I raised my children on Nantucket Island. I have often described it as living for 28 years on a ship at sea. In the eighties and nineties, we did not get off the island much; I had a demanding business and with the kids in school our travel calendar was limited by both time and budget. I am hoping that now with the internet and more frequent options to come and go things might be different for families living on island. Small town life (especially isolated small town life) has it's pros and cons. The pros are innumerable , but the one that still astounds me is the way people step in and up for one another. No one ever wants to experience illness or tragedy; if something befell you or your family the community was there. The cons are many; in spite of the island's size and short distances people can be left out. When the tourist season is over, winters are long and hard, too many people use alcohol and drugs to get by.
For 12 years now Nantucket has had a generous community project. It is simply a book club: One Book One Island, the chosen book is free, making it easy for anyone to be included. Once there has been time to read there are free events to gather the readers for discussion and experiences that relate to what they have read.
I was reminded of Nantucket's One Book when I read George Monbiot's article in the Guardian about Frome, a town in Somerset U.K. which has been involved in a collective project to combat isolation. Although still waiting for formal results, 'the preliminary data seem to show when isolated people who have health problems are supported by community groups and volunteers, the number of emergency admissions to hospital falls spectacularly. While across the whole of Somerset emergency hospital admissions rose by 29% during the three years of the study, in Frome they fell by 17%. Julian Abel, a consultant physician in palliative care and lead author of the draft paper, remarks: “No other interventions on record have reduced emergency admissions across a population.”
The Compassionate Frome project was launched in 2013 by Helen Kingston, a GP there. She kept encountering patients who seemed defeated by the medicalisation of their lives: treated as if they were a cluster of symptoms rather than a human being who happened to have health problems. Staff at her practice were stressed and dejected by what she calls “silo working”.
They set up "community connectors" to help people find the help they needed. Sometimes this meant handling debt or housing problems, sometimes joining choirs or lunch clubs or exercise groups or writing workshops or men’s sheds (where men make and mend things together). The point was to break a familiar cycle of misery: illness reduces people’s ability to socialise, which leads in turn to isolation and loneliness, which then exacerbates illness."
Remarkable as Frome’s initial results appear to be, they shouldn’t be surprising. A famous paper published in PLOS Medicine in 2010 reviewed 148 studies, involving 300,000 people, and discovered that those with strong social relationships had a 50% lower chance of death across the average study period (7.5 years) than those with weak connections. “The magnitude of this effect,” the paper reports, “is comparable with quitting smoking.”
Helen Kingston reports that patients who once asked, “What are you going to do about my problem?” now tell her, “This is what I’m thinking of doing next.” They are, in other words, no longer a set of symptoms, but people with agency. This might lead, as the preliminary results suggest, to fewer emergency admissions, and major savings to the health budget. But even if it doesn’t, the benefits are obvious.
The sense of belonging benefits us all and it can start with something as simple as one book.