Lessons from COVID-19: Improving Social Health to Build Community Resilience

Abstract:

Research from the pandemic and previous emergency situations has demonstrated the value of strong social ties for community resilience. Yet social isolation and loneliness are common among older adults, who may be especially vulnerable when disaster strikes. This article recommends ways to improve social health proactively and preventively so that communities are better prepared for climate change. Specific suggestions for federal policymakers, city officials, community-based organizations, and individual citizens are provided.

Key Words:

social health, social connection, community resilience, loneliness, social isolation, COVID-19

Imagine it is early 2020. You are an older adult whose spouse passed away a few years ago and whose children and grandchildren live out of state. Normally, you stay engaged by spending time with friends at the community center and participating in hobbies. But now you are stuck at home alone. Although you own a smartphone and computer, you struggle to use them—and besides, calls are not satisfying substitutes for hugs. Days of isolation go by, which stretch into weeks and months as the pandemic persists.

Now imagine that it is 2050. You are an older adult living inland in a coastal state. A flash flood sweeps through your neighborhood from the nearby river, which had swollen due to heavy precipitation, melting ice caps, and extreme weather events. You are stranded in your home, too frail to attempt leaving on your own. Power and service were taken out with the flood, so you cannot call for help. You wait anxiously, hoping someone will come.

In these two bleak scenarios—whether facing a global pandemic spread through viral transmission or a natural disaster triggered by climate change—the takeaway is the same: Older adults and people of all ages cannot survive or thrive alone. To prepare for future emergencies, we as individuals, communities, and a society must strengthen our social ties.

The Pandemic Points the Way

The pandemic has shown that strong social ties are essential for community resilience, which is defined as a region’s capability to prepare for, respond to, and recover from threats (Drolet, 2021).

Researchers looked at county-level data on family stability, community cohesion, volunteerism, public trust, and other indicators of social capital in the United States from 2012 to 2016. They then mapped this data with the county-level spread of COVID-19 between March and July of 2020. After controlling for potential confounders, the researchers discovered that higher levels of social capital were associated with significantly lower numbers of cases and deaths (Makridis & Wu, 2021). Similarly, another study found that counties with strong social ties among friends, family, and members of the same social groups, as well as connections among residents, elected officials, and decision-makers, had fewer excess deaths during the pandemic (Fraser, Aldrich & Page-Tan, 2021).

This trend extends beyond the United States. In Austria, Germany, Great Britain, Italy, the Netherlands, Sweden, and Switzerland, an increase in social capital corresponded with a decrease in cases and deaths (Bartscher et al., 2021). As one epidemiologist noted, countries that have fared relatively well tend to be “distinguished by high levels of political cohesiveness, social trust, income equality and collectivism, like New Zealand, Taiwan, Norway, Iceland, Japan, Singapore and Denmark” (Kaufman, 2022). Researchers in Denmark attribute much of the country’s success with vaccinating people and keeping the virus at bay to “samfundssind” or community spirit (Adler-Nissen et al., 2022). Trust in each other and in institutions, coupled with a sense of camaraderie, led Danes to adopt COVID-19 policy more readily.

In Bhutan, people rallied to support one another (Drexler, 2021). In addition to implementing a swift and sweeping public health strategy, officials sent care packages to older adults; actors, sports personalities, and other influencers promoted “Our Gyenkhu” or a sense of collective responsibility; thousands of citizens volunteered to join the national corps; and farmers altruistically donated crops. As a result, as of February 2022, only five residents had died due to COVID-19. Reflecting on the experience, Bhutan’s representative at the World Health Organization concluded that pandemic resilience came less from the health sector, and more from social capital and “the willingness of society to come together for the common good.”

These examples illustrate that, around the world, instead of spreading the virus more quickly through social interaction, relationships provided protection against COVID-19 through collective efficacy and social support. According to sociologists, this is because social ties facilitate collaboration and mobilize resources by leveraging trust at the individual level and activating social norms at the community level (Wu, 2021). Although contact can spread illness, rapport can prevent illness and promote wellness.

Drawing Direction from Disaster

This lesson should not come as a surprise. Researchers have documented that social ties fueled community resilience in past emergencies, too.

The 9.0 magnitude earthquake and accompanying tsunami that struck Japan in 2011—killing around 20,000 people, most of whom were at least 65 years old, and displacing another 300,000 people—offers insights (Rafferty, 2021). Ichiro Kawachi, professor at the Harvard T.H. Chan School of Public Health, happened to be studying the health of Japanese older adults at the time and was able to document their progression following the disaster.

Kawachi and his colleagues found that social participation buffered against cognitive decline (Hikichi et al., 2020). Older adults who socialized regularly fared better than those who remained isolated in the aftermath of the earthquake and tsunami. He concluded that “interpersonal relationships, a shared sense of identity, shared norms and values, trust, cooperation, and reciprocity” were more important for resilience than “material resources such as medical supplies, food, or shelter” (Feldscher, 2019).

