People: peers, pain and power

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People: peers, pain and power

David Halpern

One of the most fascinating and important areas in life is surely the fine line between wanting to help, and being wary of, those around us. It’s a tension woven deeply into policy and into our humanity.
 
Recently I had one of those afternoons where an accident of meetings seemed to tell this story especially well. We are working on an interesting health project with Nesta, the Health Foundation, Voluntary Voices, Newcastle University and PPL called Realising the Value. It is about supporting people, and those around them, to better manage their health – and to change the relationship between healthcare providers and the people and communities who interact with them.

As part of this project, I found myself on a panel at a Nesta-organised event on People Powered Health, alongside Edwin Fisher. Edwin works on peer-to-peer support groups and gave examples of groups from across the world, including China, the US and Latin America where people help each other to preserve health on their terms.

We considered how human-centric principles should be baked into the design of health services. Project RED in Boston, for example, uses iPads to explain better to those leaving hospital how to manage their medication and conditions – allowing more time and detail than a busy clinician may have. Those who experience this programme have reduced readmission rates – down by 30% in the 28 days after discharge.

But our panel discussion also left the bounds of healthcare institutions and considered Holt-Lunstad et al’s famous (2010) meta-analysis on social isolation. It found that social isolation has negative impacts on life-expectancy equivalent to smoking 15 cigarettes a day. A study published this week has found that stopping the membership of social groups (such as book clubs, faith communities or trade unions) during the transition to retirement is akin to all forms of quitting vigorous exercise in terms of mortality risk – with each one lost responsible for a loss of 10% on quality of life measures too.  

Social connections are crucial to health. These connections are a source of self-sustaining well-being that our traditional health system is yet to tap or recognise consistently. The benefits of having strong community ties will be explored during the course of the Realising the Valueprogramme, which has been designed to collect evidence on what good person and community-approaches to health and wellbeing look like.
 
After the session with Edwin, my day ended with a seemingly very different discussion in the Lords, hosted by Lord Lindsay and chaired by Prof Ragnar Lofstedt (from the Kings Centre for Risk Management). It was a small but impressive group, including figures such as Paul Slovicfamous for his work showing how people typically respond much more strongly to a single death or image, than to reports of thousands dying. He noted, for example, how donations for Syria that had flat-lined as the death toll had climbed through the 100,000s, but shot up 17-fold in response to the photo of Aylan Kurdi lying on a beach. It’s a statistic that itself seems to encapsulate something deep about the human condition, and how we evolved to think about those around us (our feelings don’t do numbers…), sometimes for good, and sometimes not. Cause for despair, or hope?

Let me conclude on a really interesting, and I thought uplifting, result that was presented at the Lords event. Molly Crockett, a researcher at Oxford, described an experiment comparing how much people would pay, or be prepared to profit from, getting an electric shock (what is it with psychologists?), versus a stranger getting the same shock. It turns out to be a rather elegant, if painful, test of an economic versus social psychological worldview. Most economic models would surely see this as a ‘no-brainer’: of course subjects would rather profit from a small pain administered to someone else than to themselves. But no: it turns out subjects strongly prefer profit from pain to themselves, not to others. Indeed, putting subjects into a brain scanner while the choices were made showed that there was no activity in brain’s pleasure centres associated with gain at another’s expense (unless, by the way, the gain flowed to a good cause – that’s a whole other conversation).
 
We have a deep desire to help and support each other, and certainly not to profit from the pain of others. We see this starkly in this lab experiment, but also strikingly across Realising the Value’spartner sites where BIT’s researchers are currently spending several weeks collecting insights. Yet, as the refugee donations example illustrates, as that link becomes more abstract, this desire can easily get lost. It is a key challenge for those in shaping healthcare, whether patients, relatives or clinicians, to build a system that can harness and foster this capacity to help ourselves and each other – of ‘realising the value’ that our common humanity and connection can bring.

Sign up to the Realising the Value newsletter to see our forthcoming March publication on behavioural factors in person- and community-centred approaches to health and wellbeing.