“You start out from a level playing field, but then it turns out, low and behold, that if you’re from a poorer background, you’re more likely to be overcome by long-term chronic conditions,” says van der Beugel. To illustrate this phenomenon, he conceived of a way to both physically and symbolically correlate the data. He mixed different material aggregates—bits of smashed brick, tarmac pebbles—into the powdered concrete in order to create variations in its density, then poured the substance into frames. Certain areas are consequently more refined, like terrazzo flooring, representing more privileged patients, while others are quite raw. He then inserted steel circular reinforcement bars, or rebar, into the wet concrete, and allowed rusty water—an intentional analogy to blood, as both contain oxidized iron—to pool around them and wend their way through the material.
In the first panel, Pathways of Patients I, the rust trails are arranged haphazardly. This is representative, says van der Beugel, of the “messy, unfiltered, noisy data” that the epidemiologists are confronted with when they initially gather their information. In the second panel, Pathways of Patients II, the same lines are rearranged according to the length of the pathway. “On the left, you have longer pathways from higher socio-demographic backgrounds,” says van der Beugel, explaining that the rust has easily carved its way through the “concrete landscape.” Toward the right, meanwhile, the rust has sunk deeper into the concrete and struggled to get through the more rough-hewn muck. The difference in the trails is analogous, of course, to variations in the difficulties of one’s daily existence as it pertains to healthcare.
In the U.K., where healthcare is free, the differences are not a matter of whether or not someone has the resources to buy more care. Rather, the differences are a matter of how quickly one’s cancer is detected and how closely one might adhere to a treatment plan, says Oliver. “If life is tough for you, then maybe lots of other things need to get done before you can see a doctor. You have different priorities, and a later presentation can mean that things are stacked against you.”