Study shows that relationships have the biggest effect on health

Can kindness, love and a strong sense of community actually make you healthier and happier? Research says that it does. A 1978 study looking at the link between high cholesterol and heart health in rabbits determined that kindness made the difference between a healthy heart and a heart attack. Kelli Harding, a professor of psychiatry at Columbia University Medical Center, revisits that research and other ground-breaking discoveries in her new book, The Rabbit Effect: Live Longer, Happier, and Healthier with the Groundbreaking Science of Kindness. She joined the Knowledge@Wharton radio show on Sirius XM to talk about the intangible factors behind good health and how a little kindness can go a long way.

Knowledge@Wharton: As you were researching your book, what did you find about the role that positive emotional connections play in good health?

Kelli Harding: As a physician, I was completely shocked. Most of us, when we think about health, we think about diet, exercise, sleep, the occasional trip to the doctor. But it’s really quite striking because there are decades of evidence that show that, in fact, probably the biggest contributor to our health is our relationships.

It’s one of those things that, as a doctor, you see every day. The way that I got interested in this is I kept seeing patients who would defy their diagnoses — somebody with a really serious illness on paper looks terrible, but then you meet them in person, and they’re doing pretty well. They’re living their lives to the fullest, and even though they have an illness, they’re still thriving in many respects.

The flip side of that was seeing patients all the time with what are treatable diseases or conditions, but they’re still not doing well. Or people for whom medically everything checks out, but they just feel really lousy or have pain that can’t quite be explained. That’s how I got interested in this. The data shows that while quality medical care is absolutely critical, access to it probably only accounts for about 10% to 20% of our health. That made me wonder, what else is out there that’s contributing?

Knowledge@Wharton: There’s a lot of territory still to cover, correct?

Harding: Absolutely. Genes definitely play a role, but what was so shocking to me is that they’re not as fixed as you think. Lifestyle is important, but again it comes back to our relationships. What we’re talking about is how we’re treated on a day-to-day basis in all the different areas of our lives — from our homes to our schools to our communities and neighborhoods, to our workplaces and our broader community.

Knowledge@Wharton: Do you think most people make this association between good health and positive emotions?

Harding: I would say absolutely not, and I think that’s the thing. We’ve been defining health very narrowly in this country, which helps explain why we’re not doing as well as we could. When you step back and look at the big picture, we spend a fortune on medical care in this country — far more than other countries per capita. But we’re not getting the health results we want. We’re practically not even on the same graph.

When you look at the decades of public health data, it’s probably because we’re really doubling down on the medical care and not investing in our social world the way that we could. That being said, medical care is important, but we also need to rethink about how we’re supporting people out in the community. As a doctor, you can fix the body, you can fix the leg, you can fix what the problem is and still fail the patient. We need to be talking about a much broader understanding of health that involves these day-to-day interactions.

Just to give you an example — because I know that there are probably a lot of CEOs or managers listening to this — but studies have shown that the strongest predictor of a man’s death from heart disease isn’t cholesterol or blood pressure. It’s his job. Or her job. Everyone knows it’s important to have a good doctor, but it’s also important to have a good manager and to give people the skills that they need to be good managers.

Knowledge@Wharton: Do you think that integrating this approach in medicine could address some of the economic questions of health care?

Harding: Oh, absolutely. It’s easy to get sidetracked with the razzle-dazzle of biomedicine, and we need to invest in research and all those good things. The other side of this is there are really low-cost interventions that are community based that can have huge impacts on people’s health down the road. In the book, I joke about how we talk about being tough on crime, but we really need to be gentle on new moms and families. We need to provide support from the beginning of life to try to help people along and also help buffer the stresses that may come.

Knowledge@Wharton: In terms of interventions, you’re talking about even at the local level of how government interacts with its citizens, right?

Harding: This is what I find really exciting, because we can all sit around and talk about how we’d wish the system would change, but this is something that every person who’s listening can do something about. That is incredibly empowering. It comes down to the support that we’re getting and all these different factors. The hug you give your child or your spouse when you walk out the door makes a difference, and not only with them. There’s this really exciting science of epigenetics and telomere research that shows that loving actions actually change our physiology. The rabbit study — that was just the tip of the iceberg, just the beginning of the studies.

Knowledge@Wharton: Can you tell us about the rabbit study?

Harding: The rabbit study was this groundbreaking study. What’s so fun as a scientist is that the most interesting findings are often accidental. This was a true accidental finding. It was back in the late 1970s when there was this question of does a high-fat diet affect your heart health? Robert Nerem was doing this very straightforward experiment involving genetically identical rabbits, giving them all high-fat diets. When it came time to look at the health of the rabbits, he noticed there was one group that was just doing particularly well. He couldn’t figure it out and thought they had done something wrong with the study. They looked around and realized what was different about that one group is that there was a researcher that wasn’t just giving the rabbits kibbles. She was actually picking them up. She was petting them. She was talking to them. She was giving them love and kindness.

What they did as good researchers was, one, they paid attention. To their credit, that was at the time kind of paradigm-shifting, that they paid attention to social environment. They felt the data was just too striking to ignore, so they replicated it. They got the same findings. They published it in Science, which is a very prestigious journal. And like many studies, it sat on a shelf for many years. That’s why I really felt it was so important to highlight that study because it really embodies so much of the work that has been done subsequently.

