Why your social life is a matter of life and death with Linda Waite: Big Brains podcast

Show Notes

Is it possible that having lunch with your friends is just as important in keeping you alive as exercising? That’s what University of Chicago professor Linda Waite is arguing. Her first of its kind research into social well-being has provided key insights into how our social lives affect our physical health.

The data from Waite’s studies have changed our understanding of what it means to be healthy. Now, she’s insisting that our health care and medical industries need to incorporate social well-being into their practice when treating patients.

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(Episode published August 26, 2019)

Transcript:

Paul Rand: It’s becoming one of the defining public health crisis of the century, loneliness.

Tape: The British Prime Minister appointed a minister of loneliness today. The new role will tackle solitude in the UK where more than 1 in 10 people feel isolated.

Tape: Government studies have found that more than 9 million people in the UK feel often or always lonely. About half of those over the age of 75 live alone, and over 200,000 Britons haven’t spoken with a friend or relative in over a month. One study even found that loneliness can hurt your health, increasing mortality the same as smoking 15 cigarettes a day.

Paul Rand: And this problem isn’t just affecting the UK. Debates about how to tackle the “loneliness epidemic” are being had in Canada and the United States. Now, one distinguished University of Chicago professor is researching how loneliness fits into to our understanding of social health, and how a more comprehensive view of social well-being could address this crisis.

Linda Waite: I work on a project that's on the ways that the social world is connected to what I call other dimensions of health.

Paul Rand: Linda Waite is one of the world’s leading experts on social well-being. Based on the data she’s collected from a national survey of elderly Americans—one of the largest groups affected by social health issues—Waite is arguing that our healthcare system needs a revolutionary change around how social health is incorporated into our overall health portfolio. It turns out that having lunch with your friends may be just as important in keeping you alive as exercising.

Linda Waite: My dream would be that people would have healthier more satisfying lives. If they and we as a society paid more attention to the social and how it connects to everything else, we could help people the same way we provide physical therapy if somebody has an injury. If we could people who were lonely develop some skills to join a club too, help with people who have some kind of, everybody's body falls apart as they get older and they fall apart in different ways, they have to figure out how to manage sex. Encourage them, help them, provide whatever would all be to the good.

Paul Rand: From the University of Chicago, this is Big Brains, a podcast about the stories behind the pivotal research and pioneering breakthroughs reshaping our world. On this episode Linda Waite and our social health crisis. I’m your host Paul Rand.

Paul Rand: To find out how social well-being should be incorporated into our overall understanding of health, it’s important to really understand what it even means to “healthy”.

Linda Waite: Oh absolutely. I think that that's the core of the project. If what you're doing is saying "what sorts of things influence health,” then you have to define health. What we did was to start with the World Health Organization definition. In 1947, The World Health Organization said that health is not merely the absence of disease it's the presence of social, physical and psychological well-being. But nobody really had taken that seriously. To think seriously about it and to measure it. And so, we took it on ourselves to especially do the social. Let me start by saying, not everybody in the world would agree with me on this. I'm sort of out there a bit, but I'm committed and I'm pushing. Social well-being would be having good social relationships. Being in a good social environment. So, the same way you can think of physical well-being as being good cardiovascular functioning, good immune functioning, the absence of cancer, you can think of social functioning as having a number of different components. In the study, the National Social Life Health and Ageing Project—which we call NSHAP—we looked at the various components, dimensions, of social well-being and we either developed measures or we took measures from other studies. Where there'd been a little bit here, a little bit there, and we put it all together. So, we developed a measure of social networks that was really extremely cutting edge.

Paul Rand: Wait’s work over the last few years on the National Social Life Health and Ageing Project has broken ground on collecting data that revolutionizes our understanding of the importance of social health. Until the project, there had been almost no real scientific attempt to measure population health while taking social well-being into account. And she says that even though the project focused on the elderly, a lot of what they learned can be applied to any age demographic.

Linda Waite: We've seen that having friends, having social support, is important it at any age. If you feel like there's somebody you could count on should you need help, then it helps you deal with stress and in fact just reduces your stress. Stress is feeling like you don't have the resources to meet a challenge and if you feel like you have more social resources, it's sort of like money in the bank. So, if you have a little savings account you don't worry about that, if you have social you don't worry about that and you have to think about it the same way.

Paul Rand: So, what did the NSHAP project find?

