When I is replaced with We, illness becomes wellness.
Social Connections
As Aristotle observed, human beings are social animals. In prehistory, it was our ability to cooperate that ensured our survival. And we still rely on other people to satisfy most of our needs. We need them for objective support but also for much more. We need them for affection and our very sense of who we are (our identity). And, to have a sense of meaning and belonging in our lives, we need to be needed by others.Footnote 1
Most of us have a wide range of social connections. We have family and other intimate relationships. We have friends. We have colleagues through work. And we may have a wide range of other contacts through sports clubs, cultural organisations, community centres (for the young and old), parents’ associations, political parties, trades unions and voluntary organisations of all kinds. So, to begin with, you might like to list all your main social connections of all kinds, in the order of their importance for your wellbeing.
To show how important these relationships are, many researchers have taken a sample of people, measured their initial characteristics, and then followed them for 10 years or so to see who lived and who died. The initial characteristics they measured included the respondents’ health and their social relationships. And it turned out that having ‘poor or insufficient’ relationships, compared with ‘adequate’ relationships is as likely to kill you as smoking cigarettes is. In each of these cases, (other things equal) you become 50% more likely to die in the next 10 years or so.Footnote 2
This is the result of a meta-analysis of 148 different studies and focuses on all forms of social relationships. Other studies focus just on loneliness. Loneliness is surprisingly common. As Vivek Murthy reported after serving as US Surgeon General: ‘To my surprise, the topic of … loneliness … received the strongest response from the public of any issue that I worked on.’Footnote 3 In the United States, 22% of adults say they often or always feel lonely or socially isolated.Footnote 4 It is a growing problem as more and more people worldwide live on their own.
Loneliness is a killer.Footnote 5 Compared with others, those who feel lonely are 26% more likely to die, those who feel isolated are 26% more likely and those who live on their own are 30% more likely to die. They lead less healthy lives, have higher blood pressure and weaker immune systems.
So what is the effect of social connections on wellbeing (rather than on life-expectancy and physical health)? Perhaps the simplest question of all about social connections is ‘If you were in trouble, do you have relatives or friends you can count on to help you whenever you need them?’ This question is asked in the Gallup World Poll, and in Chapter 8 we have seen its key role in explaining differences in wellbeing across countries. In the Central African Republic, 29% say Yes to this question (the lowest proportion of any country) while in Iceland 99% say Yes (the highest proportion). This difference of itself causes an estimated difference in average wellbeing of 1.4 points (out of 10) between the two countries.Footnote 6
Similarly, family relationships (having a partner) increase wellbeing and so do high-quality working relationships (see Chapter 8). But we have not so far looked at the importance of relationships that people have in the community. That is what this chapter is about.
We are concerned here with the whole network of social relationships outside the family and the workplace. We are also concerned with the norms and values embedded in these relationships. Together, these phenomena comprise the ‘social capital’ of a community. So we shall examine
community networks (sometimes also called ‘civil society’),
trust and social norms and
some specific community activities – culture, sport and religious worship.
We shall look at the following issues:
How important are social networks and volunteering?
How important is a culture of trustworthy behaviour?
The importance of inequality, crime, diversity and immigration.
How do cultural, sporting and religious activities affect wellbeing?
Community Networks
The idea that social networks matter is hardly new. It was central to the founders of sociology including de Tocqueville (who described their importance in nineteenth-century America), as well as Durkheim, Dewey and Weber. But in recent times, their importance has been highlighted above all by Robert Putnam of Harvard University. In Bowling Alone (2000) he contrasted a society where people do most things with other people (including going bowling) to a society where people do more on their own. He showed that in the United States, membership of group associations was in sharp decline.
He then, working with John Helliwell, showed that this was bad for people’s wellbeing. In a seminal article the two of them studied what determined life satisfaction among the 84,000 people covered in the early waves of the World Values Survey.Footnote 7 They studied both individual and national influences upon life satisfaction. And they showed that an increase of one in the average number of organisations that people belonged to raised average wellbeing in a country by 0.3 points (on a scale of 0–10). Trust also had a strong effect (see ‘Trust’ section below). Similar results have been found in many subsequent studies. These later studies have also shown how social connections have buffered people against the negative effects of recession and natural disasters, by being of greater help the greater the disaster.Footnote 8
Volunteering
All the networks we have been considering depend on volunteering. The governing committees are often volunteers, and most of the work is done by volunteers. This is true whether the organisation operates for the benefit of its members or to help others who are more disadvantaged. In the latter case, the activity is twice blessed – it blesses those being helped, but it also blesses the helpers. (‘It is in giving that we receive.’)
