community: a matter of life and death?

Posted on June 4, 2009

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There was no suicide, no alcoholism, no drug addiction, and very little crime. They didn’t have anyone on welfare. Then we looked at peptic ulcers. They didn’t have any of those either. These people were dying of old age. That’s it.” (Malcolm Gladwell, Outliers, p. 7)

“Living a long life, the conventional wisdom at the time said, depended to a great extent on who we were—that is, our genes. It depended on the decisions we made—on what we chose to eat, and how much we chose to exercise, and how effectively we were treated by the medical system. No one was used to thinking about health in terms of community.

(In finding the answer to this mystery of health) they had to look beyond the individual. They had to understand the culture he or she was a part of, and who their friends and families were, and what town their families came from. They had to appreciate the idea that the values of the world we inhabit and the people we surround ourselves with have a profound effect on who we are.” (pp. 10-11)

Can living in community dramatically affect the physical health of a whole town?

The Roseto Mystery

“Roseto Valfortore lies one hundred miles southeast of Rome in the Apennine foothills of an Italian province. In the style of the medieval villages, the town is organized around a large central square.” (p. 3) A group of Rosetans immigrated in 1882. They called their new settlement, Roseto, Pennsylvania.

“Stewart Wolf was a physician. He studied digestion and the stomach and taught in the medical school at the University of Oklahoma. He spent his summers on a farm in Pennsylvania, not far from Roseto—although that, of course, didn’t mean much, since Roseto was so much in its own world that it was possible to live in the next town and never know much about it.” (pp. 5-6)

Wolf recalls, “One of the times when we were up there for the summer—this would have been in the late nineteen fifties—I was invited to give a talk at the local medical society. After the talk was over, one of the local doctors invited me to have a beer. And while we were having a drink, he said, ‘You know, I’ve been practicing for seventeen years. I get patients from all over, and I rarely find anyone from Roseto under the age of sixty-five with heart disease.” (p. 6)

“Wolf was taken aback. Heart attacks were an epidemic in the United States. They were the leading cause of death in men under the age of sixty-five. It was impossible to be a doctor, common sense said, and not see heart disease. Wolf decided to investigate.” (p. 6) “The results were astonishing. In Roseto, virtually no one under fifty-five had died of a heart attack or showed any signs of heart disease. For men over sixty-five, the death rate from heart disease in Roseto was roughly half that of the United States as a whole. The death rate from all causes in Roseto, in fact, was 30 to 35 percent lower than expected.” (p. 7)

“Wolf brought in a friend of his, a sociologist from Oklahoma named John Bruhn, to help him. ‘I hired medical students and sociology grad students as interviewers, and in Roseto we went house to house and talked to every person aged twenty-one and over,’ Bruhn remembers. This happened more than fifty years ago, but Bruhn still had a sense of amazement in his voice as he described what they found. ‘There was no suicide, no alcoholism, no drug addiction, and very little crime. They didn’t have anyone on welfare. Then we looked at peptic ulcers. They didn’t have any of those either. These people were dying of old age. That’s it.’” (p.7)

“Wolf’s profession had a name for a place like Roseto—a place that lay outside everyday experience, where the normal rules did not apply. Roseto was an outlier.” (p. 7)

Next they studied the dietary practices expecting to find an answer. They found that the Rosetans were cooking with lard in stead of the much healthier olive oil they had used in Italy. They ate high fat meat and too much sugar. 41% of their calories were from fat! They smoked heavily and struggled with obesity. They were not prone to exercise either. Next they studied their genetics to see if there was a connection. Other people from the same region of Italy did not share the remarkable good health. They studied the region of Pennsylvania to see if there was something environmentally that would influence such outcomes. “Wolf combed through two (local) towns’ medical records. For men over sixty-five, the death rates from heart disease in Nazareth and Bangor were three times that of Roseto. Another dead end.” (p. 9)

“What Wolf began to realize is that the secret of Roseto wasn’t diet or exercise or genes or location. It had to be Roseto itself. As Bruhn and Wolf walked around the town, they figured out why. They looked at how the Rosetans visited one another, stopping to chat in Italian on the street, say, or cooking for one another in their backyards. They learned about the extended family clans that underlay the town’s social structure. They saw how many homes had three generations living under one roof, and how much respect grandparents commanded. They went to mass at our Lady of Mount Carmel and saw the unifying and calming effect of the church. They counted twenty-two separate civic organizations in a town of just under two thousand people. They picked up on the particular egalitarian ethos of the community, which discouraged the wealthy form flaunting their success and helped the unsuccessful obscure their failures.” (p. 9)

“’I remember going to Roseto for the first time, and you’d see three-generational family meals, all the bakeries, the people walking up and down the street, sitting on their porches talking to each other, the blouse mills where the women worked during the day, while the men worked in the slate quarries,’ Bruhn said. ‘It was magical’”. (p. 10)

“When Bruhn and Wolf first presented their findings to the medical community, you can imagine the kind of skepticism they faced. They went to conferences where their peers were presenting long rows of data arrayed in complex charts and referring to this kind of gene or that kind of physiological process, and they themselves were talking instead about the mysterious and magical benefits of people stopping to talk to one another on the street and of having three generations under one roof. Living a long life, the conventional wisdom at the time said, depended to a great extent on who we were—that is, our genes. It depended on the decisions we made—on what we chose to eat, and how much we chose to exercise, and how effectively we were treated by the medical system. No one was used to thinking about health in terms of community.

“Wolf and Bruhn had to convince the medical establishment to think about health and heart attacks in an entirely new way: they had to get them to realize that they wouldn’t be able to understand why someone was healthy if all they did was think about an individual’s personal choices or actions in isolation. They had to look beyond the individual. They had to understand the culture he or she was a part of, and who their friends and families were, and what town their families came from. They had to appreciate the idea that the values of the world we inhabit and the people we surround ourselves with have a profound effect on who we are.” (pp. 10-11)

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