The Roseto Effect

Yesterday at work I was discussing ways of reducing health disparities (differences in health outcomes between groups) in the Medicaid population. A brilliant colleague brought up Malcom Gladwell’s “Outliers” which describes the Roseto effect.

Roseto, Pennsylvania, originally a small town of Italian immigrants, shed light on external influences that impact health. Dr. Stewart Wolf noticed that the town’s incidence of heart attacks was much lower than the national average. So began a long-term study on the residents of Roseto! They were known for smoking, drinking alcohol, lack of exercise, obesity, and eating copious amounts of animal fats and sweets, all of which contribute to heart disease. Yet Roseto residents were healthier than most Americans! Why? After obtaining lab tests and histories from town residents, Dr. Stewart Wolf hypothesized that their close social connections had a protective effect on heart disease. Before the 1970s, the town residents maintained a unique culture of a close-knit community with high levels of civic engagement, community support, multigenerational homes, and social gatherings. In fact, Dr. Stewart ruled out other causes such as genetic effect by proving that Roseto residents who moved to other communities had a higher incidence of heart disease. Not only did Roseto residents have better health, they had low rates of suicide, alcoholism, drug addiction, crime, and welfare assistance. The Roseto effect theory strengthened after the 1970s when the town became more Americanized and close-knit social ties broke down, contributing to increased heart attacks.

I sometimes wonder why billions of dollars are spent by modern medicine to treat symptoms of chronic diseases. Studies like the Roseto effect offer a root cause analysis approach. Go after the causes, not the effects!

Stress, loneliness, and helplessness are HUGE factors that contribute to poor health. Being able to trust and confide in other people and receive support during difficult times are crucial to human survival. We are emotional beings! In my opinion, love and spirituality are just as important as a statin or antidepressant medication in improving our wellbeing.

Public health and governmental agencies are finally accepting that other factors besides medical care contribute to good health. Social determinants of health (stable housing, access to healthy food, access to nature), cultural influences, adverse childhood experiences, and social connectedness are hot topics in government right now. In Medicaid, there are many pilot projects that focus on improving a person’s mental health, housing issues and social support in addition to physical health.

My colleague wanted to use the Roseto model to look at health disparities:  analyze why certain groups are healthier than others and share this knowledge to promote changes in groups who are not as healthy. Understandably genetic factors are hard to change, but changing one’s lifestyle or social support is an achievable goal. Or is it?

We live in the time of Millennials, constant screen time, multiple Facebook checks, and decreasing in-person socialization. How can we maintain close-knit social ties when technology is forcing us to do otherwise? I don’t know the answer to this question. As a pseudo-nomad ─ having lived in Houston, Dallas, Los Angeles, and Sacramento ─ with few close friends, I myself have not been able to maintain social connectedness where I currently live.

My dream? Live in one city for an extended period of time and cultivate a close community of friends and family who spend time with each other on a regular basis and help each other out.

A girl can dream, right?  🙂

Check out the video below that explains the Roseto effect.



Toni Morrison’s Views on Work

The New Yorker Magazine can go to extremes to appease its well-educated and slightly stuffy audience.  In depth articles on plant behavior, lingerie in the Middle East, and Bob Marley’s life can get overly complicated. But sometimes they publish pieces that are generous in their simplicity and authenticity, allowing one’s heartstrings to be pulled as if a harp is being strummed for a Celtic tune.

The following New Yorker excerpt by Toni Morrison, which describes her father’s advice about her childhood job, is one of those moving bodies of words that washes away built-up grime.

Advice that Toni Morrison received from her father:

  1. Whatever the work is, do it well—not for the boss but for yourself.
  2. You make the job; it doesn’t make you.
  3. Your real life is with us, your family.
  4. You are not the work you do; you are the person you are.

In the words of Toni Morrison herself:

“I have worked for all sorts of people since then, geniuses and morons, quick-witted and dull, bighearted and narrow. I’ve had many kinds of jobs, but since that conversation with my father I have never considered the level of labor to be the measure of myself, and I have never placed the security of a job above the value of home.”

A big thank you to Toni Morrison’s father for arguing against the career-driven, individualistic American way of life. He stressed the importance of family and home and core identity which are unrelated to one’s work. When I left a career in medicine and was jobless, I had no clue who I was outside of my identity as a doctor. What did I value? What hobbies did I have? Who did I enjoy hanging out with?

To be honest, it was that value of home that saved me from losing my sense of self. It was my friends and family members (and dog!) who lifted me up to try harder,  be better, and smile brighter. My family accepted me despite setbacks with my career because they knew all along that my core would never change. I learned that jobs can come and go but your support system never leaves you.

I am extremely grateful to my family for their unconditional love, and I must also thank myself for discovering who I was at my barest moment.

This New Yorker piece also applies to those entering retirement as they will be challenged to create a meaningful life without a career. I hope you can learn from Toni Morrison’s experience and spread this simple yet powerful wisdom!