A good example of these two-way benefits is the Experience Corps that flourishes in many American cities and enables old people to feel needed by giving meaningful support to children. The volunteers must be at least fifty and they deliver literacy support to primary school children up to the third grade. Most of the volunteers have high school education only, and they get two weeks’ training in how to deliver the literacy support. They then work in schools delivering this support for fifteen hours a week. In Baltimore, the volunteers have been carefully followed up in a controlled trial, lasting on average for six months. Compared with a wait-list control group, the volunteers who participated in the trial found they had increased ‘the number of people they could turn to for help’, as well as their level of physical activity.Footnote 9 Over two years, when compared with controls, they were found to have increased their brain volume in both the hippocampal and cortical areas.Footnote 10 This makes good sense: contacts between young and old not only advance the young, but they rejuvenate the old.
Another clear example of the benefits of volunteering comes from the experience of East Germany after reunification with the West. During reunification, much of the voluntary activity that had prevailed under Communism collapsed, and the wellbeing of the previous volunteers fell much more than that of other East Germans.Footnote 11
Social networks serve many functions. Some of these are very practical services for their members, while others reach out to the wider community. Through all forms of social connection, the happiness of one person affects the happiness of others. This is demonstrated clearly by the Framingham Heart Study. The connections it studied included not only what we have called community networks but also relatives, friends and colleagues. For each member of the sample, it repeatedly measured their happiness and that of their close contacts. It found that if your relative, friend or neighbour became happier, you became significantly more likely to be happy – and thus to make others happy in your network. This effect was then passed on through two further waves of contacts.Footnote 12
But networks can also of course transmit negative outcomes. The sociologist Nicolas Christakis, who showed how networks spread happiness, also showed how they can spread obesity.Footnote 13 So the message that a network transmits is hugely important. One key message is about trust.
Trust
‘Do you think that most people can be trusted (or alternatively, that you can’t be too careful in dealing with people)?’ You might like to try giving your own answer to this question. At the national level, the proportion of people saying Yes to this question is an obvious measure of the extent of trustworthy behaviour in the community. The proportion who say Yes varies hugely from 5% in Brazil to 64% in Norway.Footnote 14 And, as we saw in Chapter 8, it has a substantial impact on average wellbeing in the country – a rise of 60% in the population saying Yes (corresponding to the difference between Brazil and Norway) increases average wellbeing by some 0.6 points (out of 10). This is similar to the gap between employed and unemployed people.
But how accurately do these answers on trust really reflect actual behaviour in a country? Fortunately, there is a simple experiment, first conducted by the Reader’s Digest. Actual wallets were dropped in the street, containing significant amounts of money as well as the name and address of the wallet’s owner. In one experiment, this was done in 20 cities in Europe and in 12 cities in the United States.Footnote 15 The experimenters counted what proportion of the wallets were returned. In Oslo and Copenhagen, all the wallets were returned, but the proportion varied greatly across the other cities.Footnote 16 And, importantly for the research, the proportion of wallets that were returned was highly correlated with the answers to the question about trust given in the same country. So we can indeed place some credence on the answers about trust.
We can also examine the effect of trust at the individual level.Footnote 17 In one survey, people were asked whether they would expect a lost wallet containing $200 to be returned. Those who said ‘Very likely’ were experiencing (other things equal) an extra one point of wellbeing (out of 10) compared with those who said ‘Very unlikely’.Footnote 18
One of the most remarkable findings about the wallet experiments is this: the more money a wallet contains, the more likely it is to be returned. This is contrary to most models of human nature. But it comes from a study in the largest cities in 40 countries, rich and poor, involving 17,000 wallets.Footnote 19 In virtually all countries, a wallet was more likely to be returned to the owner if it included some money. And the more money there was the more likely the wallet was to be returned (see Figure 14.1).
Moreover, higher trust has another important effect – it not only raises average wellbeing, but it also reduces the inequality of wellbeing. This is because high trust raises wellbeing more for those who are initially disadvantaged.Footnote 20 Using the European Social Survey, it is possible to simulate the distribution of wellbeing in two cases.
