Maybe you may have heard of the Blue Zones – five regions of the world notable for the highest longevity, meaning that people live longer, on average, than anywhere else on Earth.
These regions are geographically and ethnically diverse in comparison with one another. Yet they all share six common characteristics, ranging from a healthy diet to regular exercise and a paucity of smoking. Yet, two of these characteristics associated with health and longevity fascinate me the most. They are family as a priority and social engagement.
As a primary care physician, I have found that the greatest obstacles not only to longevity but also to physical, mental and even spiritual well-being are what are known as the social determinants of health. Poverty, poor education, transportation problems, inadequate housing, unstable relationships, workplace stress and lack of real social connectedness are just a few of these variables.
The United States is challenged by high rates of depression, suicide and substance use, among other socially-connected health problems. Meanwhile, life expectancy at birth has declined for three consecutive years. Disease and death rates are disproportionately high among the most marginalized members of society.
According to the Centers for Disease Control and Prevention, only about 20 percent of factors affecting health can be addressed by health care, while the remaining 80 percent are because of socioeconomic, environmental and behavioral factors.
It is no coincidence that social connectedness is a protective factor for those at risk of suicide, or that measures of well-being such as longevity have been associated with communities that have greater family and social engagement. Indeed, evidence suggests that as social beings, we need each other at the family and community level. Our very health and survival seems to depend on social infrastructure.
Let me briefly illustrate my point. Suppose I am counseling a patient about the complexities of managing their diabetes through exercise, weight management, dietary change and medication treatment to reduce risk of diabetic complications, such as kidney failure or heart disease. Now suppose the same patient just lost a job, is going through a divorce and has no local social support network.
Social infrastructure promotes social engagement, including engagement in family life, community and civic life, and even spiritual life. A society that builds effective spaces and institutions to bring people together in meaningful, productive and rewarding relationships may enjoy the rewards, not only of economic success but also better physical, mental and spiritual health. It begins with supporting families, especially those on the margins of the community.
What do things like excellent schools, welcoming places of worship, safe and inviting public spaces, civic organizations and quality affordable housing have to do with health? Perhaps everything.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.