Does life exist beyond social networks
Unemployment, social networks and health inequalities
Social Networks and Health Inequalities pp 309-328 | Cite as
- Gerhard Krug
- Stefan Brandt
- Markus Gamper
- André Knabe
- Andreas Klärner
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Unemployment leads to impairment of physical and mental health.
Unemployment leads to impairment of physical and mental health.
- There are two important theses on the role of social networks in this context.
Thesis 1: Unemployment changes social networks in such a way that they no longer fulfill their positive function for health (media orthosis).
Thesis 2: Unemployment leaves social networks unchanged and people with resource-rich networks suffer less from health problems due to unemployment (moderate orthosis).
So far, there is little empirical evidence on either of these theses.
The few quantitative analyzes measure networks only indirectly and are severely limited in their informative value due to the lack of longitudinal data.
Qualitative studies would benefit from more systematizing network influences and thus making them accessible to quantitative analyzes for testing.
For many of those affected, the loss of employment is an event that affects their life cycle, thereby triggering stress (Pearlin 1989) and consequently having a negative impact on health. Meta-analyzes show that the unemployed have a poorer state of health and a mortality risk at least 1.6 times higher than that of employed persons (Herbig et al. 2013; Norström et al. 2014; Roelfs et al. 2011). It turns out that unemployment is primarily associated with lower mental health, but also physical health, and in some cases with riskier health behavior (especially with regard to tobacco consumption) (Freyer-Adam et al. 2011; Khlat et al. 2004; Paul and Moser 2009; McKee-Ryan et al. 2005).
Evaluations of the studies “Gesundheit in Deutschland aktuell” from 2010 and 2012 (Kroll et al. 2016) and current health insurance data (Knieps and Pfaff 2016) show that mental problems (depression, anxiety disorders, etc.) occur more frequently in unemployed people, and that their state of health is clear and that they smoke more often and exercise less than those in employment. While international studies tend to point to higher alcohol consumption among the unemployed (Henkel 2011), there are no notable differences in this regard for Germany: Unemployed women even consume alcohol to a health-critical extent less often (see also Eggs et al. 2014).
Unemployment also negatively affects the consumption of decent and healthy foods such as fresh fruits and vegetables and one hot meal a day. In international research this is referred to as "food insecurity". In the USA, for example, a study on the effects of the 2007–2009 recession showed that unemployment and “food insecurity” correlate strongly (Huang et al. 2016). Evaluations of the Socio-Economic Panel (SOEP) show that the share of expenditure on food in the household budget is significantly higher at 19.2% for the unemployed, but the absolute sum of 205 EUR compared to employed households (13.7% and 362 EUR) is considerably lower (Pfeiffer et al. 2016).
A number of theoretical analyzes assume that social networks play an important role in the health effects of unemployment. Some of the literature assumes that unemployment has an impact on the network and that this change in the network in turn has an impact on health (mediator effect, see e.g. Jahoda 1981; Warr 1987). Others assume that networks reduce the negative health consequences of the stress caused by unemployment (moderator effect, see e.g. Cassel 1976; Cobb 1976; Atkinson et al. 1986).
The present article provides an overview of empirical analyzes on the subject of networks and unemployment. In general, both in everyday language and in science, the term unemployment denotes the lack of gainful employment (see also Ludwig-Mayerhofer 2018). This means that people who do productive work from an individual and social point of view (e.g. in the household or in voluntary work) can be unemployed in this sense. In Germany, according to the social law definition of the Federal Employment Agency, people are listed as unemployed in the official statistics who are gainfully employed but do so for less than 15 hours per week.
An alternative would be the term unemployment, which on the one hand refers precisely to the lack of paid work. On the other hand, the term is also used by the Federal Statistical Office to denote an alternative, internationally comparable measurement concept. This is based on the labor force concept of the International Labor Organization (ILO) and describes people as unemployed who work less than an hour per week.
In the following - also following the literature we have reviewed - we will mostly speak of unemployment, with the term unemployment being largely used synonymously. This is explicitly not associated with any evaluative statement about unpaid work.
First, in Sect. 2, the state of research on unemployment and health is presented. In Sect. 3, the concrete meaning of social networks in relation to unemployment and health is discussed. Sect. 3.1 summarizes empirical research results on the role of networks as mediators, and Sect. 3.2 summarizes research on the role of moderators. Section 4 concludes with a summary and assessment of the state of research.