Linda Waite: So the project it has is its heart a nationally representative survey of about 3000 adults, community dwelling older adults, who were ages fifty-seven to eighty-five when we first contacted them. We sent a field interviewer, an highly trained professionals to their home, and she started with this series of questions on social networks. So, tell me about your friends. We allow them to list up to five people. The person we're talking to we call ego in this network speak. So I might say, oh my father and my brother Brad and my friend Hava and my colleague Kate. And then we find out how each of those people is connected to ego, how often they talk, whether they live together, whether they speak about health, the quality of their relationship. But then we find out how Dad is connected to each of the other people. How were they associated? Do they know each other? Do they speak? How often do they speak? Generally, a larger network, better connected, with good relationships among the people and diverse kinds of people is on average better.Social participation.

Paul Rand: What does that mean?

Linda Waite: Social participation means you do stuff with other people. We ask, how often do you go to church or religious services? How often do you attend the meetings of organized groups like a book club or an exercise group or a bowling league or how often do you get together with friends and neighbors? So people who don't participate socially at all in any of these things, we would say are socially isolated. We also measure social support which is extremely important. It's do you have the feeling, the assurance, the perception that if you needed help there would be places to get it?We also ask about the marriage or partnership.We ask how happy they are with their marriage? We ask about sexuality and the relationship, we ask a lot about that. We also ask about masturbation? We ask about sexual satisfaction? How emotionally satisfied are you? So we find out about their primary relationship.

Paul Rand: The data from Waite’s study are publicly available, and researchers all over the country are using it to delve deeper and extract important information about how the ways we socialize can affect our overall health.

Linda Waite: With a colleague at Michigan State, we looked at the link between marital quality in older adults and the development of risk factors for cardiovascular disease, incident hypertension, a new stroke, a new diagnosis of heart disease. And what we found was it mattered for women, it didn't matter for men. So poor marital quality put women at risk of developing heart disease.

Paul Rand: But not for men.

Linda Waite: Not for men. And we have a lot of hypotheses.

Paul Rand: I bet you do.

Linda Waite: So,based on other people's work, we know that women are more physiologically reactive to stress. There's a researcher at Ohio State Janice Kiecolt-Glaser who's done really foundational work in this area. She brings couples into a lab. She puts an indwelling catheter monitoring for a galvanic skin response and so on and then has them talk about something that they don't agree about. And women are more physiologically reactive to the relationship tension than men are.

Paul Rand: One factor in social health that can go overlooked is how our senses either help us or keep us from having a good social life. If I can’t see, hear or touch you, it’s hard to make a connection. And if social well-being can be an indicator of physical health, then could studying someone’s senses tell you whether they’re at risk of dying?

Linda Waite: Let me tell you about one of the things that the team found that nobody ever expected. One of the people on the team is Martha McClintock who's emeritus here. She is the smell queen. She really did foundational work on pheromones. So, she beat us up until we agreed to include olfactory assessment in this study. And Martha showed that people who couldn't recognize any common household smells, we gave them four, were 35 percent more likely to die in the next five years than people like them with the normal sense of smell. This is a screener that can be used clinically. Check somebody’s sense of smell and it would tell you who is at risk that you might need to look more closely. So that was huge. It turns out that poor olfaction is also connected to incident Alzheimer's disease. Nobody knew about this.

Paul Rand: So anybody listening right now is going to be whiffing things.

Linda Waite: Whiffing things and I actually wrote Martha when I heard about this and said are there any smell exercises. And they said absolutely and sent me a link. Have I done it, no, but I but I do try and…

Paul Rand: Improve your smell.

Linda Waite: Or make it more conscious.

Paul Rand: When Waite and her team incorporated the data about social health into the overall health of the population studied, they found something surprising. Many individuals who would be categorized as being in robust health by normal medical standards were shown to actually be vulnerable to all sorts of complications.Normal medical standards focus on the absence of disease, but the social health data revealed issues that were under the surface, issues that could lead to death or incapacitation within five years. At the same time, people with chronic diseases who normally would be labeled unhealthy, were actually shown to be quite healthy and not at risk when social well-being was factored in. The implications of this study could have a dramatic effect on how our medical system should be thinking about health. That’s coming up after the break.

Paul Rand: The implications of Wait’s research point to a future where it should be just as important for doctors to ask about how often you’re spending time with friends and connecting with your family as it is for them to ask if you’re sleeping well or in any pain. If social well-being has this much of an effect on us, shouldn’t the medical establishment be incorporating it into every aspect of their work?

