What keeps us well? For decades, social scientists, doctors and others have struggled to find the answer, but it has eluded them. Keeping well relies on a host of factors. Some of them are material (money, food, lodgings), some of them more spiritual (feeling like we belong, sharing an identity with others).
The relationship between health and the chances we have in life are well documented. The silver spoons with which some babies’ mouths are filled at birth seem to ward off future illness, as do secured places at public school and other expressions of privilege. There is nothing new in this message, but its importance endures.
Being able to afford the basics to keep healthy seems fundamental: a job to give us sufficient resources to live, a secure roof over our heads, nutritious food on the table and adequate clothing on our backs. Access to services is key. We need to be able to see a doctor when illness dictates and we should be able to go to school to learn, travel freely and feel protected. We should also be treated fairly.
In addition, family and kinship - the urban geographers and sociologists of the 50s and 60s assured us - form the crux of society. Their fragmentation results in isolation and poverty.
Family (however we choose to define it) and friends have been researched many times. Men with partners to cherish and look after them seem to live longer. Women who live with others - nuns for example - fare even better. Gay men with HIV who have a clear sense of belonging to a gay community have better outcomes than those who do not. People with strong family ties often recover more fully, and more quickly, from periods of depression. The examples are many, but the conclusions are consistent: intimacy and significant relationships are important.
However, a growing research base - yet to be fully noticed by health colleagues - recognises the importance of ‘weak ties’ in maintaining health and well-being. This research does not reflect on the roles of lovers, families or friends, but seeks to assess the importance of incidental people in our lives - whoever they may be, whatever the life we lead. These might include the local taxi driver, the neighbour who gives out hymn books at church or the shopkeeper who engages us in trivial conversation. Such incidental encounters hook us into the communities we live in and foster a sense of belonging.
There are some important messages here relating to how we engage with local people in our day-to-day business in the NHS. It might not be just the advice we give, or the prescriptions we dispense, which keep people well. It might also be the quality of the interactions we have. For example, regular contact with a podiatarist who is known to patients and takes an interest into what is happening in their lives might be as important in keeping them well as the mobility that results from good foot care.
It would be naive to suggest that politeness and courtesy will keep the nation healthy, but the quality of people’s interactions is an important part of their well-being. Ensuring patients have regular contact with familiar staff might be a health improvement resource yet to be fully exploited - an investment to reduce future burden on the NHS.