Knowledge@Wharton: In the book, you also discuss loneliness, which the medical community is looking at more and more. How does loneliness impact health?

Harding: Loneliness kind of comes in two flavors. It’s the number of connections you have, and then it’s also how connected you feel to others. Elvis used to have this saying that he’d feel lonely in a crowded room, which is an example of the second one. The thing is, loneliness is as significant a health risk as well-established factors, such as smoking 15 cigarettes a day, heavy alcohol use, even high blood pressure and obesity.

It’s amazing, though, because for most of us, our experience going to see the doctor is that they may ask how many drinks we have, how many cigarettes we have. But how many times do they ask, “When did you last call a good friend? When did you meet someone for dinner or coffee?” Those connections are quite critical. We need to start talking about them seriously. That’s why it felt so important writing The Rabbit Effect and making sure that information is in the hands of all of us, because we’re making a difference. Once we’re empowered with that knowledge that loneliness is not good for our health, we can actually start doing things within our circle of influence to make things better for other people.

Knowledge@Wharton: What is the impact of the high divorce rate here in the United States?

Harding: What’s happening in our homes is a big piece of this. There are studies that show that being married is health-protective if it’s a happy marriage. And there are other interesting studies showing that healthy, positive relationships and marriages can reduce pain if the relationship is strong.

I think the challenging part is it sounds all good and nice to say, “Well, just be kind, and everything will be fine.” But being kind is a practice, and it’s hard. It involves having to learn to navigate conflict, and conflict comes up many, many times a day. Part of it is also recognizing it’s a practice and then building our skillset, because we have to be doing a better job of this.

Knowledge@Wharton: How does education play into this?

Harding: The education data for me was mind-boggling on two fronts. The statistics say that for every one life saved by biomedicine, it seems as though education saves eight. Just to put that in perspective, not finishing high school is the equivalent of a lifetime of smoking. We don’t talk about that when we talk about education. For all the teachers out there, you don’t always think of yourself [as playing] a health role, but you’re actually boosting the health of your students.

Another piece of this might be that education is also often linked to what we feel is a purpose or a calling. This is where the data gets super cool, and [shows] how our social world gets under our skin. There’s now increasing evidence that having a life purpose, feeling optimistic — all those things actually can prolong telomeres, can help us live longer and help us live better even when illnesses do come.

Knowledge@Wharton: The hope is that you’re also reducing stress levels, correct?

Harding: Yes, and I talk about that in the later part of The Rabbit Effect. The interplay between the hidden factors in our lives — our physical and mental health — is probably mediated by the stress response. Stress is just a natural part of life.

But how can we learn to roll with things better? The really great thing is that it’s not fixed. We can absolutely use techniques to improve [our response], and we can help offset the stress in other people’s lives — like by hugging someone. Positive interactions like that are plenty, and they reduce stress; they boost the immune system.

Spending time in nature boosts the immune system. People in hospitals who are exposed to a garden recover a day faster. They require less pain management, less intervention from staff. There are all these really amazing things that we can do that are low-cost, and that seem to have a really great health boost.

Knowledge@Wharton: Fairness is another element that you tackle in the book. I don’t think anybody believes that our society, our culture, is fair 100% of the time.

Harding: Fairness is a major predictor of health. I do go into that because I think as a society there is a lot of conversation around overt unfairnesses. But there are these microaggressions, these things that happen over time. You can even Google “microaggressions” and just look up examples of them. There’s a great website that was started by somebody at Columbia and managed by students, and it shows these tiny little events that happen during the day, but they have a cumulative health effect. It’s pretty fascinating. It’s sort of like death by a thousand paper cuts, and it can happen in a variety of ways.

What’s encouraging is that we can all become more aware of our biases and try to be kinder to other people by not adding to those paper cuts, essentially. For instance, we have the medical students at Columbia take an online test where you can look implicit bias. The most important takeaway from those tests is just the idea, “Well, maybe I have some assumptions and actions that I’m not even aware that I’m doing.”

Knowledge@Wharton: You start the book asking an interesting question: What are we missing in medicine? What are the missing components in medicine that could help tackle these issues?

Harding: That’s the million-dollar question that’s been driving my career, and I think it comes down to kindness. It really comes down to thinking about how we’re treating each other, both on an individual level and how we’re treating each other as a society. It’s all those social dimensions of health that we are not talking about in the hospital.

People who work in health care are at high, high [risk] of burnout, and I think part of it is because we’re aware that we’re not addressing this. It feels overwhelming to put that responsibility just on the health care system alone. This is really all of us. It’s treating each other with dignity and learning to navigate conflict in a way that’s about supporting people and not tearing them down.

It’s keeping in mind those relationships. Again, going back to the CEOs who are listening, we’re so focused sometimes on the bottom line, and we need to be looking at the process and the people involved. You can probably toss out your human [resources] manual and just rewrite it as, “Be kind.” We need to be kind to people in our schools, in our workplaces and all of these different capacities.

When you’re driving on the road, be kind. You never know what somebody else has going on. We can learn to be more empathetic towards one another, and boy, do we need it right now.