As the Solidarity City Cologne network we draw attention to the unequal access to health care and the social conditions for health and illness. In the spirit of a city based on solidarity, we are committed to dismantling discriminatory barriers in the health care system and ensuring access to health care for all. To do this, we must focus on the conditions that need to be changed:
INCOME AND HEALTH:
Life expectancy and health depend largely on income and class. In Germany, for example, the richest 10% of the population live around 10 years longer than the poorest 10%. People with lower incomes also get sick more often, more severely and for longer than the wealthy. The relationship between health and economic position is linear, which means: the lower our income, the earlier we die, which we see in Cologne, too. In Mülheim for example people in average die six years earlier than in Lindenthal! These figures show serious injustices in our society: Different forms of disadvantage always affect the same people and have an accumulating impact on their health.
INFRASTRUCTURE AND HEALTH
Wealthy people specifically have better access to medical care. Not only the preferred treatment of privately insured people plays a role in this. There are also more doctors and pharmacies available in parts of the city where more wealthy people live. Compared to city center in Chorweiler twice as many people have to be cared for in a single family doctor’s practice.
Of course this results in longer waiting times for the patients, less treatment time, as well as stressed staff. And when it comes to medical care by specialists, it looks exactly the same, which is why people in structurally weak parts of the city often have to wait longer for urgently needed therapies or medication or do not even get properly diagnosed. But not only is medical care determined by our social class. Whether and how often we get sick is generally a question of income and other social factors.
LOCATION AND HEALTH
Our health is influenced by where and how we live. Where and how we live depends in turn on our income and our chances on the housing market. People who have little money or who have difficulties finding a place because of discrimination or physical limitations often live in less healthy environments.
People who live in Lindenthal have an average of 10m² more living space than people who live in Kalk. How much space we have for our privacy has a decisive influence on our stress level and that in turn on our immune system and our health.
Other environmental factors also play a role: constant noise from airports, rail networks and motorways, for example constantly stress us, which is unhealthy. Poor air quality also leads to illness, especially in our airways. In 2016, at least 550,000 people in Europe died from air pollution.
This means our health also depends on the level of pollution from the busy streets near our home and how many green spaces there are (most green spaces, and thus less noise and pollution can be found in Ehrenfeld, Nippes and Lindenthal, and the least in the city center, Chorweiler and Porz).
WORK AND HEALTH
Our working conditions also have a significant impact on our health: Those who have a stressful and physically demanding job get sick more often. Anyone who is precariously employed or in insecure work and who is afraid of losing his*her job cannot take sick leave long enough to cure properly and get well.
Only recently we were reminded of the exploitative conditions in German butcher shops, because employees suffering from COVID-19 were forced to continue to work. This not only endangered themselves, but also all colleagues who work there under the same conditions
DISCRIMINATION AND HEALTH
Social inequality is of course not only determined by our income. Also unemployment and lower educational qualifications lead to poorer health and shorter life expectancy.
Other structural inequalities such as racism or sexism (which in turn often have a say in social class) also affect our health: Recurring experiences of discrimination are stressful, not to mention the fact that even life-threatening discrimination can occur in medical institutions. The maternal mortality rate at birth in the USA is more than three times higher for black women than for white women.
Much medical research has been and is primarily aimed at (cis-)male bodies, which means that, for example, strokes in women are less frequent and later diagnosed than in men. Trans people and people who do not identify with the female or male gender are regularly exposed to discrimination in Europe
health systems, which can lead to poorer treatment and considerable psychological stress.
People who are in the asylum procedure receive only the most necessary acute care, which aggravates the chronic course of illness. The constant worry of getting sick accompanies an everyday life that is often shaped by struggles for decent housing, access to education, forced precarious jobs and the constant threat of deportation. In addition to legal hurdles, adequate care is prevented by language barriers and discrimination.
In the corona pandemic, we clearly see which groups are better protected and which people are less protected. People in refugee accommodation or homeless people are not only exposed to a greater risk of infection, they often have no insurance cover and therefore only limited access to the health system. The same applies to many people from other EU countries or to self-employed who can no longer pay their contributions due to financial difficulties
SOCIAL DETERMINANTS OF HEALTH: WHAT MAKES US SICK
Whether people are healthy or sick, depends not only on their individual behavior and physical conditions, but also on the social conditions in which they live. Poverty and illness are not an individual failure, but a structural problem that affects society as a whole. Inequality in income, living conditions, environmental influences, working conditions and education, as well as racism and various forms of discrimination are determining factors for health.
Health needs healthy living in an intact environment, a safe residence status, healthy air, the chance of good nutrition and sufficient opportunities to move. Health needs social conditions that enable social participation, co-determination and education free from discrimination and power structures. The connections between living conditions and health have been known for decades and have been adequately scientifically proven. But despite increasing prosperity, the difference in life expectancy between poor and rich people has even increased in Europe in recent years.
It is possible and urgently necessary to counteract this with political measures. Our health is a valuable, vital asset and everyone has the right to physical integrity and good health care!
But instead of the common fight against disease-causing factors in our working and living environment, the individualization of illness takes place: Individuals are made responsible for their health.
Therefore, it is fatal that we change our health care (private) economic logics such as supply and demand, and thus subject to competition, cost reduction and profit pressure. This makes it impossible to look at the social causes of illness. The well-being of the patients – and everyone equally – necessarily becomes neglected. The supply landscape that is created to be in line with the market, affects the most vulnerable of our society.
As long as there is no body that coordinates health care fairly, there will always be more practices, hospitals and pharmacies where people can pay more money.
As long as there is no unconditional access to medical care for everyone, some people will just not be supplied, which can also be fatal for public health (especially in pandemic times)
As long as our education system cannot offer all people the same opportunities, poverty and thus also lower life expectancy are passed on from generation to generation.
And as long as there are no clear rules against exploitative and precarious working conditions, there will be sick working conditions and people who have to go to work sick to earn money.
Health for everyone can only exist if we are aware of the basic structures of inequality in our society and ready to change them!