2 unemployment and health
The negative relationship between unemployment and health has been proven many times. Usually, the thesis that unemployment causes health problems is opposed to the thesis of the selection of people in poorer health. However, the majority of the literature is based on the causation thesis (Kroll et al. 2016; Brand 2015; Wanberg 2012).
In their meta-analysis, Paul and Moser (2009) report that most research on unemployment and health deals with the effects on mental or general health. Physical health plays a subordinate role here. This also applies if one restricts oneself to analyzes with an explicitly causal-analytical design.
Cygan-Rehm et al. (2017) report negative effects on mental health among respondents in the USA, Great Britain, Australia and Germany. The results of Mandemakers and Monden (2013) also show that the negative effect on mental health depends on the level of education. Higher educated unemployed people suffer less from health problems because their chances of being re-employed are better. Although Mandemakers and Monden (2013) report a negative health trend before unemployment, they do not interpret this as evidence of health selection, but rather as negative consequences of the anticipation of unemployment. Young (2012) can also show negative effects on mental health for the USA. These can neither be explained by the loss of income due to unemployment nor by the (non) availability of health insurance. In addition, the state of health, measured on the basis of a depression scale, does not return to the level before unemployment even after returning to work.
For Italy, Minelli et al. (2014) did not find any causal unemployment effects. However, they relate to self-assessed health. With regard to Finland, Böckerman and Ilmakunnas (2009) also find no causal effects of unemployment on self-assessed health, but they show that people who become unemployed at some point were previously in poor health. You interpret this as evidence of the direct selection thesis. By contrast, Tøge and Blekesaune (2015) report a strong negative causal effect of unemployment on self-assessed health in 28 EU countries, which increases with the duration of unemployment. However, since they do not find any concurrent negative health trends before entering unemployment, they rule out the selection thesis. According to Pearlman (2015), unemployment as a result of company closures has a negative impact on self-assessed health, while unemployment for other reasons does not affect health. Gebel and Voßemer (2014) find statistically negative effects on life satisfaction, but no effects on the health satisfaction of respondents in Germany. They interpret their results as evidence of negative causal effects on mental and not physical health. On the other hand, Schmitz (2011) initially finds negative health consequences of unemployment on health satisfaction, mental health and hospital stays, but not for the unemployed who have lost their job due to a company closure. Since this group of unemployed, in contrast to the other unemployed, does not show any health effects, for the author this points to the pure selection of employees who have fallen ill into unemployment and not to negative health effects of unemployment itself. Salm (2009) also comes to similar results for the USA. It finds no effects on the physical or mental health of employees who have become unemployed as a result of company closures and concludes from this that there is no causal effect of unemployment.
On the basis of Norwegian data, Black et al. (2012) work out physical health, here coronary diseases. Korpi (2001) analyzes Swedish data and uses causal analysis methods to report no health effects of current unemployment, but negative effects of past unemployment. In a further analysis, which does not allow any control of unobserved third-party variables, the author can find a connection between poor health and the increased risk of becoming unemployed. According to his own statement, this confirms both the causation and the selection thesis.
Further work deals with health behavior, which can ultimately affect physical health. Marcus (2014) finds significant positive effects of unemployment on cigarette consumption and the body mass index in Germany. However, this is contradicted by the analyzes by Schunck and Rogge (2012), who also examine the effects of unemployment on smoking behavior in Germany, but do not find any significant effect on the duration of unemployment.
Qualitative research focuses primarily on how those affected deal with the situation of being unemployed. Based on the results of her analysis of group discussions with long-term unemployed, Morgenroth (2002, 2003) describes unemployment as a process of grief that can result in depressive circles. The starting point for the creation of this circle is that the emotional occupation of gainful employment as a lost object is not given up. Instead of constructive mourning work in dealing with the loss of a job, forms of processing appear as "pathological derailments" through which this emotional occupation is maintained and which constantly reinforce themselves as vicious circles of depressive reactions (cf. Morgenroth 2003, p. 23 ).