Linda Waite: I'm working out a book with William Dale who used to be head of geriatric medicine here and moved to City of Hope. We're making the argument that there are things that that the medical system focuses on that they overdiagnosis, and there are things that they underdiagnose. Here they are, and here’s why, and we ought to be thinking about health more holistically including the social component. Now that we know that this stuff is going on people are starting, or communities or organizations are starting to develop interventions. So, if somebody is socially isolated, what can you do about that? If somebody is lonely, what can you do about that? Doctors and geriatricians, and I'm still working on this with William, could talk to their older patients about their sex lives. Encouraging people, like you encouraged them to eat a nutritious diet, encouraging them to work on their relationship. Maybe giving them some tools? If you’re making sure you get blueberries and bran flakes, maybe you should focus on your relationships too. Assess them and then maybe put in a little effort. It doesn't have to be a lot. You know most people have siblings right. They might have cousins or nieces and nephews. You know, you can make an effort to increase contact and relationship quality. Do something nice, send a birthday card, take your brother out for lunch or a beer. Just make it a higher priority.

Paul Rand: So those are things that, as you work goes along, that ability to have health care professionals asking about those questions, having recommendations on those areas is as important in your mind as it is covering the physical areas. And if there's anything getting in the way of that happening what is it?

Linda Waite: It’s that the physicians don’t want to say to this eighty-nine year old man, how’s your sex life? Often what I hear is that the person will say, I don't want to talk about it. So, it's not a conversation that either party is

Paul Rand:Wanting to have.

Linda Waite: Well, or comfortable with. But maybe you just have to open the door and you know people weren't so comfortable with lots of other things they take for granted now.

Paul Rand: But there's a lot of other areas you mentioned that may not get into how's their sex life. But…

Linda Waite: Right right right right. How often are you getting out to church or you're going bowling or you doing any volunteer work?

Paul Rand: And so now that the studies are showing the importance of what it is that you're articulating. Are there efforts in place, or is there pushback about taking time because it's not uncommon to go to a doctor's office and to not feel as if you're getting a great deal of attention. You are there to deal with the immediacy of the issue that you have and then shuttled out the door. This would add to it in a not unsubstantial way.

Linda Waite: It could be a prescription right. It could be, I'm going to refer you to our social worker. I say she's right over here. You can see her for 15 minutes now and make an appointment and she’ll help connect you to services and figure out how we can do better on this to make sure you have the support. But there's been a lot of work recently on a related, but very distinct concept which is loneliness, which is the feeling that you're alone. You could be surrounded by a lot of people but feel like you have nobody to talk to, that that you don't fit in, that nobody likes you know that. Loneliness is a big problem for older adults because they lose people. Right. It's part of getting older. If you're still alive, the chances are higher that some of the people you love are not. Right. And it gets harder to get out and get around. So it may be that you have people you just can't get to them as often as you could. So that's a big problem and something where there are people thinking about it and what we could be doing. The military is doing some interventions for returning troops, trying some out on loneliness. Social participation, we could make that easier. There's a really wonderful set of studies by led by Linda Freed who is at Columbia now, she's a physician and she developed a volunteer program for older adults. They recruited older adults in poor neighborhoods to be volunteers in kindergarten and first grade classrooms in poor areas of Baltimore. They assess the kids and the older adults and everybody did better. The older adults had better physical function, they had better mental health. The kids had fewer disciplinary action. There’s a huge literature on it. AARP has taken this over. So we could do more of this right. It's harder for older adults to find volunteer opportunities, you know, to actually get the training to have somebody walk them through it. But we could we could do more of this as a society

Paul Rand: As Waite is working to get the medical establishment to incorporate her research into how they take care of the health of patients, she’s already starting to plan her next massive study. That’s after the break.

Paul Rand: No matter how much data researchers collect, they’re always hungry for more. Waite’s team is already planning what its next project is going to investigate.

Linda Waite: A group of us are thinking about the next study. We're planning a study like NSHAP of the gay, lesbian, bisexual and trans older adult community. This is different because it's a very hard community to sample. If you want to to say we've got a nationally representative sample, it's a lot easier with the general population than it is with this population. So we're thinking about how to do that. And then what we want to do is basically the same study and then all the things that are specific to this population

Paul Rand: And do you have a hypothesis of what you'll be finding different?

Linda Waite: Well here's what we know we have to look at, The National Institute of Health is very interested in the gay, lesbian, bisexual, and trans community because there are well-documented health disparities. That population tends to have worse mental and worse health behaviors than they should have given their education and age and so on. So what's going on? There are a lot of possibilities: discrimination, stress? I'm very interested in what happens, especially to older, say lesbian older adults who are now in their 70s. Did they ever come out to their families? What happened when they did? Because what we hear in just little bits and pieces is that rejection by the family really is the source of many of the disadvantages. You know cutting off, you’re disinherited, you have to move out, if you lose the resources of your parents and that generation then you're disadvantaged no matter our solution. So that's a possibility. Also health care, finding health care and that's especially a problem for the trans community. So these are all things that we want to look into.