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Health is about communities, not just individual care, researchers say

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National health expenditures are expected to hit $3.35 trillion this year, most of it spent on care for one person at a time: doctors’ visits, hospital stays, prescription drugs. But to really improve the health of Americans, two new studies suggest, we also need to aim for a culture of health in communities as a whole.

In one of two studies out last week in the journal Health Affairs, researchers found that deaths from preventable diseases, such as cardiovascular disease and diabetes, declined significantly over time in communities with tight-knit health networks, such as hospitals and community centers working together to promote exercise or track a flu outbreak. In the second, a team found that cohesive neighborhoods foster good mental health during adolescence, with life-long benefits for children who grow up there.


“Building a culture of health is about how we can get our communities to place greater value on health and well-being,” says Glen Mays at the University of Kentucky, author of the first paper on preventable deaths. “Communities and members of the public absolutely have a clear role in shaping the environment for health.”

Mays and colleagues analyzed survey data from local health officials in 360 communities around the country, collected by the National Longitudinal Survey of Public Health Systems in 1998, 2006, 2012, and 2014. Each official was interviewed about the roles and interactions of various health organizations in his or her community, including government public health agencies, hospitals, community health centers, nonprofit organizations, and more.

The researchers compared those community profiles to causes of death in each area. They found that in locations where many health organizations work together closely and actively to assess and engage a community’s health needs, there was a significant decline in deaths due to cardiovascular disease, diabetes, and influenza — all preventable illnesses. And while more affluent areas were more likely to have large health networks, the effect applies across all communities, says Mays. “There are a large number of communities that have attained these networks, even in low-resource areas.”


Still, the team concluded that less than half of the US population resides in communities with strong, interlinked health networks, so there is much work to be done.

In the second paper out last week, Louis Donnelly of Princeton University and coauthors used data from a long-term health study on 2,264 children born in US cities between 1998 and 2000. Based on interviews with parents and children, from birth to age 15, the team found that teenagers who grew up in neighborhoods with strong social bonds and neighbors that take action — say, by intervening when children fight in the street — experienced fewer depressive and anxiety symptoms than those from neighborhoods with less social cohesion. Again, the association was independent of neighborhood income. The results align with previous single-city studies in Chicago and Baltimore.

That reduction in depression and anxiety in youth is important because mental health problems during adolescence are a strong predictor for a person’s well-being as an adult, including their risk of drug addiction, unemployment, suicide attempts, and early parenthood. Health care professionals should be aware of such neighborhood dynamics when determining if a child is at risk for depression or anxiety, says Donnelly.

By focusing on a community as a whole, we can identify new ways to improve health for all the citizens, such as by supporting local health organizations, says Mays. “These are activities we know how to implement, and they are not very high-cost activities. It’s a matter of generating the will and the leadership.”


Megan Scudellari is a science reporter based in Needham. You can follow her on Twitter @Scudellari.