Americans now understand that their health is at risk if they smoke, overeat, and fail to exercise. But a growing body of evidence suggests that public health also depends on a less widely understood influence - social cohesion. And while many Americans have stopped smoking, gone on diets, and put on jogging shoes, American society has become, if anything, less cohesive.
Consider what happened in Roseto, a small Italian-American community in eastern Pennsylvania. During the 1950s, when the town first caught the attention of medical researchers Stewart Wolf and J.G. Bruhn, Roseto posed something of a mystery. Death rates in the small town of about 1,600 people were substantially lower than in neighboring communities. In particular, the rate of heart attacks was about 40 percent lower than expected and could not be explained by the prevalence of factors known to increase the risk of the disease. Citizens of Roseto smoked at the same rate as neighboring towns, they were just as overweight and sedentary, and their diet consisted of about the same amount of animal fat. But the one feature that stood out was the close-knit relations among residents in the community. The town had been originally settled by immigrants during the 1880s, who all came from the same village in rural Italy. The researchers noticed the social cohesiveness and ethos of egalitarianism that characterized the community:
Proper behavior by those Rosetans who have achieved material wealth or occupational prestige requires attention to the delicate balance between ostentation and reserve, ambition and restraint, modesty and dignity. . . . The local priest emphasized that when preoccupation with earning money exceeded the unmarked boundary it became a basis for social rejection. . . . Rosetan culture thus provided a set of checks and balances to ensure that neither success nor failure got out of hand. . . . During the first five years of our study it was difficult to distinguish, on the basis of dress or behavior, the wealthy from the impecunious in Roseto. . . . Despite the affluence of many, there was no atmosphere of "keeping up with the Joneses" in Roseto.
But as young people began to move away to seek jobs in neighboring towns and the community entered the mainstream of American life, the social taboos against conspicuous consumption began to weaken, as did the community bonds that once maintained the town's egalitarian values. About a decade into the study, the researchers noted:
For many years the more affluent Rosetans restrained their inclination toward material indulgence and maintained in their town the image of a relatively classless society. When a few began to display their wealth, however, many others followed. By 1965 families had begun to join country clubs, drive expensive automobiles, take luxury cruises, and make flights to Las Vegas.
The unforeseen consequence of improved material well-being and, probably more important, rising socioeconomic disparities was that the incidence of heart attack in Roseto caught up with neighboring towns within a span of a decade.
The notion that social cohesion is related to the health of a population is hardly new. One hundred years ago, Emile Durkheim demonstrated that suicide rates were higher among populations that were less cohesive. In 1979, after a nine-year study of 6,928 adults living in Alameda County, California, epidemiologists Lisa Berkman and S. Leonard Syme reported that people with few social ties were two to three times more likely to die of all causes than were those with more extensive contacts. This relationship persisted even after controlling for such characteristics as age and health practices, including cigarette smoking, drinking, exercise, and the use of medical services. The basic findings of the Alameda County Study have since been confirmed in more than a half dozen epidemiological studies in different communities.
These findings have ominous implications if the political scientist Robert Putnam is right that social capital is declining in America [see "The Strange Disappearance of Civic America," TAP, Winter 1996]. …