Originally posted on Linkedin, October 9, 2023
For decades, the health care system has embraced the philosophy of “manage what you measure.” Hospitals and health plans measure hospital admissions and length of stay. The public health community measures the rate of premature deaths, cancer rates and opioid overdoses. Though useful for planning, none of these measures actually offers a blueprint for health improvement. Rather, they simply portray the prevalence of disease or risk factors for disease.
As we measure away, the health of our communities declines. UnitedHealth Foundation found that between 2020 and 2021, the percentage of adults who had three or more chronic health conditions increased by 5 percent. Rates of cancer increased by 10 percent. The percentage of adults who reported their mental health was not good 14 or more days in the past 30 days increased 11 percent. In fact, life expectancy has fallen to its lowest level in two decades, and COVID-19 is only part of the reason why. Heart disease, suicide and liver disease round out the reasons we are dying younger..
Instead of chronicling the decline of our population’s health, it’s time we start doing something about the root causes, such as the degree of social connectivity within our communities. And, if we cannot resist the temptation to measure, then I propose we start measuring the right things, like the social fitness of our communities.
Back in the 1960s, researchers noticed that an Italian-American community in a town called Roseto, Pennsylvania, enjoyed a diet that was 41% fat, drank alcohol and smoked as much as anyone else in those days. Many were obese. By today’s measures, Roseto was a community with poor population health. Yet researchers discovered something interesting: not one of Roseto’s residents died of a heart attack or stroke. In fact, their death rate of men over 65 was half that of the national average. They suffered no ulcers, suicides, drug addictions or alcoholism. What was their secret?
OK, not just porches, but front yards, backyards and streets. They gathered constantly, watched out for one another, celebrated, grieved and lived together — often several generations under one roof. They did not have the newest cath lab or the most venerated oncology department. Instead, what they had was a deep and abiding sense of community. That community sustained them and gave them the purpose, meaning and hope that we all need to stay healthy.
Imagine if, instead of hypertension rates per capita, we measured the degree of community connection. Even better, imagine if your doctor wrote you a prescription, not to reduce blood pressure, but to play cards with your neighbor every Tuesday. It may sound odd to our American ears, but study after study has proven the health benefits of close social connections.
We know that loneliness is as harmful as smoking 15 cigarettes a day, and yet we continue to slink into the gym alone, workout with our headphones on and leave without ever once making a meaningful human connection. Just how healthy are those workouts?
In his book “Bowling Alone,” Robert Putnam noted that in 1995, “More Americans are bowling today than ever before, but bowling in organized leagues has plummeted.” Bowling, in Putnam’s well-researched book, is a proxy for social connectivity. As he wrote, “The broader social significance … lies in the social interaction and even occasionally civic conversations over beer and pizza that solo bowlers forgo. Whether or not bowling beats balloting in the eyes of most Americans, bowling teams illustrate yet another vanishing form of social capital.”
At Element3 Health, we have dedicated ourselves to encouraging people to pursue their passions together. Playing bridge, hiking, and, yes, bowling, are activities that build meaningful relationships and ultimately promote better health.
In a world of multi-billion health care facilities and blockbuster drug discoveries, the challenge is in helping people to understand that good health has a much simpler (and cheaper) prescription: social connection. We can understand the science of how plaque builds up in our arteries and occludes blood vessels. It’s more difficult to appreciate how being socially active, even despite other risk factors, causes you to have better health outcomes. So, it may be awhile before doctors leap to their prescription pads and start recommending their patients join choirs or quilting guilds.
Nonetheless, I am hopeful that we will begin to change our thinking about the causative relationship between social isolation and poor health. What makes me optimistic? First, during the COVID-19 pandemic we saw that isolation and loneliness were as lethal as the virus itself. Second, consider smoking. There was data since the 1950s that smoking causes lung cancer. Despite the evidence, little was done about it by the government or public health community until decades later. But unlike smoking and the formidable tobacco industry, there is no well-financed industry to push back against efforts to change our behaviors. “Big Couch” is not going to stand in the way of you and your pickleball club.
So, I am hopeful that a change is on the horizon — one that promotes social engagement and meaningful connections as the prescription for good health. Then, when we manage what we measure, we can measure what matters.
#measurewhatmatters #loneliness #socialconnection