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Love as a Public Health Intervention

Levine, Marissa, J., MD, MPH; Cooney, Mary, Ann, MPH, MSN, RN

Journal of Public Health Management and Practice: January/February 2018 - Volume 24 - Issue 1 - p 87–89
doi: 10.1097/PHH.0000000000000736
State of Public Health

Virginia Department of Health, Richmond, Virginia (Dr Levine); and Association of State and Territorial Health Officials, Arlington, Virginia (Ms Cooney).

Correspondence: Mary Ann Cooney, MPH, MSN, RN, Association of State and Territorial Health Officials, 2231 Crystal Drive, Suite 450, Arlington, VA 22202 (mcooney@astho.org).

The authors declare no conflicts of interest.

Hurricane Harvey demonstrated that, in the words of expert CBS storyteller Steve Hartman, “When Mother Nature is at its worst, human nature is at its best.”1 Love and caring were in full display without regard to race, ethnicity, political beliefs, or other superficial differences. People came together in ways we see repeated in times of crisis: Neighbors caring for neighbors. Maybe John Lennon was correct. “Love is all you need.” Fifty years ago on June 25, 1967, in the first live global television broadcast, the Beatles sang the words that would capture hearts and minds of generations to come. Lennon himself stated that the lyrics were meant to galvanize action to “promote change.” Imagine a world where positive change occurs simply through love.

The word “love” has several meanings and is most often understood as a verb defining romantic feelings for another. Examples are parental love toward children, familial love for friends and relatives, and other strong individual caring and nurturing emotions or actions directed toward another person or group of people. Love, used as a noun, though, defines a state of compassion, care, and significant desire for a good outcome. Gary Chapman, author of several books on the meaning of love, describes looking at love as a way to change every aspect of our lives. Many will agree that loving comes naturally to us, and loving in our social connections and broader relationships improves and enhances our daily lives and sustains us in tough times2 (Figure 1).

FIGURE 1

FIGURE 1

While not determinants of health in the strictly scientific sense, actions that are motivated by love, care, compassion, helpfulness, and respect improve both actor and recipient well-being. We have known this for years as it relates to relationships and early childhood development.3 And though social epidemiologists may not directly reference “love” per se, they are now finding that developing strong individual and community connections builds a sense of well-being and reduction in the areas of interpersonal crime, domestic violence, and substance abuse. Love, as a context within which we live, may have powerful public health implications.

This may be very good news, since public health officials find themselves at an important crossroad in the ongoing effort to protect health and promote well-being for all. Our current assessment of the health of populations identifies disparate outcomes, significant chronic disease burden, and concern with an unhealthy developmental trajectory. For many children, this foretells an ominous future for many in the next generation. Some even describe an epidemic of loneliness.4 In the words of Albert Einstein, we can't expect the thinking that got us here to help us solve these problems. Has our thinking to date resulted in the design of systems (organizations, communities, governments) devoid of or inhibitory to the basic human need of establishing and maintaining loving and caring relationships?

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Thinking Differently: Through the Relationship Lens

Thinking differently, what if the attainment and maintenance of health and well-being were actually a problem of design? If so, as designers, we would be discussing the creation and maintenance of the necessary health-promoting infrastructure to best ensure the desired outcomes. But the infrastructure we are talking about is the human systems that are needed to ensure we are working together in an intentional, aligned, and focused manner. In other words, working together from the perspective of relationships based on love and caring. And when considering bricks and mortar infrastructure, should not we ask whether the built environment can be better designed to promote (and not inhibit) loving and caring relationships? Any good architect or designer knows that you start with the function you are trying to support or promote. We postulate that the essential function for which our designs must intentionally improve is the loving, caring relationship. An intentional approach to align our efforts to focus on designing human systems that promote and maintain loving, caring relationships may represent the greatest opportunity for us as public health leaders as we work to redefine the infrastructure necessary to protect health and promote well-being.

What we are referencing here is the application of the science of a socioecological model. This is an evidence-based prevention framework where a person's health and well-being are inextricably linked to his or her immediate and extended environments. Moving from the individual outward, family, community, and the global environment impact the health of an individual. Relationships with family, schools, workplaces, and the social connections to community all influence the trajectory of health.

