Justice and equality as a zero-sum game

All social science research contains worldviews. Society is diagnosed as being in a state of needing attention and action. Different ways of approaching societal issues inevitably carry strengths and weaknesses, and in the worst case, researchers become trained into a tunnel vision where they cannot see how things are connected.

In the past 20 years, social epidemiology has risen to become a hugely popular and important area of research. The very designation makes its popularity easy to understand: The idea is that in the same way that you can follow diseases and health in populations, you can follow the socially determined circumstances that make some more inclined to have certain kinds of (health-related) concerns. A classic example from alcohol research is that people with higher socioeconomic status have less negative consequences of alcohol use. This notion is bound to challenge our view of health-related justice.

Like all other research traditions, social epidemiology also entails its own risks of epistemic tunnel vision. Notions of justice and equality can easily become simplified zero-sum games in which some are winners and others losers.

In Finland, those living on the west coast have historically had better socioeconomic circumstances than those living inland and in the east of the country. The west coast provides better soil for cultivation, ample fishing, and more exchange to the west and with the outside world, which have all contributed to the population's economy, health, and well-being. This is also the area of Finland that borders Sweden and has a sizeable population with Swedish as their mother tongue as a result of Finland being a part of Sweden for 600 years.

If we only look statistically at these Swedish speakers as a group, without seeing the historical and geographical context or the generally higher standard of living, we could conclude that Swedish speakers in Finland are on the whole better off than the rest of the population. Many national populists and far-right commentators use such statistics to claim that the entire language group consists of upper-class oppressors.

Statistical interpretations can become schematic and, in the worst case, reactionary. Social epidemiologists are usually highly aware of the dangerous assumptions that can arise from the fact that the paintbrush is so broad and at the same time so convincing and evident in mathematical terms: a historical case which has similar over- and undertones is that Jews are better off than other population segments.

Threats, winners, and losers

Identifying patterns of health inequality plugs into our contemporary morality where everyone should be treated the same and have the same starting point. Social epidemiology measures and brings into light something that almost all people can agree is wrong: the mechanisms of injustice. However, the seemingly number-based and amoral worldview of epidemiology may not always capture all or even the most important injustice when problematised further. If a repeated research task is to identify winners and losers, the definition of social weakness and social strength will become extra important for conclusions and agenda formulations.

As social scientists, we are schooled to sniff out those who are losing out and who need society's support for having the same chances in life as everybody else. The research task is sometimes automatically interpreted as that of detecting vulnerability, victims, and winners and not necessarily to understand the sustainability and complexity of a system as a whole. The result is that some admirable and important research risks getting stuck in a one-tracked focus making it difficult to hold people accountable who do not keep their part of the social contract. From addiction research we know that a victimisation or a dismissal of peoples’ agency and capability is not only a difficult path for rule of law and accountable welfare state interventions; it can also make it more difficult for people to get out of their vulnerable situation.

As researchers we need to remind ourselves of the extent of the responsibility in our assignment. As the Swedish health professor Hans Rosling (2019) reasoned, our statistical evidence often remains a contribution to the discussion. It seldom presents a coherent story and trajectory with explanations. In this way, social epidemiology is in fact very much “epidemiology” and nothing else. In comparison, sociologists’ message can, for example, be empirically both less compelling and concretely useful: there is no hard evidence of how the masses’ health and well-being are distributed. But the understanding of why this is so is anchored in the great historical development of ideas, and is a path where sociologists or humanists can show greater strength.

However good our intentions are, predictable research with a fixed perspective is often a sign of stagnation. Tunnel visions and blind spots can perhaps be remedied by mixing researchers of different traditions in common environments and research projects. This can be difficult to achieve in a sensible way: researchers rarely have time to engage in difficult epistemic discussions and immerse themselves in the work of other researchers in a meaningful way. Mixed epistemic environments do not necessarily mean that the argument becomes more nuanced. On the contrary, sometimes the camps just get stronger and the dividing lines bolder. Until a solution to the increasing deep-drilling specialisations and adherent worldviews is reached, it is important to continuously reflect upon the tunnel visions and blind spots that we all have.

In this issue

The contributions by Piispa et al. (2022) and Pylväs-Korolainen et al. (2022) focus on non-medical use of prescription drugs (NMUPD). The message is that this phenomenon must be understood from the users’ perspective. Based on survey data, Piispa and colleagues are able to show an association between a low education level and illegal drug use, on the one hand, and intoxication-oriented and other non-medical use of prescription drugs, on the other. Intoxication-oriented use is also related to younger age and current smoking. The factors associated with NMUPD that Pylväs-Korolainen et al. (2022) were able to discern concerned living alone and being outside the labour market. Frequent binge drinking and a high number of drug prescriptions were associated with both NMUPD and illicit use.

Marionneau and Järvinen-Tassopoulos (2022) have mapped the treatment and help services for gambling during COVID-19 in terms of the experiences of gamblers and their concerned significant others. Concered significant others are also discussed by Hellum and colleagues (2022), in a study investigating what problems concerned significant others of heavy drinkers experience prior to seeking professional help. Alcohol policy measures are studied in terms of alcohol taxation, alcohol consumption, and cancer in Lithuania by Rovira and colleagues (2022) and in view of hospital admissions and fall injuries among elderly Norwegians (Bye et al., 2022). Finally, Ólafsdóttir and Marinósson (2022) explore the experiences of individuals brought up by relatives with excessive alcohol use, examining their own alcohol use in adulthood.