The epidemic of drug overdoses in the United States offers additional insights. Researchers have examined the link between social capital and deaths due to drug overdose from 1999 to 2014. They reported that counties with the most social capital were 83% less likely to have high levels of drug-related mortality (Zoorob & Salemi, 2017). In other words, community connectedness may also prevent deaths of despair.

From Disconnected and Vulnerable…

But to reap the benefits of strong social ties, people must have strong social ties in the first place. That is not currently the case for many older adults.

Surveys in recent years estimated that 24% of older adults were socially isolated and 43% felt lonely (Cudjoe et al., 2018; Perissinotto, Stijacic Cenzer, & Covinsky, 2012), and disconnection may have worsened as a result of COVID-19. Research by the AARP Foundation and the United Health Foundation (2020) revealed that two-thirds of older adults had few social relationships or infrequent social contact with others during the pandemic, and 73% agreed that the pandemic has made connecting with friends more difficult.

This is a problem for several reasons. First, widespread disconnection amounts to a public health priority. People who are not socially active are more likely to develop dementia, and those with poor social relationships have a 29% increased risk for heart disease and a 32% increased risk of stroke (Kuiper et al., 2015; Valtorta et al., 2016). Disconnection can also be deadly. In one study, for example, socially isolated older adults had a higher risk of disability and were more likely to die following hospitalization, compared to their more connected counterparts (Falvey et al., 2021). This is true across different types of disconnection; one’s risk of dying increases by 29% if socially isolated, 26% if lonely, and 32% if living alone (Holt-Lunstad et al., 2015). In turn, a lack of social ties among older adults costs Medicare an extra $6.7 billion each year (Flowers et al., 2017).

Disconnection also puts community members at peril. In 2021, Hurricane Ida tore through Louisiana and left older adults stranded in their homes without power. One 86-year-old man in New Orleans described struggling to stay alive (Reckdahl, Bogel-Burroughs, & Kasakove, 2021). Because the elevator was out of service and he was too frail to make it down the stairs, his age restricted him from seeking help and safety. A week passed in isolation before he was rescued.

Similar stories came from Chicago during the 1995 heat wave, which broke records, shut down power grids, and caused severe heat-related illnesses. As the sociologist Eric Klinenberg shared, “Hundreds of Chicago residents died alone, behind locked doors and sealed windows, out of contact with friends, family, and neighbors, unassisted by public agencies or community groups” (University of Chicago Press, 2015). Among them, men were more than twice as likely to die, which he attributed to “the social relationships that elderly women retain but that elderly men tend to lose.”

To prepare for climate change and extreme weather events, the evidence is clear: we need to strengthen social ties to build community resilience. But how?

…To Connected and Resilient

First, we must act now to strengthen social ties and thereby build community resilience. As Sebastian Junger described in his book “Tribe” (2016), people often unite during or after crises, but uniting people before crises can help save lives.

I recommend taking a proactive, asset-focused approach by complementing efforts that aim to minimize social isolation and loneliness with efforts that aim to promote and improve social health. Social health is the dimension of well-being that comes from connection and community (Social Health Labs, 2021).

Improving social health is a prevention strategy that can benefit everyone, not just older adults and not just those who are isolated or lonely. When people are socially healthy, they experience better physical and mental health, too. For instance, they have stronger immune systems, are less likely to develop depression, and enjoy greater happiness—and evidence suggests that this link is causal, not merely correlational (Cacioppo, Hawkley, & Thisted, 2010; Howick, Kelly, P., & Kelly, M., 2019; Killam, 2015; Saphire-Bernstein & Taylor, 2013). Most importantly for community resilience, being socially healthy means having people upon whom you can rely for practical help, information, and emotional support in times of need. This is an essential resource when facing climate change and natural disasters.

Second, we must take a multilevel, multisector approach, engaging and activating a range of stakeholders, from everyday citizens to influential leaders. It also means coordinating efforts across different sectors in society.

At Social Health Labs, we have been leading discourse on how to do that through hosting a series of convenings with experts, innovators, and community members. The series, Connect+Conversations, explored the roles that healthcare, technology, education, government, design, and other sectors can play in improving people’s social health and creating the conditions for a more socially healthy culture (Social Health Labs, 2022a). Importantly, the series also explored what individuals can do in their own lives and neighborhoods.

Sidebar:

The Connect+Conversations series identified key strategies to reduce and prevent loneliness and improve social health. The insights from eight convenings with 26 experts and more than 2,500 community members in 55 countries are summarized in a recent report titled Creating the Conditions for Social Well-Being. Download the report.

Last, we must see older adults as resources, not liabilities, in the fight against climate change. Assuming that older adults exclusively need to be helped, without being helpers too, is both patronizing and a missed opportunity. For one, this assumption strips them of the potential meaning, purpose, and connection that comes from volunteering, helping others, and being engaged in the local community (Killam, 2019). A key contributor to disconnection among older adults is feeling discarded by society and being viewed as a burden or invisible, and loneliness is often accompanied by perceiving life as less meaningful (Stillman et al., 2009). For another, while older adults may be more vulnerable and susceptible to the consequences of climate change, they also can be agents of change with a wealth of wisdom and skills to contribute to the cause.