In his qualitative study of action and interpretation practices in the context of and in relation to unemployment, Rogge (2013) shows how people experience unemployment in different ways. Based on an identity-theoretical heuristic, Rogge describes the effects of unemployment as an interplay between contextual and individual processes (ibid., P. 64 ff.). Rogge summarizes these modes of action in five biographical identity modes ("rearrangement of the self", "liberation of the self", "struggle for the self", "decay of the self", "transformation of the self"), whereby the psychological burden of unemployment with the each mode may vary. Especially in the context of the “struggle for the self” there is a fundamental shaking of the self-image through a feeling of incongruity and worthlessness, while in the mode “decline of the self” unemployment is experienced as damaging and can produce irreversible effects. Decisive for the mode in which people go through unemployment, in addition to lifestyles, as well as the provision with economic resources and cultural capital, last but not least, reference persons in the social network of the unemployed. Rogge describes a normative split in personal relationship networks by separating "people who (allegedly) stigmatize unemployment on the one hand, and people who (supposedly) destigmatize it, normalize it or represent alternative and solidary interpretations" (ibid. P. 272). This split results not only in a selective turn to or averted from relationship partners, but Rogge assesses this split as "highly relevant for the mental health of the unemployed" (ibid.).
3 The role of networks in the link between unemployment and health
On the other hand, networks can also help to mitigate the negative effects of unemployment. In contrast to the generation thesis, this thesis of the weakening of negative effects assumes that the networks remain fundamentally unchanged. It says that the unemployed with a resource-rich network can better compensate for the negative effects such as loss of income or loss of meaning. The network then provides social, material, emotional or instrumental support for coping with unemployment. The thesis of weakening is also often called buffer- or Moderate orthosis (see Fig. 1) (see also chapter "Social status, social relationships and health").
The literature on the respective theses is presented in the following two sections. It becomes clear that empirical research on health inequalities has seldom dealt with testing both theses, although at least the thesis of production represents one of the theoretical foundations of research on unemployment and health.
3.1 Media orthosis: network changes as a cause of health effects
The media orthosis is based on a causal chain in which unemployment has a negative effect on the existence and composition of the network in the first step. The changed networks then have a negative impact on health in the second step of the causal chain. It is true that the media orthosis occupies a prominent position in the explanation of negative health effects, in that social contacts are described as one of the latent functions of work that are impaired by unemployment. However, only very few papers can be found that subject the thesis to a direct empirical test.
Paul et al. (2009) report that the negative effect of unemployment on mental health can be fully explained by deprivation of the latent functions of employment. However, the authors do not provide any analyzes of the relevance of deprivation in the sub-area of “social contacts”. Janlert and Hammarström (2009) examine a number of theoretical concepts relating to the relationship between unemployment and health, including social support and network size. You do not find any noteworthy effects for either of the two.The results of Creed and Macintyre (2001) are similar; they find no correlation between social contacts and mental health among the unemployed, but significant correlations between mental health and financial burdens (manifest function) and the latent functions of collective goals, time structure and status . In a study by Krug and Eberl (2018), panel data analyzes were carried out taking into account unobserved heterogeneity and potentially reversed causal directions. There were no indications of mediation effects for the number of close friends (strong contacts) or for membership in at least one association (weak contacts), nor were there any indications of the household income. Instead, some of the negative health effects were conveyed through the lower subjective social status of the unemployed.
While only a few papers deal with the complete causal chain between unemployment, networks and health assumed in the media orthotic, there are far more papers that examine at least part of this process. In addition to the connection between networks and health, this is the influence of unemployment on social networks. A number of analyzes of changes in the size and structure of the networks of the unemployed can be found in the literature. Klärner and Knabe (2016) show, for example, that the transition into unemployment is associated with the loss of the opportunity structure of the job to establish and maintain social relationships. Diewald (2007) reports that the number of friends differs between short-term and long-term unemployed. Short-term unemployed experienced a slight increase, while the number of long-term unemployed people fell in the number of friends. Atkinson et al. (1986) analyze the social relationship networks of around 80 male labor market participants. They report no influence of unemployment on the network size, but show a change in the composition of the network members - which is not described in detail. Russel (1999) shows that the networks of the unemployed also consist to a large extent of the unemployed. This has a negative impact on the availability of social support and help with finding a job. On the basis of a standardized survey of unemployed people in Glasgow, Lindsay (2009) can show that long-term unemployed people less often than other unemployed people use former work colleagues for job seekers, but just as often search through close family and friends. According to Jackson (1988), an analysis of male unemployed people shows that the non-family network shrinks in the course of unemployment, which increases the proportion of family ties in the network. In an analysis based on only 60 teachers but comprehensive with regard to networks, Röhrle and Hellmann (1989) report only minor differences with regard to the size of the network for teachers with shorter, longer or no unemployment at the time of the survey.
