Social & Community

Happy Holidays and Jingle Bulls!

'Tis the season for Social and Community:

United Kingdom's focus on loneliness| Policy papers and Annual Reports
https://www.gov.uk/government/publications/loneliness-annual-report-the-first-year

Vivek H. Murthy, MD
https://www.vivekmurthy.com/

National Academies of Sciences, Engineering, and Medicine. 2003. The Future of the Public's Health in the 21st Century. Washington, DC: The National Academies Press.
https://nap.nationalacademies.org/catalog/10548/the-future-of-the-publics-health-in-the-21st-century.

It's a Wonderful Life Bank Run
https://youtu.be/iPkJH6BT7dM?si=fJgYPYsvyzN7WyGT

Baz Luhrmann, Everybody's Free to Wear Sunscreen, from Mary Schmich's essay published in 1997. https://youtu.be/sTJ7AzBIJoI?si=QHWe9nETq8EIHT98

Additional Reading

Social Determinants of Health Are Our Life Circumstances, Office of Disease Prevention and Health Promotion, US Department of Health and Human Services
https://health.gov/news/202207/social-determinants-health-are-our-life-circumstances

In a world of cheaply made bargains, the social and commercial determinants of health are not jargon! Thank you for taking the time to listen.  ciao, for now.   

drmichelabull.com

Transcript

Episode 6 Social & Community

By Michela Bull, DHSc

Welcome, friends.  It’s hard to believe that it’s the end of 2023.  We’re upon the season’s solstice, and well underway with various traditions of light.  I’m so glad you’re here.  

Recently I asked a few high school students what their favorite holiday movie was.  The one mentioned most often was Home Alone.  The VHS version was watched in my family well beyond the be kind and rewind days. We passed the video around households as the generations grew.  Home Alone was a favorite and had a lot to say about family dynamics during the holidays.  

In 2017, the United Kingdom created the position, Minister for Loneliness, under the authority of the Secretary of State for Culture, Media, and Sport.  There have been a few Ministers to hold the office since inception.  Without any sarcasm or cynicism, to be the Minister for Loneliness sounds like a job with an immense number of supporters, attached to an intensely complex effort.  Where does one start to soothe and resolve loneliness encircling one diverse nation?  Let alone (excuse the pun), how do we begin to help a planet with over 8 billion people feel less lonely?  How would public health experts begin to put cerebral arms around a problem such as loneliness?  

The former US Surgeon General, Vivek Murthy, wrote a book entitled Together:  The Healing Power of Human Connection in a Sometimes Lonely World.  As a physician, Dr. Murthy calls out Loneliness as a significant public health threat.  I quote from his website:  Loneliness is affecting not only our health but also how our children experience school, how we perform in the workplace, and the sense of division and polarization in our society.

Dr. Murthy’s statements about loneliness and his concerns for the public’s health and welfare caught my attention years ago.  When the pandemic struck, isolation and chronic stress became daily topics of global discussion.

Loneliness and isolation in a hyperconnected world present a paradox….

I went back in the literature to see what public health experts published around the same time the term, social determinants of health, was coined and thereafter, widely used.  I reviewed a report entitled, The Future of the Public's Health in the 21st Century by the National Academy of Sciences, published in 2003.  On page 56, the Social Determinants of Health are discussed.  I’m going to read a portion of the 2nd paragraph verbatim, from page 57:  

The evidence amassed strongly and consistently points to the impor-

ance of these conditions as significant determinants of population health.

Because they also feature prominently in the committee’s determinants-of-

health model, the evidence related to four conditions whose importance is

robustly supported is reviewed here: (1) socioeconomic position, (2) race

and ethnicity, (3) social networks and social support, and (4) work conditions.

While the groundwork for the social determinants of health had been going on for some time, years of empirical knowledge on health and health care models had garnered the importance of social connections and support systems in both the professional and personal spheres.  

In full transparency, I wasn’t looking for anything to prove a preconceived point.  Memory informed that things changed quickly around 20 years ago, but memory can play tricks on all of us.  As mentioned in the Academies’ report, population health and health care models reverberated from evolution, too.  The report underlines how rapidly medicine changed from the late 1980s to the date of publication.  Yet, healthcare models and delivery systems were still trying to catch up in 2003, as they are 20 years later.  If you were alive during the millennium, take a moment to think about how much faster things move today, how much information we take in, process, and dish out in a 24-hour period.  

My research for this episode truly took me aback when I was reminded just how quickly the cultural and social landscapes changed, from 1999 to 2005.  During that brief window of time, 3 social media platforms were launched between 2003 and 2005.  I’m not going to name any names but:  One is a search engine with social media components, the 2nd is a social network that’s already rebranded itself, only to be referred by its original name by anyone who still uses it, and 3rd, a platform that allows users to create channeled content.  All 3 platforms operate today as embedded parts of the social and cultural lexicon.  One was launched right after the other, typical of the convergence of new technology with business enterprise.  Be the first to bring a new product to market, take over the market, then dominate the market. That recipe isn’t likely to change.  It reflects the point that change, whether long in research and development or as quick as a market shift that presents business opportunity, takeovers happen fast.  It’s astounding what’s taken place since everyone was freaking out over the hype that was Y2K.  