A growing body of literature identifies the critical role of these loving and caring relationships (or “generative” relationships—where both parties are better off as a result) at key milestones in our life course.5

Prosocial and procaring activities, such as performing kind acts, may also improve individual self-satisfaction and create stronger feelings of self-worth simply by caring for another, a pay-it-forward concept, if you will. These acts also have an effect on the recipient. Peer support recovery programs for alcohol and substance misuse or addiction, such as 12-step programs, provide this kind of support through a strong sense of fellowship and a sense of belonging, helping prevent and reduce relapse. Suicide prevention and recovery support for those who are survivors of suicide maintain that feelings of connectedness and hope come from working together in groups led by peers with a shared experience.6 In a recent article in Harvard Business Review, former US Surgeon General Vivek Murthy notes that creating a workplace that promotes loving and caring relationships among coworkers lessens feelings of loneliness and, as a result, the positive relationships enhance performance and reduce stress and loneliness.7

Much of the focus of the impact of caring relationships has been at the individual level. Perhaps this human-centered system design focused on generative relationships has a role in developing and enhancing community resilience? Is Texas' resilience after Harvey more a function of the generative relationships observed than the amount of resources available? Could leaders who truly love and care for their constituents be the difference? In areas where evacuation was recommended, did social connections with neighbors contribute to someone moving to a shelter for care? Building resilient communities in which resilient children grow and develop is an important goal in a country with disparate health outcomes. Perhaps we can link our community health improvement and community resilience building efforts under this potentially powerful unifying relational concept.

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Opportunities for Public Health Officials

Consider that the absence of these generative relationships may explain the disparate population outcomes, burden of chronic disease, and poor trajectory of so many children. Maybe we have unintentionally designed (or allowed to deteriorate) neighborhoods, communities, organizations, processes, and policies in a manner that did just the opposite of what is needed because we did not factor in the value of the generative relationship. By doing so, we actually inhibited or placed significant obstacles in the attainment or maintenance of such relationships. If so, and generative relationships are truly critical to our health and well-being, then we have to act now on the tremendous opportunity to redesign our neighborhoods, communities, organizations, processes, and policies to intentionally promote generative relationships, to create human systems as they were intended to be—places where it is easy to care and love one another because everything we do and build values the attainment and maintenance of those relationships. Imagine for a moment what it would look like if we did so:

  • Healthy, connected communities would be designed to ensure that all had a voice and were valued.
  • We would ensure that every child grew and developed in the context of a loving, caring adult.
  • Systems of health care would be designed around people and value the relationships of both the provider and the patient.
  • Places where we live, work (including our own health departments), and play would make it easy for us to practice prevention day in and day out by fostering these relationships.
  • Policies at the highest levels would ensure that health is a focus and that attainment of health is dependent upon social connections. Health in all policies, at its root, is really about generative relationships protected and promoted in all policies.
  • Leaders would become voices of change and role models who clearly articulate that caring is an evidence-based practice and a vehicle to prosperous communities

To conclude, we again turn to the words of Steve Hartman. “The challenge will be, as the flood waters recede, will we still be able [to] love at these same record levels?”1 Perhaps, through intentional design that values and fosters love and caring, we can attain and maintain the levels of love that will improve the health of all communities.

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References

1. CBS. How the worst of Harvey brought out America's best. http://www.cbsnews.com/news/how-the-worst-of-harvey-brought-out-americas-best. Aired September 1, 2017. Accessed September 16, 2017.
2. Chapman G. Love as a Way of Life; Seven Keys to Transforming Every Aspect of Your Life. New York, NY: Doubleday Religion; 2008.
3. National Scientific Council on the Developing Child. Young Children Develop in an Environment of Relationships. Working Paper No. 1. Published 2004. Retrieved from http://http://www.developingchild.net. Accessed September 16, 2017.
4. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality. Perspect Psychol Sci. 2015;10(2):227–237.
5. National Research Council and Institute of Medicine; Committee on Integrating the Science of Early Childhood Development; Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education; Shonkoff JP, Phillips DA, eds. From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, DC: National Academies Press; 2000.
6. Strine TW, Chapman DP, Balluz LS, Mokdad AH. Health-related quality of life and health behaviors by social and emotional support: their relevance to psychiatry and medicine. Soc Psychiatry Psychiatr Epidemiol. 2008;43(2):151–159.
7. Murthy V. Work and the loneliness epidemic: reducing isolation at work is good business. Harv Bus Rev. 2017. https://hbr.org/cover-story/2017/09/work-and-the-loneliness-epidemic. Accessed September 20, 2017.
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