Another strand of literature examines the effects of unemployment on the level of social support and on the frequency of contact with network members. According to Atkinson et al. (1986) unemployment reduces both family support and the frequency of contact with acquaintances and friends. A separate analysis according to occupational status (worker vs. salaried employee) shows that the frequency of contact only decreases with workers. According to the authors, the fact that blue-collar workers are more affected than white-collar workers by financial constraints due to unemployment cannot fully explain this finding. Gallie et al. (2001) use data from several countries to show that, overall, the unemployed often meet friends and acquaintances, but are less likely to receive special support benefits than those in employment. In their previously mentioned analysis of teachers, Röhrle and Hellmann (1989) report neither the effects of unemployment on the frequency nor on the intensity of contact. In contrast, unemployed teachers were more satisfied with their network and received more social support than their working colleagues.
Qualitative analyzes also show the dissolution or loss of relationships with colleagues or friends from the world of work and the reduction to the homogeneous network of the closest (mostly family) ages (Cattell 2001; Stead et al. 2001) . The social stigmatization and devaluation of the unemployed is cited as the cause of the downsizing and homogenization of networks as a result of unemployment (cf. Knabe et al. 2017; Hirseland and Lobato 2014; Stead et al. 2001).
The aforementioned processes of downsizing and homogenizing networks can have a negative impact on health. For example, Cattell (2001) describes the health consequences of these structural changes in the network on the basis of 100 qualitative interviews with residents of London who are affected by unemployment and poverty: Among the respondents are many people with mental illnesses and very low self-confidence, including many women, who are materially dependent on their partners. The downsizing and homogenization of networks as a result of unemployment promotes a lack of social support, social dependency and social pressure. In view of these dynamics, health problems are exacerbated rather than mitigated. In particular, the lack of involvement in gainful employment leads to negative well-being due to a lack of moral support and a lack of social opportunities to build self-confidence.
However, networks are not only the cause of problems, they can also help in coping with the negative and health-stressing psychological consequences of unemployment. The actors themselves can respond to the negative consequences of unemployment on their social networks with strategies aimed at expanding the scope for action by shifting social activities to social circles outside the labor market, e. B. in neighborhoods or political groups (see Marquardsen 2012). The availability of opportunity structures for such action strategies beyond the labor market as well as the social and institutional recognition of alternative social roles to that of the employed increases the individual possibilities for action to acquire or defend a recognizable identity by staging one's own personality in such a way that unemployment in the The background moves and instead positive social roles in the network are emphasized (Knabe et al. 2017).
3.2 Moderate orthosis: networks as protection against the negative health effects of unemployment
The thesis of the buffer function is based on the assumption that social support mediated by networks reduces the negative material and emotional consequences of critical life events such as unemployment and thus strengthens the resilience to cope with unemployment (Cassel 1976; Cobb 1976; summarized e.g. by Sattler and Diewald 2010).
The homogenization of social relationships does not only have negative effects on health. Networks made up of mostly unemployed people can provide a shelter from stigma and be an important source of emotional support. Stead et al. (2001) point in this context to the ambivalences of health-promoting and health-damaging mechanisms in social networks. You analyze the social inclusion in disadvantaged communities in Glasgow on the basis of eight group discussions with a total of 53 participants. The respondents' networks are characterized as relatively homogeneous in terms of social status, poor in resources and in some cases with strong group-internal norms of harmful behavior (“pro-smoking community norms”) with simultaneous delimitation of overriding social values (“isolation from wider social norms”) . Unemployment is more the rule than the exception in the networks of the participants. Although the relationship structures researched in this way offer identification opportunities and practical help and thus have a buffer function for the negative (psychological) consequences of long-term unemployment, at the same time the respondents were encouraged to smoke in their networks rather than supported in quitting.
A look at the available sources of social support shows that social networks are one of the first and most important points of contact to mitigate the negative consequences of unemployment, mostly through practical help in emergencies (e.g. assumption of medical treatment costs by relatives) as well as emotional support ( Edin and Lein 1997; Hill and Kauf 2001).