Dear Listeners, I’m not trying to put a pickle in anyone’s party punch by showing up to the holiday soiree, with talk of chronic stress and lonely dismay.  No way!  

If you’re young, please don’t think I’m picking on you, or social media because the indicators suggest the adults don’t know how it’s impacting them, either.  We’re all human subjects of the social media experiment.

Let’s reflect on work conditions and the value of work, topics of public health study before, during, and after the pandemic:  Do you have a toxic work environment?  Do you have a supervisor with a management style termed as a destroyer?  That’s a real term.  Oh, and destroyers are always convinced they’re innovative builders, when their really destroyers.  Such supervisors are bad for workers’ health, as well as the organization’s health.  The bonds, relationships, and conditions at work matter to our health, as they do at home.  Moreover, all of the above directly affect the organization’s financial health.

Earlier, I mentioned the students’ informal survey said their favorite holiday movie was Home Alone.  A story about Kevin, a young boy who is accidentally left behind when his family travels out of town.  He is left to spend Christmas alone.  At the beginning of the movie, Kevin loathes the fact that he lives in a large family, with a full house.  By the end of the film, he’s lonely and missing everyone.

The holiday season can be a tumultuous, stressful, exhilarating, and lonely time of year.  After the break, a holiday movie review, but not of Home Alone.  On this episode, we’re gonna to get into it:  The domain of Social and Community!  

Whether you’re feeling lonely, or curious about continuity, stay tuned…

I’ll be right back….

The film, It’s A Wonderful Life was based on a story by Philip Van Doren Stern, and directed by Frank Capra.  It mimics aspects of Dickens’ A Christmas Carol, namely a central character forced into a review of his own life, the quality and meaning prior to a high stakes deadline:  In other words, before it’s too late.  The central character can’t take stock of the inherent value of his life, without the help of guides who change the viewer’s perspective.

While the character of Ebenezer Scrooge is visited by 3 guides, representing angels of Christmas past, present, and future; George Bailey’s character is guided through a view of his life had he never been born, had he never existed.  George is guided through new insights by an angel second class trying to earn first officer’s wings.  The characters of Ebenezer Scrooge and George Bailey could only self-examine and gain new perspectives about themselves through another lens.

Full disclaimer:  I don’t have a favorite holiday movie, in the same way I don’t have a favorite song.  A favorite on that kind of scale for me is impossible.  However, for as many times as I’ve seen It’s a Wonderful Life, I never appreciated how much it had to say about the Social Determinants of Health.  The film’s topics are still relevant in the hyperconnected 21st century, juxtaposed with the complexity of isolation and loneliness.

I will repeat what the character, Clarence, says when he’s first introduced to his charge, I like George Bailey.  George Bailey, the Bailey family, and the fictional town of Bedford Falls, New York represent the importance of Social and Community.

George, much like Kevin in Home Alone, dreams about getting away, from the same people, and the same routine.  More than anything, George wants to attend college, travel the world, and build things. George Bailey’s father and uncle Billy started the Bailey Building and Loan, one of the town’s few financial institutions and lends money to borrowers so they can purchase homes.  

George is a magnanimous person by nature.  He self-sacrifices again and again throughout the film for the good of others.  George is ready to depart Bedford Falls for college, and leave responsibilities of the Building and Loan to his younger brother, Harry who has just graduated from high school.  It’s a happy night – Harry is excited about the graduation dance.  George and his father eat dinner together and have a discussion.  Peter Bailey is tired and worn from years of keeping the Building and Loan open.  He tells George that he laments not being financially able to send both sons to college together.  George repeats the brothers’ plan.  Harry will help Dad run the business for 4 years while George is away at school, then he’ll go.  

Peter Bailey stops eating and folds his hands in front of him.  He tells George that Harry is quite young to take on such a position.  George retorts that Harry’s no younger than he was when he did the same.  His father replies, “Well, you were born older, George.”  George is deaf in his left ear, and in case you don’t already know why, I won’t spoil it for you.  George knows his father said something, but since his father is sitting on his left, he asks, “How’s that?”  His father repeats, “I said you were born older.”  Unbeknownst to both, it’s the last conversation they will ever have.

For the sake of brevity, I’m going to fast forward to the Bank Run Scene. 

The local population is fearful over rumors of a run on the bank.  The rumors turn out to be true, directly affecting the solvency of the Bailey Building and Loan and the economic security of everyone in Bedford Falls.  Potter, the richest man in town sees an opportunity, and makes a viciously villainous play.  When the town’s panic is in full swing, Potter makes a creepy call to his business nemesis, George Bailey.  In the guise of a syrupy sweet, wellness check, Potter inquires, “George, there is a rumor around town that you’ve closed your doors…George, are you all right, do you need any police? Mobs get pretty ugly, sometimes, you know.”  Potter tells George that he’s taken over the bank and offering customers 50 cents for every dollar in their accounts.  Potter’s narrative is that he’s doing the town a favor.  In other words, among the hungry he dangles half a sandwich when the day before they had a whole one.  George Bailey puts himself between the crowd and the door of the Building and Loan and begs the customers not to take Potter’s bait.

