Karl Gauffin is a researcher and docent in public health science at the Department of Public Health Sciences at Stockholm University. His research focuses on health inequalities, with current interests in the unequal effects of pandemics and political responses to them, sociological perspectives on mental health, and how ideas about risk, resilience and technological development shape the future of public health.
Q: What is your academic background, and what led you to become a researcher in public health?
My background is in political science, and quite early on, I became interested in health as a social and political issue rather than just a medical matter. At the time, I was particularly interested in health and illness as social categories and how health status relates to social stigma and discrimination.
Later, through an MSc in Health Inequalities and Public Policy and a PhD in Public Health Sciences, I became increasingly convinced of the value of taking a population health approach to health issues. I think that addressing the structural drivers of health problems, and finding ways to regulate them, is often far more effective than relying on medical professionals to advise individual patients on their lifestyle choices.
Q: Your research has examined health inequalities from several perspectives, from childhood conditions and working life to migration and the COVID-19 pandemic. What is it about health inequalities that continues to interest you as a researcher?
Health inequalities are the most concrete manifestation of social inequality that I can think of. Research on social stratification can sometimes be quite abstract, but the fact that social inequalities translate into differences of several years in healthy life expectancy makes them very tangible.
From a research perspective, I also think that health inequalities strike a good balance between being a broad and a specific study area. We can apply established theoretical frameworks and accumulated knowledge to an ever-changing society, where the mechanisms may change while the underlying drivers of health inequalities often remain quite stable.
The pandemic was a stress test of established theories, and we learned a lot. In the early stages, when relatively little was known about the virus and the disease, social groups seemed to be quite equally affected. As knowledge about the disease increased, however, people with more resources were often better positioned to protect themselves, while those with fewer resources remained more exposed and vulnerable. We could see how existing patterns of privilege and disadvantage translated into a strikingly unequal burden of covid-19.
Another way to keep up the interest in the study area is to take advantage in its inherently multidisciplinary nature. My own research moves between social epidemiology, the sociology of health and the medical humanities. I find that shifting between these perspectives helps me to approach familiar questions in new ways.
Q: Another strand of your research looks towards the future and how concepts such as risk, resilience, probability and technological development shape the way we think about public health. What questions about the future of health are you most interested in exploring?
One of the most fundamental principles of public health is that it is better to prevent a problem than to deal with it once it has occurred. Some of the greatest public health achievements in human history, including improvements in sanitation, maternal healthcare, and vaccination, have been based on this principle. Alongside better nutrition, safer working conditions and the development of social welfare systems, these preventive factors have led to massive increases in life expectancy, not least through reductions in child mortality.
However, when we turn to the conditions commonly described as today’s major public health challenges in Sweden, particularly those related to mental health, I’m less convinced that prevention is always the way to go. In fact, I think excessive risk management is often bad for our health. We live in a time when we are intensely preoccupied with anticipating risks and trying to control the future, and this preoccupation can become a source of anxiety in its own right.
There are many ways to study this. I’m particularly interested in our relationship to diseases that have not yet emerged, but which we anticipate and attempt to address in the present, e.g., through testing, screening and risk profiling. How do institutions, technologies and individuals relate to the possibility of future illness? And how does this anticipation shape the way we think about health and illness in the present?
Q: Across your research, a recurring theme is how broader social and political structures shape individual health. Has the way you understand health inequalities changed over the course of your research career?
Ever since I began my university studies, I have been interested in how political and social bodies, such as the state and local communities, respond to, challenge or reproduce social inequalities. Early on, I was inspired by the political theorist Nancy Fraser, who in the 1990s developed her ideas about social justice as a matter of both economic redistribution and cultural recognition. I still find these two dimensions useful for understanding how health inequalities emerge and are sustained, and how they operate in concrete situations.
During the pandemic, for example, we could see how economic resources shaped people’s ability to protect themselves from infection and its consequences. But we could also see how differences in the social and political recognition of particular groups influenced their access to vaccination and other essential services. In a recent paper, I have explored these questions through the concept of “protectability”, which I suggest can serve as an analytical category for understanding the political nature of health inequalities. Asking “Who is considered worthy of protection?” draws attention to how some groups are seen as more deserving of support and protection than others, and how these distinctions can contribute to unequal health outcomes.
This illustrates something that has remained central to my research throughout my career: health is a deeply political issue, and that is what makes it so interesting and important to study.