Heflin et al. (2011) investigate the coping with emergencies in families with low incomes based on qualitative interviews with 50 women from the USA and find that costs for medical emergencies in the absence of government aid and already exhausted individual strategies (other, less important bills are not paying, accumulating debts, etc.) can be dealt with in particular through the use of social networks. Sometimes the distress can be alleviated by the financial resources from the network. However, the aid remains uncertain and often ineffective and unsustainable. Networks are even less suitable for covering continuous needs. The consequences are health risks from not using medication and treatments such as B. Painkillers, contraceptives and asthma medication or treatments by the doctor or dentist. Hill and Kauf (2001) describe very detailed mechanisms for the use of social support based on an analysis of 16 unstructured, qualitative individual interviews with employed and unemployed mothers living in households with very low incomes (less than $ 500) in urban and rural areas of Iowa (USA ) Life. Many of the women surveyed are very reluctant to borrow money. In contrast, informal work opportunities such as B. Babysitting for relatives, friends and neighbors. In the analysis, social support appears as an important resource in the network. From the family circle in particular, almost all of the mothers interviewed received small gifts of money, clothing and toys for the children or food. Social support from neighbors and friends appears less material than practical in everyday life, e. B. in the form of childcare, transport and distribution of children's clothing. Social support from the everyday network of relationships is used more frequently than institutional offers. However, this form of support is often only available to a limited extent, as the network partners often also only have limited resources. In addition, the level of support received from the network is reduced by the fact that it is often not accessed in order to maintain a sense of self-efficacy and not to become too dependent on this rather unreliable form of support. Premji and Shakya (2017) show, based on 30 interviews with migrant women, that social isolation is a central mechanism of health impairment through unemployment, in addition to intensified search efforts and increased household and educational tasks. In addition, they point out that the unemployed are more likely to find jobs with poor quality of employment back in the labor market.
As in the case of the mediator effects of social networks, there are only a few quantitative studies that explicitly address the moderator effects of social networks in the case of unemployment.
Atkinson et al. (1986) report that the negative impact of unemployment on mental health is mitigated by family support. They do not provide corresponding analyzes for network size and frequency of contact. However, they emphasize the greater relevance of the analysis of extra-family networks, since in the nuclear family, being affected by unemployment at the same time makes the question of the support function superfluous. Gore (1978) examines 100 men from two company closings how their health development is related to social support. Those who said they had access to social assistance were less likely than other unemployed people to have symptoms of physical illness. Axelsson and Ejlertsson (2002) compare the mental health of unemployed and employed young adults in a cross-sectional study. Unemployment is negatively related to health, although this relationship is weakened by social support. Schwarzer et al. (1994) examine more than 200 emigrants from East to West Germany. They show that those who could resort to social support had fewer physical complaints. But they also point out the negative impact of illness on the availability of social support. The study by Milner et al. (2016) is the only one we know of who investigates the moderator effect on the basis of a population sample and with the help of causal analytical methods. The focus is on the impact of social support on mental health. The authors use the panel study Household, Income and Labor Dynamics in Australia (HILDA) and confirm the moderator effect in fixed effects analyzes. Social support is measured using a mean value consisting of ten items, which, however, for further analysis - for reasons not specified in detail - is coarsened into a polytomous variable with the characteristics low, medium and high social support. It turns out that the negative effect of unemployment on mental health is weakened by high social support, but cannot be completely avoided.
4 Summary and assessment of the state of research
For those affected, unemployment can go hand in hand with a deterioration in physical and, above all, mental health. It is debated to what extent unemployment is also causally responsible for poor health. To answer this question, on the one hand, research designs are required that are particularly well suited for causal analyzes. Significant progress can be observed here in the quantitative analyzes of recent years, such as the more frequent use of longitudinal data and the application of statistical methods to control unobservable third-party variables. On the other hand, however, analyzes of the causal mechanisms through which unemployment leads to adverse health effects are also required. One of these hypothetical mechanisms is based on the idea that social networks are highly relevant to health inequalities. To the extent that this mechanism can not only be explicated theoretically but also empirically confirmed, the research on this also serves as a contribution to the overarching discussion about the causal influence of unemployment in contrast to selection effects.