He pleads, “Can’t you understand what’s happening here?  Don’t you see what’s happening?  Potter isn’t selling, Potter’s buying! And why? Because we’re panicky, and he’s not, that’s why.  He’s pickin’ up some bargain.  Now, we can get through this thing, all right we’ve got to stick together, though.  We’ve got to have faith in each other.” 

We’ve got to stick together, though, George says.

What he’s saying is we can fight for the long-term health and welfare of this community if we stick together, but if we act out of fear, if we act based upon mob mentality, if we act without thinking…. it’s done and Potter’s won. 

The newly married Baileys offer their own honeymoon money to fund the building and loan until the bank reopens.  In one fell swoop, George Bailey, with the help of his family and community busts a move for Social Determinants of Health.  On both micro and macro levels, George Bailey slam-dunks it in the domains of Economic Security, Neighborhood & the Built Environment & Social & Community - a Trifecta for the Social Determinants of Health.  He earns at least 5 gold stars for the domain of Education, as well.  In the long-term, George knows what will happen to Bedford Falls, and he appeals to his own hometown, the very same place he’s been wanting to get away from since the film’s first scene.  The community decides the better long-term business model for Bedford Falls is to keep the Bailey Building & Loan afloat.  The local community envisions a town of homeowners, in lieu of renters under the ever-pressing thumb of one slum lord.  

A raven appears a few times throughout the film.  The raven represents Uncle Billy’s eccentricity and penchant for the domestication of wild animals.  The raven also foreshadows ominous events to come.

George’s fears of economic ruin and scandal turns to terror when he sees, with Clarence’s help, what happened when George Bailey was omitted –his life, his place, and his identity erased.  In the alternate universe without George Bailey, Bedford Falls becomes Pottersville.  George is more than stupefied, he is horrified.  When George finds ZuZu’s petals, and realizes it was just a view of a wish he no longer has. He can’t wait to get home to Bedford Hills, and the life he thought better to end in a moment of despair.

Think we don’t have 21st century versions of greedy Potter?  Not too long ago, there was a series of congressional hearings where the head of a major US financial institution named after an ironic action word had to testify as to why the bank committed identity and financial fraud against its own customers. Hedge-funders or venture robber barons are buying up entire neighborhoods they’ll never reside in.  Do you think such businesspersons care about local communities and neighborhoods, or in the words of George Bailey, are they just pickin’ up a bargain?  Do you think such businesspersons care if a quality school or health care facility is ever built, again?  Those are present day real-world examples with implications and consequences for everyday people.

If virtual connection can fill lonely spaces and the human need for kinship, what do people do when they don’t have access to the internet?  What if they live in a country where access to the internet is restricted or forbidden, along with education?  

It can be a lonely time of year.  Healthcare facilities and providers are overwhelmed with the seasonal tripledemic.  Crisis and support centers do what they can.  I’m not dismissing the importance of fathers, in any way.  Men and boys suffer, too.  But I think even the most strident of brothers would agree that it’s never been a kind world to girls and women.  There are mothers all over the planet who are worried about the health and welfare of their children and families.  Perhaps, they’re in mourning for the loss of children, biological or not.  I can’t imagine that kind of despair, the same way I can’t imagine the loneliness of the girls and women in Afghanistan, Iran, Pakistan, Yemen, Saudi Arabia, Ukraine, Russia, India, China, and in the United States where the same are still denied full autonomy.  As we enter the year 2024 women and girls on every continent remain repressed, isolated, and disconnected.  It’s not a community or a country when over half of any population remains unconsidered. 

I have a ritual at the end of every year.  I read the following poem as reflection.  It’s by one of my favorite poets, and I'm going to read it for you now...

A thought went up my mind today –

That I have had before –

But did not finish - some way back –

I could not fix the year –

Nor where it went – nor why it came 

The second time to me –

Nor definitely, what it was –

Have I the art to say –

But somewhere – in my soul – I know –

I’ve met the thing before –

It just reminded me – ‘twas all –

And came my way no more –

That was by Emily Dickinson, and she wrote that in 1863. 

I don’t know if there will ever be a prescription for loneliness, except to try to increase the meaningful relationships in our lives and take interest in our local communities.  I have so much to be grateful for this year, and a lot to strive and hope for in the next.  

There’s a saying in Arizona that it’s always summer after 10:00 am.  I hope that your holiday is warmed with the spirit of good company.  As someone who lives in one of the hottest places on earth, my recommendation for any snowbirds heading towards the Valley of the Sun is to bring a hat and wear sunscreen.

I wish you the best in 2024.  Above all, I wish you Copacetic Health.  Thank you for taking the time to listen.  Ciao, for now.