(i) Where everyone has a low level of trust, both in others and in institutions.
(ii) Where everyone has a high level of trust.
In the latter case, average wellbeing is much higher. But wellbeing is also much less widely dispersed, because people with the lowest wellbeing have improved their wellbeing the most.
In some countries, trust has fallen sharply since the 1960s (e.g., in the United States) while in others it has risen (e.g., Denmark and Italy). This may help to explain why life satisfaction has not risen in the United States since the 1960s while it has risen in many European countries.Footnote 21
In many countries, low levels of trust are associated with corrupt behaviour both among public officials (police, judges, railway clerks) and in business. So the wellbeing equation in Figure 8.5 looks very similar if trust is replaced by averaging the answers to the following questions: ‘Is corruption widespread throughout the government or not?’ and ‘Is corruption widespread within business or not?’ None of this is surprising. For, if we reflect on our own experience, we can see how clearly our own wellbeing has been affected by how well others around us behave.Footnote 22
In the debate on social capital, critics have complained that these results were driven by high levels of trust and social networks in Scandinavia and claimed that Scandinavia was also well known for its high rate of suicide. However, in fact, Scandinavian suicide rates are similar to the European average.Footnote 23 Moreover, similar equations explain both national suicide rates and national wellbeing (and indeed the rate of road accident deaths).Footnote 24
Inequality
As many people have pointed out, the countries with the highest levels of trust (like those in Scandinavia) also tend to have the highest levels of income equality.Footnote 25 So how does income equality affect community wellbeing?
First, there is the immediate effect of the diminishing marginal utility of income. This means that countries with a given average level of income will on average be happier the more equal the distribution of income. But this effect is not large.Footnote 26 A second effect can be through the impact of income inequality on the pattern of human relationships. The basic idea is that people feel most comfortable with people like themselves. So the greater the differences in income between individuals, the greater the social distance and the less the sense of ease.
However, despite both these points, few researchers have found any substantial correlation between income inequality and average national wellbeing. This may be surprising given the correlations between income inequality and social trust (and many other good things) so powerfully demonstrated by Wilkinson and Pickett.Footnote 27 But John Helliwell and his colleagues have provided evidence that looks like an explanation.Footnote 28 In their view (evidenced below), what really matters is the inequality of wellbeing. This will reflect the ‘spirit of equality’ in a country, which affects the equality of everything (the distribution of social services and the codes of behaviour, as well as household income inequality). And this general equality (best proxied by the equality of wellbeing) will then affect the average levels of wellbeing.
Table 14.1 provides the evidence for this approach. It uses the European Social Survey (2006–15), the World Values Survey (waves 1–6) and the Gallup World Poll (2008–14). In each of these surveys, it is the wellbeing inequality in their country that has a strong effect on the wellbeing of the citizens. Income inequality (measured by Gini) has a small and often insignificant effect. Even if wellbeing inequality is dropped from the equation, the partial correlation coefficient on Gini does not rise above 0.07 in absolute magnitude. So we should take the issue of equality very seriously, but just tackling income inequality alone will not be enough to make a huge difference.
European Social Survey | World Values Survey | Gallup World Poll | |
---|---|---|---|
National standard deviation of wellbeing | −0.20 | −0.17 | −0.10 |
National Gini coefficient of income | −0.02 | −0.01 | −0.04 |
National log GDP per head | 0.18 | 0.21 | 0.39 |
Controls for gender, age, education, employment and mental states | |||
N | 301,960 | 243,875 | 1,133,621 |
Crime
As we have seen, trustworthy behaviour is a key ingredient of a happy society. And one variant of untrustworthy behaviour is crime. Crime affects community wellbeing in two ways: it hurts the victims and it spreads the fear of crime even more widely. To capture both these effects, one can estimate an equation in which the average wellbeing in each community is explained by the logarithm of its annual crime rate (after allowing for many controls and a fixed effect for each community). When this is done in Britain, the coefficient is substantial (0.14).Footnote 29
But crime is also not great for most of the criminals. In one study of people in mid-life, the number of self-reported crimes they have committed explained as much of the dispersion of wellbeing (other things equal) as did income.Footnote 30 A high proportion of criminals have mental health problems and need treatment. But also crucial for prisoners is their lack of supportive social connections. When people come out of prison, connections can be crucial in determining whether they re-offend. In Los Angeles, the Anti-Recidivism Coalition’s mission is to help them re-establish connections (including to employment and education). In 2018, 11% of those helped returned to prison, compared with an average of 50% for the state of California.
