What determines health? Community does.

I was included in a holiday email from Sam Coghlan in which he wrote about his new understanding of "Social cohesion."

He writes: "Social cohesion" is what brings us together. It is our community glue.

(Just like the conference organizers said: "Social cohesion is the ongoing process of developing a community of shared values, shared challenges and equal opportunity within Canada, based on a sense of trust, hope and reciprocity among all Canadians.")

His email reminded me of this article:

Why do some people get sick and others don't?

A Conversation with J. Fraser Mustard, M.D (Canadian)

http://imaginewhatif.com/Pages/Mustard.html

Some quotes I pulled out:

"See how this story starts to come together. With that information we can now say, "What happens to you in the first three years -- in terms of the quality of nutrition and nurturing -- is going to determine your basic skills throughout the rest of your life. It will determine how well you perform in the school system. It will determine how well you cope with what you have to do as an adult. And where you live, and how your work is structured, will have a huge influence on your vulnerability.

Kids in poor communities where there are strong social support networks and extended families appear to do all right.

Large urban centers like San Francisco, Los Angeles, and New York will have devastating effects on children, because it is not as easy to build a rich social support structure as it might be in a place like Iowa, where the social structures are pretty good even though the region may not be that rich.

So the determinants of health turn out to be these closely-related factors: how well you can cope with challenges, in what kind of environment you were brought up, and what kind of community support you have.

We have six auto assemblers in Ontario. Because they have to be part of our workers' compensation system, we have begun looking at their job structures and their sickness/absence rates. The biggest assembler -- General Motors -- has 10 percent of its labor force off work every day. Honda has less than two percent off every day. The structure of work and control in the two plants is fundamentally different. In the Honda plant they work more in teams, and they take more control.

The "readiness to learn" measurement is like birth weight: It could be collected across the whole community, because the teachers can make the assessment. In the US, where this assessment has been made and aggregated by state, you can look at, say, grade eight math performance. If the state has a higher proportion of kids not ready to learn when they come into kindergarten, that state doesn't do as well in the math performance in the eighth grade.

We are pretty comfortable that the same measure -- "readiness to learn" -- will also predict health burdens as people move into adult life

Neither the U.S. nor Canada has yet designed as full a mechanism for supporting organizations in improving the health of the population, as it has for supporting organizations that provide treatment for people who are sick. It is a basic failure in our society.

The biggest failure in your culture and mine is that we argue about poverty and welfare. We don't argue about how to sustain a reasonably cohesive and integrated community which optimizes human development -- for everybody.

If we want to make that happen, our recreational systems, our educational systems, our health promotion, our health care systems, and our economy need to all work together. You can't run a good business if you don't have a reasonably high quality population as a work force and as consumers, and if you don't have a reasonably secure society. "