Community as medicine: Addressing the risks of social isolation

07/31/2019

As a primary care physician and a member of a community blessed with many elders, I often contemplate the process of aging and what we know about living long, active and healthy lives. I think about how our choices about how much and what we eat, whether we smoke and drink alcohol, and the regularity with which we exercise all matter. Yet the greatest factors in longevity found in a seminal meta-analysis are the degree to which we have close relationships and how socially integrated we are. 

As I write this article, I am visiting my grandmother in celebration of her 90th birthday. Like the elders in the landmark “blue zones” study that examined communities with many centenarians, my grandmother lives independently, is creatively and meaningfully engaged, keeps her home tidy and clean (and still shovels her own walk), and has close relationships with her family, especially with her daughter, whom she sees nearly daily. She is blessed with a few very close relationships with loved ones in whom she can confide. She is integrated in her community. 

But my grandmother is fortunate. Increasingly, people in our society report feeling lonely, isolated and without a single person in whom they can confide. We now know this is as risky to one’s health as obesity or smoking a pack of cigarettes a day. Study after study underscores how dangerous social isolation is for our health; a 2015 study done by Nicola Valtorta and colleagues found that social isolation increases one’s risk of heart attack by 29 percent and of stroke by 32 percent. Being isolated increases the risk of dying in the next seven years by 30 percent. Clearly this is a threat to our collective wellbeing.

What can we glean from the experiences of those living in the so-called blue zones? Places like Sardinia and Okinawa, and amongst the Latter Day Saints of Loma Linda, where people live healthily to a ripe old age? Though many things stand out—including varied diets, with not a single gluten-free, low carb, dairy-free regimen among them—it is notable that elders in these communities are integrated into the fabric of the lives of their families and friends. On the island of Okinawa, for example, children are assigned to a “moai,” a group of five or six people who agree to be there for each other for life. Adults can form these groups, too, meeting regularly and meaningfully sharing with each other their challenges and joys, and giving and receiving assistance when needed. Elders are honored and treasured, supported and celebrated. 

One of the conclusions drawn in a longevity meta-analysis conducted by Julianne Holt-Lunstad in 2010 is that we have a clear understanding of the health risk of social isolation. It is now time to turn our attention to doing something about it. We can consider this in many ways. 

Within the context of our individual lives: do I have a friendship I could nurture with intention? Is there an estranged family member with whom there could be healing? How do I show up for friends in need of a compassionate ear? Could I host a regular potluck dinner at my home, or in a rotation with friends? Do I smile at people? Make small talk with the bank teller? Cuddle my children?

Within our work realm, where we spend so much of our time, what would it be like to start each work day or meeting with a brief check in regarding how we are doing? Or with an expression of something for which we are feeling grateful?

And for those of us in medicine, how can we respond to this poignantly pressing health risk? What is the physician’s role in community, in society? How can we explore the intersection of social support and positive peer influence toward health and resilience on physical, emotional and spiritual levels? Might there be a role in community health centers like the Coastal Health Alliance for a health care provider applying community as medicine, so to speak? What would that look like? Academically, what would a community medicine fellowship look like if it fully considered what is meant by the medicine of community? What sort of community-weaving structures, programs and experiences can support people in strengthening social bonds?

I look forward to deepening this inquiry both at the Coastal Health Alliance and in my work in the Commonweal Garden. We do community well here in West Marin, and we are well-equipped to explore the medicine of community. I look forward to sharing some of what we are co-creating with medical students and fellows, in our Community Medicine Circles and the Art of Vitality program, and in the series of Retiros para Mujeres, which we are conducting in collaboration with Abriendo Caminos. 

We are blessed to live in a place where people know each other. Yet even here, isolation happens. Let this be an invitation to call up a friend you’ve been meaning to reach out to, or to introduce yourself to neighbors. Engage in meaningful dialogue about what is on your heart. Listen. 

 

Anna O’Malley is an integrative family and community medicine physician with the Coastal Health Alliance. A Bolinas resident, she is the founder and director of Natura Institute for Ecology and Medicine in the Commonweal Garden. For opportunities to engage in community as medicine, visit naturainstitute.org.