By contrast, people who are more satisfied with their lives are much less likely to commit crime. This is true even after controlling for a large range of other factors. Happiness is a strong predictor of good behaviour.Footnote 31
Ethnic Diversity and Immigration
We come now to a troubling aspect of human nature. As we have said, most people feel more comfortable with people like themselves. That is why in his analysis of social capital, Robert Putnam distinguished between ‘bonding’ capital (networks that bring together people who are naturally close to each other) and ‘bridging’ capital (which bring together people who are naturally more different and less close).
A healthy society needs both types, including bridging capital. For, at least in the United States, there is strong evidence that trust is lower in areas of greater ethnic diversity. In such cases, people are not only less trustful of other ethnic groups but also less trustful of their own group; they tend to withdraw and to participate less in the life of the community.Footnote 32 There is similar evidence in Britain that diversity in a local area reduces somewhat your satisfaction with your area.Footnote 33 In Europe, the evidence is less clear-cut, but for many people diversity is certainly an issue.Footnote 34 However, even in the United States and Canada, there are many individuals for whom diversity is not an issue – especially those people who regularly talk to their neighbours.Footnote 35
A somewhat different issue, though related, is immigration – the flow of people into a country from outside. This has become a major political issue. We now know a considerable amount about the impact of immigration upon all those involved.
About 3% of the world’s population live in a different country from where they were born. Today’s levels of global migration are unprecedented and reflect the greater ease of travel and communication. Economists tend to favour migration because world output increases when people move to more productive environments. But what does the wellbeing approach say about the gains and losses from migration?
Three lots of people are affected.Footnote 36 The first is the people who move. On average, international migrants increase their happiness when they move by 0.6 points (out of 10). This is a lot. Most migration is to happier countries and, after moving, migrants become on average about as happy as the existing residents in the country where they end up.Footnote 37 This change happens very quickly; and second-generation immigrants are on average as happy as their parents were after they moved.
The second group affected is the family that the migrants left behind. According to the evidence, they remain as satisfied with life as they were before, partly because they often receive very large financial remittances from their migrant relative.
Finally, there are the original residents of the country to which the migrants migrate. Resentment against immigrants is particularly common among less-skilled workers, who feel that migrants undermine their bargaining power in the labour market. This can clearly reduce their wellbeing. But there is little persuasive evidence of large effects, and there is no evidence across countries that those with high proportions of immigrants are less happy because of it. In fact, the happiest ten countries in the world include on average 17% of their population who were born abroad.
This said, immigration has become a huge political issue and, as Chapter 17 shows, it has fuelled populism and undermined the stability of politics in many countries. Whatever the findings of wellbeing science, Paul Collier is surely right when he argues that migration flows would be highly destabilising if they were not effectively managed.Footnote 38
Culture, Sport and Religion
Finally, let’s look at some of the most enjoyable things we do in the company of others: the arts, sports and (for some) religious worship.
By the arts we mean mainly music, dance, drama, cinema, visual arts, museums and book clubs. In most of these, we can either perform actively or we can be attendees while others are performing. In each case, there is normally a social element and the activity is also intrinsically uplifting.
To study the wellbeing effects of these activities is not easy. There is obviously a short-run effect, but if we want to study the longer-term effect there is a problem of timing. In one study, the researchers investigated the effect of attending music events.Footnote 39 They studied the long-run effects on life satisfaction by taking two standard social surveys and (including a fixed effect for each person) they asked ‘How much was a person’s life satisfaction increased by attending at least one of each type of music event in the last year?’ The average effect of each type of event was about 0.1 points of life satisfaction (out of 10). On the other hand, when the researchers used time-use studies and looked at the contemporaneous effect over a shorter time, the effect on happiness (a hedonic measure) was nearer to 0.8 points (out of 10). The effects were strongest when group activities are involved.
