Good health is about relationships. Having a go-to doctor, a primary care provider (PCP) who gets to know you over time and supports your goals for health, has been demonstrated to make a difference in overall health outcomes. One reason for this—our relationships with PCPs are more than transactional because generating health is more than just going to the doctor when you’re sick so she can prescribe medication for relief and then send you on your way. In the long term, a fully successful doctor-patient relationship requires an investment of time and shared goals between patient and PCP and the realization of those goals outside clinical walls.
Cultivating a relationship with your PCP is essential for your individual health, but what about your community’s health? Given that 80% of health outcomes are generated outside clinical walls, having a PCP bond is important but not enough to sustain individual or community health. How we interact with institutions and systems that are designed to sustain healthy populations—including everything from health and public health systems to housing, transportation, and education—influences what happens at the community level and across and within populations.
A relational approach is important not just for health care but for how we interact with the world around us to ensure our collective well-being. This is top of mind for me on the eve of the national election.
I’ve written before about voting and health. It’s clear to me that voting is an important and overlooked health behavior that when started early can have lifelong benefits to physical and mental health—sometimes directly and other times indirectly. What’s also clear is that voting, however important it may be, is only one transactional component of democracy.
Democracy is about more than what happens in the voting booth. It’s about social cohesion—in other words, how we relate to one another individually and collectively to achieve our goals for health and well-being and how institutions in our society that were created to support those goals meet the challenge.
The most acute example of this occurred during the COVID-19 pandemic when counties across the country with the highest levels of collectivism—a key dimension of social cohesion—also saw the highest levels of mask usage independent of political affiliations. This was possible because of relational interactions—levels of trust and shared goals within communities that had been cultivated over years.
There are many other examples. According to one study, neighborhoods considered to be less socially cohesive were linked to increased depression, smoking, and not walking for exercise. Another study found that higher perceived neighborhood social cohesion was associated with lower incidence of stroke, after adjustments for traditional risk factors for stroke. Social cohesion has also been tied to greater health care access and improved health, though results differed for those in rural vs. urban areas.
What’s at stake now during this national election is the relational aspect of democracy itself—how we work with one another to preserve our vibrant democracy as well as the infrastructure that ensures our health and well-being. This includes how you vote, of course, but goes far beyond the voting booth.
In an age of rising division and disinformation, this means prioritizing what pulls us together and not what pushes us apart. It means drawing strength from political bubbles without getting sucked into the echo chamber of one-sided arguments. It means realizing that the fight for health equity benefits all of us irrespective of our political affiliations.
As we cast our votes and await election returns, it’s incumbent on all of us to remember that democracy is not a spectator sport. No matter the outcomes, democracy demands that we ensure institutions created to support our health and well-being endure and are accountable for our collective wellbeing now and for years to come.