Dear Students:
Each week, I've written about a variety of health problems and concerns. Most of what I've written has aimed to inform and advise you as individuals who are learning to make your own choices and seek your own well-being. Some have touched on our need to look out for each other and to help support each other as members of a common community. The health benefits of community building, however, far exceed one-on-one mutual support.
When public health researchers look for the factors which determine our health as a population, they find that social and economic relationships are in fact the most powerful factors. One dimension of these relationships is something known as "social capital." Social capital is a measure of people's participation in their community?their sense of trust and their inclination to cooperate for mutual benefit. It includes everything from a community's density of associational memberships to levels of interpersonal trust and norms of reciprocity.
Public health researchers like Ichiro Kawachi study the relationship between social capital and individual health. Kawachi has found that variations in these indicators of social capital correlate strongly with mortality rates. In fact, a 10 percent increase in a community's sense of mutual trust is associated with a nine percent lower level of overall mortality!
Social scientists have long known that social cohesion is a critical determinant of public health. Emile Durkheim, for instance, compared suicide statistics in European countries over time, and concluded that the lowest rates of suicide consistently occurred in societies exhibiting the highest degrees of social integration.
More recently, case studies like Stewart Wolf's of the small town of Roseto, Pennsylvania have shown that social cohesion can have a remarkable effect on a variety of public health outcomes. Wolf found that until the early 1960s, the Rosetans smoked as much as their neighbors, were just as overweight and sedentary, and consumed the same high-fat diets, but had a 50 percent lower mortality rate from heart disease. The only features that seemed to distinguish Roseto from neighboring towns were unusually close family ties and cohesive community relationships. Roseto had more than two and a half times the number of civic associations per capita than its neighbors, and most of them were locally-based, not branches of national groups.
By the mid-1960s, however, people began to look outside of Roseto for work and community group memberships began to decline. Older community ways were gradually replaced by more modern behaviors. Most interesting, homes in Roseto, which had always been built with porches facing the street, were now built with porches at the back, overlooking private yards. By the 1980s, Roseto's heart attack rate was exactly the same as its neighbors.
Health care providers understandably focus a great deal of attention on their individual patients. It turns out that that attention may be a lot less helpful than we'd like to think. Public health researchers point out that medical services have relatively little impact on a population's health. Did you know, for instance, that for almost every measure of population health, the U.S. ranks 25th in the world? We are 25th in life expectancy and 25th in infant mortality. The only population health statistic in which we lead is spending?we spend nearly half of the entire world's health care dollars!
And it's not really all about individual health behaviors either. At least twice as many Japanese men smoke, for instance, than American men, but Japan currently leads the world in life expectancy. Americans who smoke are also twice as likely as their Japanese counterparts to die from smoking-related illnesses.
Commentators like Stephen Bezruchka argue forcefully that the key to understanding these differences lies in social hierarchy, the gap between those on top and those on the bottom in society. They point out that hierarchy has to do with ranking by political, economic, and social status?with gender, class, race, and education. They argue that more egalitarian societies are more likely built on relationships of mutual support, sharing, trust, caring, and community. The very building blocks of social capital.
We need to start small, right here at home. Many of us at Bowdoin are seeking to build a stronger sense of community, to find ways to understand and support each other. The more respect and concern we show one another and the more we are able to build a sense of trust and social obligation amongst ourselves, the greater will be our community's social capital as well as our own individual well-being. There is much to learn, much to be done and much to gain here under the Pines.
Good luck to you all with papers and exams! Take good care of yourselves.
Jeff Benson, M.D.
Dudley Coe Health Center