Empowering older adults to get involved is a triple threat: their participation can improve social health and build community resilience at the local level and help fight climate change more broadly, all while alleviating their own sense of isolation or loneliness.

Recommendations

To improve community resilience proactively and preventively, we must employ a multilevel, multisector approach to social health and involve older adults as partners in the fight against climate change. To accomplish this, four key stakeholders are well poised to have an impact: federal policymakers, local city officials, community-based organizations, and individual citizens.

Federal Policymakers

In the United States, federal policymakers have begun giving social isolation and loneliness the attention it deserves through legislation (Killam, 2021). But this needs to expand from ad hoc support for disconnected older adults to an integral part of emergency preparedness efforts for all citizens.

In the $65 billion plan that the White House put forward last year to prepare for future pandemics, social health and community resilience were notably absent—even though the success of the entire plan hinges upon our ability to come together and support each other (Lander & Sullivan, 2021). Strong relationships should be key to the national strategy, whether preparing for public health crises, natural disasters, or climate change. And, given rates of disconnection and polarization, the existence of strong relationships cannot be assumed; the United States needs to proactively nurture and invest in them.

To remedy this situation, the government could announce a national call to action. There are resources available on Ready.gov, a public service campaign that aims to “educate and empower the American people to prepare for, respond to and mitigate emergencies” (U.S. Government, 2022). Yet, despite having lived in multiple cities and states across the United States, I have never once heard about or been invited to participate in a community preparedness plan. Federal leaders could first expand these resources with more information on how to strengthen social ties locally and build community resilience. Then they could promote the resources more widely by supporting state and city officials in implementing them and by raising awareness through engaging local residents.

City Officials

City officials could first establish a baseline for community resilience in their jurisdictions, using existing data or partnering with local academic institutions to collect data. For instance, researchers in Japan measured community-level social capital using indicators like participation in local groups and levels of trust (Saito et al., 2017). In the United States, the Joint Economic Committee published state- and county-level data on social capital in 2018, which includes indicators such as family unity, social support, and collective efficacy. City officials can use this data to identify priority regions where community resilience may be lacking.

Next, city officials could take coordinated action in those neighborhoods. One approach that has proven popular during the pandemic is mutual aid networks: groups of neighbors volunteering to match resources, such as groceries or childcare, to people who need them (Mutual Aid Hub, 2022). These hubs served as lifelines while forging new and lasting community relationships. However, given the hurdles the groups face, more formal, structured support from city officials—whether through coordination or funding—would amplify their impact (de Freytas-Tamura, 2021).

Community-Based Organizations

Nonprofits, neighborhood associations, and other local organizations play a pivotal role in strengthening social ties and thereby building community resilience. One example is Connection New Brunswick, a program led by the Canadian Red Cross (2022) in collaboration with numerous local service providers to connect older adults with the community. Its approach is preventive, aiming to help older adults find friends and access the resources they need to age and thrive in place—before disaster strikes.

Another example is the Community Living Campaign in San Francisco (2022), for which I serve as a board member. Through our Community Connectors program, we offer a range of virtual and in-person activities and outreach for older adults across the city, including emergency preparedness planning. As a result, 84% of participants know more neighbors whom they feel comfortable asking for help and 68% have helped a fellow neighbor. By building these relationships proactively, the support system is in place for when emergencies happen. We saw this play out during the pandemic, when our community members checked in on one another regularly and got creative about staying connected safely.

Individual Citizens

When Hurricane Harvey swept through Texas in 2017, locals were quick to communicate and help each other using the Nextdoor app. As they reported, “Neighbors have taken to Nextdoor to discuss evacuation routes, current flood levels, ask for assistance from a neighbor, or find the closest shelter” (Nextdoor, 2017). Researchers later confirmed that people who communicated on the platform received more help and were more resilient (Page-Tan, 2021). Using communication tools to stay connected with neighbors and support one another is one step individuals can take, although it requires access to digital tools and knowledge about how to use them.

Another way individuals can contribute is to take ownership in their neighborhoods now. At Social Health Labs, we run a monthly microgrant program to support community builders across the country with small stipends for local projects (Social Health Labs, 2022b). From people like Dana in Florida who hosted intergenerational gatherings and Dyah in Ohio who distributed welcome brochures to new residents, I have seen the power of individuals rising up to connect people in small yet meaningful ways. More actions like these from inspired changemakers are necessary to slowly but surely reweave our social fabric.

COVID-19 has reinforced that social ties are essential for community resilience. With the inevitable threats of future pandemics, natural disasters, and climate change, we need to prepare—and preparation begins with relationships. In addition to asking how we can support older adults, we should ask another question: How might older adults help lead efforts to improve social health and build community resilience? How might they leverage their life experiences and knowledge to connect people across generations and galvanize action? Older adults need to be both the beneficiaries and the benefactors of this work.

Kasley Killam, MPH, is a Harvard-trained social scientist and the founder of Social Health Labs, a nonprofit that leads initiatives to improve well-being through connection and community.

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