Community Cures

George Monbiot calls it one of the most dramatic medical advances in decades. It will save countless lives. It will improve treatment outcomes radically. It will reduce hospital stays. And yet, it is not a new drug. It is not a new surgical procedure. The dramatic advance is a community effort to provide the sick with stronger social connections.

In a town called Frome in the British county of Somerset, local citizens decided to provide community support to the ill. The results were dramatic:

While across the whole of Somerset emergency hospital admissions rose by 29% during the three years of the study, in Frome they fell by 17%. Julian Abel, a consultant physician in palliative care and lead author of the draft paper, remarks: “No other interventions on record have reduced emergency admissions across a population.”

Who discovered and implemented this program? And, what does it look like in practice?

Monbiot has the story:

The Compassionate Frome project was launched in 2013 by Helen Kingston, a GP there. She kept encountering patients who seemed defeated by the medicalisation of their lives: treated as if they were a cluster of symptoms rather than a human being who happened to have health problems. Staff at her practice were stressed and dejected by what she calls “silo working”.

So, with the help of the NHS group Health Connections Mendip and the town council, her practice set up a directory of agencies and community groups. This let them see where the gaps were, which they then filled with new groups for people with particular conditions. They employed “health connectors” to help people plan their care, and most interestingly trained voluntary “community connectors” to help their patients find the support they needed.

Sometimes this meant handling debt or housing problems, sometimes joining choirs or lunch clubs or exercise groups or writing workshops or men’s sheds (where men make and mend things together). The point was to break a familiar cycle of misery: illness reduces people’s ability to socialise, which leads in turn to isolation and loneliness, which then exacerbates illness.

Why does it work?

Social stress causes inflammation and inflammation is not your friend when you are ill:

… people without strong social connections, or who suffer from social stress (such as rejection and broken relationships), are more prone to inflammation. In the evolutionary past, social isolation exposed us to a higher risk of predation and sickness. So the immune system appears to have evolved to listen to the social environment, ramping up inflammation when we become isolated, in the hope of protecting us against wounding and disease. In other words, isolation causes inflammation, and inflammation can cause further isolation and depression.

It’s not exactly news:

A famous paper published in PLOS Medicine in 2010reviewed 148 studies, involving 300,000 people, and discovered that those with strong social relationships had a 50% lower chance of death across the average study period (7.5 years) than those with weak connections. “The magnitude of this effect,” the paper reports, “is comparable with quitting smoking.” A celebrated study in 1945 showed that children in orphanages died through lack of human contact. Now we know that the same thing can apply to all of us.

Dozens of subsequent papers reinforce these conclusions. For example, HIV patients with strong social support have lower levels of the virus than those without. Women have better chances of surviving colorectal cancer if they have strong connections. Young children who are socially isolated appear more likely to suffer from coronary heart disease and type 2 diabetes in adulthood. Most remarkably, older patients with either one or two chronic diseases do not have higher death rates than those who are not suffering from chronic disease – as long as they have high levels of social support.

We assume that Frome, in the county of Somerset, is a relatively homogeneous British town. It does not suffer from cultural diversity. We recall, because Harvard sociologist Robert Putnam researched the issue, that more diversity lowers social capital. More diversity causes people to hunker down, to stay within themselves and their families, to avoid social contacts where they do not know the rules and thus run a constant risk of offending. Diversity isolates people.

So, we are forced to conclude that diversity, per se, is not only confusing. It will damage community ties, draw down your social capital and will make you sick… or, if you are already sick, it will make you sicker.