Community Epidemiology Quotes

One of the central elements of resilience, Bonanno has found, is perception: Do you conceptualize an event as traumatic, or as an opportunity to learn and grow? “Events are not traumatic until we experience them as traumatic,” Bonanno told me, in December. “To call something a ‘traumatic event’ belies that fact.” He has coined a different term: PTE, or potentially traumatic event, which he argues is more accurate. The theory is straightforward. Every frightening event, no matter how negative it might seem from the sidelines, has the potential to be traumatic or not to the person experiencing it. Take something as terrible as the surprising death of a close friend: you might be sad, but if you can find a way to construe that event as filled with meaning—perhaps it leads to greater awareness of a certain disease, say, or to closer ties with the community—then it may not be seen as a trauma. The experience isn’t inherent in the event; it resides in the event’s psychological construal. It’s for this reason, Bonanno told me, that “stressful” or “traumatic” events in and of themselves don’t have much predictive power when it comes to life outcomes. “The prospective epidemiological data shows that exposure to potentially traumatic events does not predict later functioning,” he said. “It’s only predictive if there’s a negative response.” In other words, living through adversity, be it endemic to your environment or an acute negative event, doesn’t guarantee that you’ll suffer going forward. What matters is whether that adversity becomes traumatizing.

The Company We Keep So now we have seen that our cells are in relationship with our thoughts, feelings, and each other. How do they factor into our relationships with others? Listening and communicating clearly play an important part in healthy relationships. Can relationships play an essential role in our own health? More than fifty years ago there was a seminal finding when the social and health habits of more than 4,500 men and women were followed for a period of ten years. This epidemiological study led researchers to a groundbreaking discovery: people who had few or no social contacts died earlier than those who lived richer social lives. Social connections, we learned, had a profound influence on physical health.9 Further evidence for this fascinating finding came from the town of Roseto, Pennsylvania. Epidemiologists were interested in Roseto because of its extremely low rate of coronary artery disease and death caused by heart disease compared to the rest of the United States. What were the town’s residents doing differently that protected them from the number one killer in the United States? On close examination, it seemed to defy common sense: health nuts, these townspeople were not. They didn’t get much exercise, many were overweight, they smoked, and they relished high-fat diets. They had all the risk factors for heart disease. Their health secret, effective despite questionable lifestyle choices, turned out to be strong communal, cultural, and familial ties. A few years later, as the younger generation started leaving town, they faced a rude awakening. Even when they had improved their health behaviors—stopped smoking, started exercising, changed their diets—their rate of heart disease rose dramatically. Why? Because they had lost the extraordinarily close connection they enjoyed with neighbors and family.10 From studies such as these, we learn that social isolation is almost as great a precursor of heart disease as elevated cholesterol or smoking. People connection is as important as cellular connections. Since the initial large population studies, scientists in the field of psychoneuroimmunology have demonstrated that having a support system helps in recovery from illness, prevention of viral infections, and maintaining healthier hearts.11 For example, in the 1990s researchers began laboratory studies with healthy volunteers to uncover biological links to social and psychological behavior. Infected experimentally with cold viruses, volunteers were kept in isolation and monitored for symptoms and evidence of infection. All showed immunological evidence of a viral infection, yet only some developed symptoms of a cold. Guess which ones got sick: those who reported the most stress and the fewest social interactions in their “real life” outside the lab setting.12 We Share the Single Cell’s Fate Community is part of our healing network, all the way down to the level of our cells. A single cell left alone in a petri dish will not survive. In fact, cells actually program themselves to die if they are isolated! Neurons in the developing brain that fail to connect to other cells also program themselves to die—more evidence of the life-saving need for connection; no cell thrives alone. What we see in the microcosm is reflected in the larger organism: just as our cells need to stay connected to stay alive, we, too, need regular contact with family, friends, and community. Personal relationships nourish our cells,

The New World was like a vast, tinder-dry forest waiting to burn—and Columbus brought the fire. That European diseases ran rampant in the New World is an old story, but recent discoveries in genetics, epidemiology, and archaeology have painted a picture of the die-off that is truly apocalyptic; the lived experience of the indigenous communities during this genocide exceeds the worst that any horror movie has imagined. It was disease, more than anything else, that allowed the Spanish to establish the world’s first imperio en el que nunca se pone el sol, the “empire on which the sun never sets,” so called because it occupied a swath of territory so extensive that some of it was always in daylight.

anthropologists are currently being cast as facilitators in the rapid production and uptake of knowledge, the fast-tracking of community outreach, and the real-time integration of behavioural and epidemiological insights (Abramowitz et al. 2018).

That European diseases ran rampant in the New World is an old story, but recent discoveries in genetics, epidemiology, and archaeology have painted a picture of the die-off that is truly apocalyptic; the lived experience of the indigenous communities during this genocide exceeds the worst that any horror movie has imagined.

Such narratives were recalled in Canada in 2009 amid public-health responses to the H1N1 epidemic, after federal agencies delivered to rural northern Native communities vaccine and face masks accompanied by unmandated body bags. Outraged community health leaders deplored this as a sign that the very agencies charged with protecting them had given up and were being readied for their deaths. Here, an epidemiological reading that public-health measures cannot prevent epidemic in rural northern Native communities appears as the rationalizing logic of a settler colonial biopolitics.

In her 1968 book, The Epidemiology of Depression, Charlotte Silverman, who directed epidemiology studies for the NIMH, noted that community surveys in the 1930s and 1940s had found that fewer than one in a thousand adults suffered an episode of clinical depression each year. Furthermore, most who were struck did not need to be hospitalized. In 1955, there were only 7,250 “first admissions” for depression in state and county mental hospitals. The total number of depressed patients in the nation’s mental hospitals that year was around 38,200, a disability rate of one in every 4,345 people.

Ironically, given the high-tech quality of the diagnostic and monitoring effort, the containment policies were based on traditional methods dating from the public health strategies against bubonic plague of the seventeenth century and the foundation of epidemiology as a discipline in the nineteenth century—case tracking, isolation, quarantine, the cancellation of mass gatherings, the surveillance of travelers, recommendations to increase personal hygiene, and barrier protection by means of masks, gowns, gloves, and eye protection. Although SARS affected twenty-nine countries and five continents, the containment operation successfully limited the outbreak primarily to hospital settings, with only sporadic community involvement. By July 5, 2003, WHO could announce that the pandemic was over.

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