transport are the only imaginable means of transport to get to the works. Hourly paid jobs bring uncertainty about the types of reimbursement offered by the Social Security Agency in the event of sick leave, and older family members can’t be protected when many other people live together in nearby neighborhoods.
“If you need to build equity in health,” Burström says, “you have to build equity in life situations. Having a safe task with enough income and smart housing are components of those smart living situations. But if you grow up in a circle of relatives where no one speaks Swedish at home and no one can help you with your household chores, you’ll probably find it harder to keep up with your studies and then get off to a worse start in the job market. Health inequalities begin with differences in life situations very early in life. “
The task has been extended
Burström is one of the other widely acclaimed task people involving extended home visits from coverage centers for children to new parents in vulnerable areas. As part of this initiative, parents receive six home visits from a nurse from the children’s coverage center and a family counselor circle, who in combination provide recommendation and support. The assignment began in Rinkeby in 2013 and has since expanded to several other locations across the country.
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