Several studies have shown that marriage or living with a partner has greater health benefits for men than women, because traditionally women are caregivers. Newer findings question whether the nurturing qualities of women are solely responsible for married men's improved health. Recent research reveals that men and women living alone have better health than those with unsatisfactory relationships with their partners. An alternative explanation of these findings may be that healthier people are more likely to marry than those with health problems.
Dr. Laura Fratiglioni and her colleagues at the Stockholm Gerontology Research Centre found that among Swedish older adults, the risk of developing dementia increased with increased social isolation ("Influence of Social Network on Occurrence of Dementia: A Community-based Longitudinal Study," Lancet, vol. 355, no. 9212, April 15, 2000). The quality, rather than frequency, of social contacts was more important in staving off impairment. People who had infrequent but satisfying interactions with families and friends fared better than those with unhappy or stressful relationships. The Swedish project also suggests that a variety of strong relationships is important—a single bond is insufficient to reduce risk. Older adults with several kinds of enduring relationships such as marriage, children, friends, and relatives were at lowest risk.
A promising finding from this study is the observation that one relationship may substitute for another. This is a key concern because death of a spouse or close friend may increase the survivor's risk for social isolation. The observation that strong connections with children, relatives, and friends can substitute for relationships with spouses or partners is especially significant for widowed, divorced, or never-married older adults.
Along with personal relationships, social activities also seem to protect against disease and increase longevity, even when the activities do not involve physical exercise. An annual study tracked the health and longevity of 2,761 older adults living in New Haven, Connecticut (Thomas A. Glass et al, "Population Based Study of Social and Productive Activities as Predicators of Survival among Elderly Americans," British Medial Journal, August 21, 1999). After thirteen years the researchers determined that "social and productive activities that involve little or no enhancement of fitness lower the risk of all cause mortality as much as fitness activities do."
Recent research reiterated the health benefits of socialization. Data from the Framingham Heart Study (a landmark study of fifty years of data about the health of residents of Framingham, Massachusetts) presented at the American Heart Association's Annual Conference on Cardiovascular Disease Epidemiology and Prevention in May 2005 found that men who were socially isolated had elevated levels of interleukin-6 (IL-6), a blood marker for inflammation that is linked to heart disease. The investigators posited that IL-6 may be elevated in men who are socially isolated because social isolation may influence health behaviors such as smoking and physical activity, which act to raise IL-6 levels. In addition, socially isolated people are often depressed and experience more stress than their more gregarious counterparts, and research has demonstrated that stress can increase IL-6 levels (Eric B. Loucks, "Social Connections: Could Heartwarming Be Heart-saving?" Meeting Report, Abstract P226 [EPI], American Heart Association, May 1, 2005, http://www.americanheart.org/presenter.jhtml?identifier=3030595).
Pets Are More Than Best Friends: They Can Help Keep People Healthy
Research conducted during the late 1990s found that pet ownership was associated with better health. At first it was believed that the effects were simply increased well-being—the obvious delight of hospital and nursing home patients petting puppies, watching kittens play, or viewing fish in an aquarium clearly demonstrated pets' abilities to enhance mood and stimulate social interactions.
A study published in the Journal of the American Geriatrics Society (vol. 47, no. 3, March 1999) found that attachment to a companion animal was linked to maintaining or slightly improving the physical and psychological well-being of older adults. Parminder Raina and his colleagues followed nearly one thousand older adults for one year and found that pet owners were better able to perform the activities of daily living and were more satisfied with their physical health, mental health, family relationships, living arrangements, finances, and friends. These findings were confirmed further by a study published in the December 2002 issue of Psychosomatic Medicine (J. Blascovich and B. Mendes, vol. 64, no. 5) using both men and women and dogs and cats.
Other research revealed the specific health benefits of human interaction with animals. One study followed people who had suffered heart attacks and found that after one year pet owners had one-fifth of the mortality rate of people without pets. Several researchers have observed that petting dogs and cats actually lowers blood pressure. The physiologic mechanisms responsible for these health benefits are as yet unidentified; however, some researchers think that pets connect people to the natural world, enabling them to focus on others, rather than simply on themselves. Other investigators observe that dog owners walk more than people without dogs and credit pet owners' improved health to exercise. Nearly all agree that the nonjudgmental affection pets offer boosts health and wellness.