A more comprehensive enquiry looked at all the arts and evaluated separately the effects of participating in any activity at least once a week or of attending at least once a year. The analysis used Britain’s Understanding Society sample, with a fixed effect for each person. Participation (as defined) raised life satisfaction by around 0.1 points (out of 10), as did attendance.Footnote 40
When it comes to sports and exercise, we shall only look at participation.Footnote 41 (Attending matches is much more like watching them on TV). Again it is useful to distinguish between long-run effects on life satisfaction and short-run effects on positive emotion. Most of the existing studies have been cross-sectional, and these show good associations between exercise and life satisfaction.Footnote 42 But an association has been more difficult to establish in panel studies of annual time-series. As for the short-run effects on mood, these are strong and reliably established. Given this evidence, there is now a strong movement among doctors in favour of social prescribing. In other words, patients are encouraged to engage in a form of cultural activity or exercise that suits them.
Religious worship is one of the oldest forms of human group activity. Religion can play at least three major roles: to instil values, to provide valuable social interaction and to offer comfort. We have discussed the general importance of the first two elements in different parts of the book. But what of the specific effect of religion?
The Gallup World Poll provides important evidence;Footnote 43 68% of adults in the world say that ‘religion is important in their daily lives’. Religious belief and practice is more common in countries where life is harder (low income, life expectancy, education and personal safety). But, after controlling crudely for those factors, there is no difference in life satisfaction between more and less religious countries. Nor, within countries where life is less hard, are religious individuals in the Gallup World Poll systematically more satisfied with life than less religious people.
The position is somewhat different if we focus exclusively on the United States, using the Gallup Daily Poll. And, allowing for other factors, people in more religious US states are on average more satisfied with life.Footnote 44 And so are more religious people. In comparisons between individuals, there is always the problem that people who are naturally happier in given circumstances may be more willing to believe that there is a benevolent deity. However, meta-analysis concludes that greater religiosity is mildly associated with fewer depressive symptomsFootnote 45 and 75% of studies find at least some positive effect of religion on wellbeing.Footnote 46 This effect is particularly prevalent in very high-loss situations, such as bereavement (and weaker after less severe losses, such as job loss or marital problems). Thus, religion can reduce the wellbeing consequences of stressful events, via its stress-buffering role.Footnote 47 There is some longitudinal evidence suggesting that it is the friendship and social support that result from religious attendance that do most to enhance wellbeing.Footnote 48
In Europe, another large study of individuals (the European Social Survey) also found small but statistically significant effects on life satisfaction of ‘ever attending religious services’ and ‘ever praying’.Footnote 49 And interestingly, the religiosity of others in the region was also found to have positive benefits both on those who are religious and on those who are not.
Conclusions
We are social animals. Social connections are vital to our wellbeing, not only for practical reasons but also for mutual affection, a sense of being needed and a source of identity. This applies not only to connections within the family and the workplace but also within the community (‘community networks’).
Community networks raise the average wellbeing in a society. Such networks depend heavily on volunteering, and volunteering benefits both the members of the community who are served but also the volunteers themselves.
The norms of a society are crucial to its wellbeing. If everyone feels they can trust the other members of society, their wellbeing increases by 1 whole point compared with a position of zero trust. High levels of trust benefit especially those who are more disadvantaged, so trust is a force for equalising wellbeing.
Societies where wellbeing is more equal also tend to have higher average wellbeing. This works through many channels, and higher income equality on its own has a very small impact on overall wellbeing.
Crime is a breach of trust, and the prevalence of crime reduces average wellbeing.
Immigration may cause political tensions but it has no measurable impact on the wellbeing of the existing residents and it confers huge wellbeing gains on the immigrants. But political stability requires controls on immigration.
Some of the most rewarding things that people do together involve the arts (music, dance, drama, cinema, visual arts, museums and book clubs). Sport and exercise also have important benefits. Religion has also been shown to raise individual wellbeing, especially in countries where life is hard or for individuals experiencing loss.
The physical environment and planning policy also have huge effects on community wellbeing. This is the next topic for us to examine.
Questions for discussion
(1) Is there convincing evidence that higher trust causes higher wellbeing (i) across countries (ii) across individuals?
(2) What can be done to increase social capital (community networks and trust)?
(3) In what way or ways does inequality influence the average wellbeing in a society?
(4) Is there convincing evidence that one person’s happiness affects the happiness of other people?
(5) Compare the arguments in favour of immigration when the criterion is world GDP and when it is world wellbeing.