On the surface, the town of Roseto, Pennsylvania, was not so different from its neighbouring towns, Bangor and Nazareth. Both Bangor and Roseto were populated largely by Italian immigrants, the townspeople shared similar trades and income levels, they had the same water source, and they even used the same hospital. So why did Rosetons have a heart attack fatality rate less than half that of neighbouring communities?
Traditional views on health would immediately point to lifestyle factors. Yet researchers in the 1950s and 1960s were astonished when they studied the lifestyle factors of Rosetons: many of the men worked in slate quarries that exposed them to long-term health hazards; they smoked unfiltered stogie cigars; rather than milk, wine was drunk with abandon; and instead of a diet of lean meats and vegetables, they fried up meatballs and sausages in lard. The researchers came to a striking conclusion that challenged traditional thinking—the social structure of the townspeople was the key to their health.
While the people of Bangor and Nazareth had shifted to a more Americanized, individualistic culture, the people of Roseto maintained the close family and social bonds that they had brought with them from Italy. Most people lived in intergenerational family homes. Homes were also close together, and people stopped to chat with friends every day, cooked with neighbours, and gathered at church together. The study counted 22 civic organizations in a town of 2,000.
Though there were gaps in wealth, it wasn’t obvious. The wealthy lived a similar lifestyle to others, and there were few applications for social assistance. Even more remarkable, Roseto had a crime rate of zero.
Over a 50-year study, the researchers confirmed their hypothesis. At the end of their 1963 study they predicted that if Roseto became Americanized, the heart failure rate would rise to the country’s average. In 1992, they returned to Roseto and found a community much like any other in America. The family and social ties that were so remarkable in the first study had eroded, and just as predicted, the fatality rate from heart attacks was unremarkably average.
The town of Roseto poignantly demonstrates that the social structure we live within determines our health and well-being to a greater degree than genetics, healthcare, and lifestyle choices. Specifically, it demonstrates why social isolation is a major determinant of health and well-being. When we look at groups of people who are most often marginalized and socially isolated—newcomers to a community, people with disabilities, people experiencing poverty—we see a strong correlation between their position in the community and poorer health outcomes.
The negative impacts of social isolation are being recognized and addressed in new and innovative ways in Waterloo Region. The City of Kitchener and United Way KW are both actively working to strengthen neighbourhoods, since interconnected neighbourhoods drastically improve the health, safety, and well-being of its residents.
The Kitchener and Waterloo Community Foundation has identified a low sense of belonging in our region, and has tasked any organization seeking community grants to focus on connecting our community and improving belonging. Roseto reminds us that our efforts must aim to be fully inclusive—to move the needle on health and well-being, we must try to interweave everyone: the marginalized with those who are not, the wealthy with those experiencing poverty, and people with disabilities with those who are currently able.
At Facile Waterloo Region (where I work), we primarily serve people with disabilities to reduce isolation and create a good life for these individuals in the community. The key to this work is creating authentic, two-way relationships. Roseto shows us that as we get more people engaged in community life, and reduce social isolation, we can have a real impact on individual health and wellbeing – not just those coming out of social isolation, but for the wider community.
Though the impact of social structures is throwing traditional thinking about health on its head, as a society we are still not at a place where we label building community networks and supports as “healthcare.” However, as the recognition of social inequities as the driver of health issues grows, so too must our definition of healthcare in Canada. We may never be able to recreate Roseto’s social structure in Waterloo Region (and we should probably skip the lard), but with a collective, community-wide recognition of the power of social networks, we definitely can move the needle on health and well-being—and be happier for it, too.