Healthy People 2010
Building on the earlier reports Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention (1979) and Healthy People 2000: National Health Promotion and Disease Prevention Objectives (1990), Healthy People 2010 (November 2000, http://www.healthypeople.gov/document/html/uih/uih_2.htm) is an updated plan from the HHS detailing 467 objectives in twenty-eight focus areas to improve the nation's health. Its two general goals are to "help individuals of all ages increase life expectancy and improve the quality of life" and to "eliminate health disparities among different segments of the population."
Nearly all of the Healthy People 2010 goals and objectives involve one or more of the three levels of prevention. For example, the overall goal for cancer is to "reduce the number of new cancer cases as well as the illness, disability, and death caused by cancer." To realize this goal may involve primary prevention to encourage people to avoid known carcinogens (cancer-causing agents, such as tobacco) and secondary prevention to encourage screenings to detect cancer in its earliest, most readily treatable stages. An example involving tertiary prevention action is the focus on disability and secondary conditions that seeks to "promote the health of people with disabilities, prevent secondary conditions, and eliminate disparities between people with and without disabilities in the U.S. population."
Healthy People 2010 not only sets forth ambitious goals related to disease prevention but also outlines population-specific health and prevention objectives. For example, the publication includes twenty-one objectives related to adolescent health, ranging from reducing
TABLE 2.11
Twenty-one critical objectives identified by the Adolescent Health Work Group
- Reduce the proportion of children and adolescents with disabilities who are reported to be sad, unhappy, or depressed.
- Reduce pregnancies among adolescent females.
- (Developmental) Reduce the number of cases of HIV infection among adolescents and adults.
- Reduce deaths caused by motor vehicle crashes.
- Increase use of safety belts.
- Reduce homicides.
- Reduce physical fighting among adolescents.
- Reduce weapon carrying by adolescents on school property.
- Reduce deaths of adolescents and young adults.
- Reduce the suicide rate.
- Reduce the rate of suicide attempts by adolescents.
- (Developmental) Increase the proportion of children with mental health problems who receive treatment.
- Reduce the proportion of children and adolescents who are overweight or obese.
- Increase the proportion of adolescents who engage in vigorous physical activity that promotes cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.
- Reduce the proportion of adolescents and young adults with chlamydia trachomatis infections.
- Increase the proportion of adolescents who abstain from sexual intercourse or use condoms if currently sexually active.
- Reduce deaths and injuries caused by alcohol- and drug-related motor vehicle crashes.
- Reduce the proportion of adolescents who report that they rode, during the previous 30 days, with a driver who had been drinking alcohol.
- Reduce past-month use of illicit substances.
- Reduce the proportion of persons engaging in binge drinking of alcoholic beverages.
- Reduce tobacco use by adolescents.
SOURCE: "21 Critical Objectives Identified by the Adolescent Health Work Group," in Healthy People 2010: Understanding and Improving Health, 2nd edition, U.S. Government Printing Office, 2000, http://www.healthypeople.gov/search/stat_21crobj.htm (accessed December 14, 2005)
violent deaths resulting from homicide and suicide to increasing seatbelt use. (See Table 2.11.)
Many Americans Believe Cancer Cannot Be Prevented
Despite widespread health and consumer education about lifestyle choices and behaviors that can help to reduce the risk of developing serious diseases, many Americans persist in the belief that there is little they can do to prevent disease. For example, a December 2005 survey commissioned by the American Cancer Society found that nearly half of survey respondents (47%) felt they had little or no control in terms of reducing their risk of developing cancer (Mike Stobbe, "Half Surveyed Doubt Cancer Preventable," Associated Press, January 19, 2006). The survey also found that 65% of people are very or somewhat concerned that they will get cancer. About 70% of people ages thirty-five to fifty-four were very or somewhat concerned, compared with 62% of people ages fifty-five to sixty-four, 55% of people ages sixty-five to seventy-five, and 47% of people seventy-five and older.
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