A few years ago, we had the opportunity to sit down with Malcolm Gladwell and share some early ideas behind Communities of Health. We said that it was time to change the conversation, from managing the cost of care to improving health. This was the only way that the health care industry and our nation would break free from the current paradigm and begin working together toward a more meaningful, lasting impact.

 

Gladwell cited the example of seatbelt use, which failed to take hold through improved convenience, laws and marketing, and only succeeded when it was ”reframed” as an issue of child safety and it became the job of us adults to wear ours when we asked the kids to wear theirs. He said that such a shift in thinking was always necessary for significant change, and he thought that ”health” might just be a big enough reframing to bring together parties across a fragmented health system for a unifying purpose.

 

In searching for solutions—whether for a new product or for national health care reform—we tend to focus on fixing what’s wrong (cost), rather than sustaining what’s right (health). This preoccupation with pathology is limiting, keeping us in narrow, endless cycles of repair, while overlooking a greater source that already exists. As social scientist, Dennis Sandow, says:

 

Attempts to change people are no longer relevant means to creating a better world. I have found that social systems which generate social, biological, and financial well-being are commonplace in networks of ordinary people.

This is a spontaneous social order arising from the emotion of love, in which ordinary people are creating extraordinary value…where everyone in the network considers everyone else in the network a legitimate contributor.

 

It is not change, but conservation that we should attend to. Conserving the emergent social systems of well-being…will bring forth a new visioning process through which we can generate the future we wish to live.

A good example is presented in the first chapter of Gladwell’s latest book, Outliers, which tells the story of Italian immigrant town, Roseto, PA. Researchers studying this “tiny, self-sufficient world” in the early 1960s were astounded to find that, at a time when heart attacks were an epidemic in the United States, Rosetans had just half the national rate, with virtually no one under 55 showing any signs of heart disease; in fact, the death rate from all causes in Roseto was 30%-35% lower than the norm.

 

To investigate, University of Oklahoma professor and physician, Stewart Wolf, and sociologist John Bruhn gathered a group of grad students to go door to door, talking to residents and taking medical histories. The anomalies could not be explained by good diet (fat accounted for 41% of Rosetans’ calorie intake), lifestyle (Rosetans smoked heavily and many were struggling with obesity), genetics (relatives living in other parts of U.S. did not share the same remarkable health), or geography (death rates from heart disease were three times higher in the two closest towns to Roseto).

 

“What Wolf slowly realized,” writes Gladwell, “was that the secret of Roseto wasn’t diet or exercise or genes or the region where Roseto was situated… The Rosetans were healthy because of where they were from, because of the world they had created for themselves.”

 

The researchers found that “the Rosetans had created a powerful, protective social structure capable of insulating them from the pressures of the modern world.” For instance, “how the Rosetans visited each other, stopping to chat with each other in Italian on the street, or cooking for each other in their backyards… extended family clans that underlay the town’s social structure… homes (with) three generations living under one roof… the unifying and calming effect of the church… twenty-two separate civic organizations in a town of just under 2,000… (and) the particular egalitarian ethos of the town, that discouraged the wealthy from flaunting their success and helped the unsuccessful obscure their failures.”

 

Roseto shows us that the real value in studying outliers is not to pinpoint what’s wrong (like watching for defects coming off an assembly line), but to help us notice what’s right, especially when it’s obscured by the prevailing frame. Gladwell writes:

 

Living a long life, the conventional wisdom said at the time, depended to a great extent on…our genes…the decisions people made—on what they chose to eat, and how much they chose to exercise, and how effectively they were treated by the medical system.

 

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 you couldn’t understand why someone was healthy if all you did was think about their individual choices or actions in isolation. You had to look beyond the individual… You had to appreciate the idea that community—the values of the world we inhabit and the people we surround ourselves with—has a profound effect on who we are. The value of an outlier was that it forced you to look a little harder and dig a little deeper than you normally would to make sense of the world.

Just as important, as Dennis Sandow reminds us, is learning to conserve what makes us well. We first read about Roseto in an article by Harvard social epidemiologist Ichiro Kawachi, who writes:

 

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.

 

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.

In our Communities of Health gatherings, we use a form of appreciative inquiry to uncover—and conserve—existing community conditions that are sources of health and well-being. Together, we ask:

 

• What’s working well around here?
• What conditions have allowed this happen?
• And, how do we create more of these conditions?

These are questions worth coming together for. They reframe our sense of what’s good and what’s possible, and point a healthy way forward.