Therefore, the comparatively small number of empirical research papers that deal with the role of social networks in the connection between unemployment and health is initially astonishing. It is all the more surprising that the literature almost routinely recurs Jahoda's (1981) concept of the loss of latent functions of work, which also includes social integration, to justify expected negative connections. The theoretically asserted high importance of social networks is not reflected in a corresponding number of research papers that deal with this mediator effect, nor of research papers that deal with the related topic of the moderator effects of networks.
Research on moderator and mediator effects of social networks does not only lag behind research on networks and health on the one hand and unemployment and health on the other in terms of quantity. In contrast to research on unemployment and health, explicitly causal-analytical research designs hardly play a role. Many analyzes are based on very small and presumably socially selective samples, no employed comparison group is used and no panel data and associated statistical methods of causal analysis are used. Certainly this cannot be blamed, especially older papers, but with the exception of Milner et al. (2016) and Krug and Eberl (2018) on new work that makes the current possibilities of statistical data analysis usable for the topic.
In contrast to research on social networks and health, it is also noticeable that hardly any measuring instruments are used that would be suitable for an adequate recording of networks and their structures.The reason for this is largely due to the fact that the literature on moderator effects in particular argues less about the actual networks, their structures and the resources they convey. Rather, reference is made to the concept of “social support”, often even to merely “perceived social support”. In addition, the effort involved in surveying ego-centered networks is very high and is therefore rarely used in surveys. A special network survey procedure would have to be designed and tested here - which is tailored to health aspects. There is great relevance for action here, both nationally and internationally.
First qualitative studies show possible mechanisms of influence of social networks of relationships on the connection between unemployment and health. A systematic categorization of network influences on the connection between unemployment and health has so far been lacking. The division into mediator and moderator effects proposed here remains very fragmentary and theses-like in view of the few empirical studies in the literature.
Cattell, V. (2001). Poor people, poor places, and poor health: the mediating role of social networks and social capital. Social Science and Medicine, 52 (10), Pp. 1501-1516. Much-cited essay in which, on the basis of qualitative studies, the dynamics of poverty and exclusion, the living environment as well as health and well-being are discussed, taking into account the role of social networks and social capital.
Jahoda, M. (1981). Work, employment, and unemployment. Values, theories, and approaches in social research. American Psychologist, 36 (2), Pp. 184-191. The essay offers a basic overview of social psychological theories on (acquisition-)Work and unemployment and particularly emphasizes the latent functions of gainful employment.
Krug, Gerhard; Eberl, Andreas (2018): What explains the negative effect of unemployment on health? An analysis accounting for reverse causality. Research in Social Stratification and Mobility, 55, Pp. 25-39. One of the few papers on the mediator effect, the analysis of which is based on panel data regressions. However, networks are only viewed as one of several mediators. In addition, only the extent of strong and weak contacts is considered as network properties.
Milner, A., Krnjacki, L., Butterworth, P., & LaMontagne, A. D. (2016). The role of social support in protecting mental health when employed and unemployed: A longitudinal fixed-effects analysis using 12 annual waves of the HILDA cohort. Social Science and Medicine, 153, Pp. 20-26. One of the few studies on the moderator effect using panel data regressions, but the focus is on social support and not on network theoretical considerations.
Labor market and social security panel (PASS): annual longitudinal survey by the Institute for Labor Market and Occupational Research (IAB), since 2007, with a focus on the social and economic situation of the unemployed and employed; regular survey focuses on social networks and health. Further information: http://www.iab.de/de/befragungen/iab-haushaltspanel-pass.aspx
Socio-Economic Panel (SOEP): annual longitudinal survey by the German Institute for Economic Research (DIW), since 1984 for West Germany and 1990 for East Germany, with a focus on the social and economic situation of the unemployed and employed, regular survey focuses on social networks and health. Further information: http://www.diw.de/de/soep
Panel poverty dynamics and labor market: nationwide qualitative long-term study on changes in the life paths and living conditions of recipients of the basic security for job seekers in connection with activation strategies. Narrative interviews, among others on the influences of the support system on life contexts in multi-person communities of need and on overcoming or consolidating integration problems of benefit recipients with a migration background. Further information: http://www.iab.de/138/section.aspx/Projektdetails/k140110309
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