Mennonite Health Journal

Reflections on Escape Fire

Kenton T. Derstine

from Mennonite Health Journal, Vol. 15, No. 2, April 2013

After viewing Escape Fire, the challenging documentary on the state of the U.S. healthcare system recommended as preparation for this summer’s gathering of the Mennonite Healthcare Fellowship, several articles on a similar theme crossed my desk(top). The invitation to write this column was the stimulus for me to articulate my perception that the theme of each seemed to overlap with the others and offer a perspective on more than a few of the moral dilemmas within our healthcare system. Perhaps I can also identify some “escape fires.”

The central thesis of Escape Fire is that it is more accurate to say that here in the U.S. we have a disease management system rather than a healthcare system. In short, our system is designed for intervention and management of disease processes rather than for disease prevention and health promotion. The result is that despite per capita spending that far exceeds every other country, the U.S. population is less healthy than that of fifty other nations.

Furthermore, the correlation between poverty and disease is striking. The Wall Street Journal Live recently identified and reported on the five “fattest” cities in the U.S.. The “winning” metropolis was McCallem/Edinburg/Mission, Texas with an obesity rate of 38.5% as well as the highest diabetes rate (21%) and the highest poverty rate (37.7%) in the country. Thus, poverty itself can be understood as not only a justice issue but a moral issue as it relates to health. In sum, the overarching moral dilemma of our healthcare system is how much is spent and how poor is the health of so many, especially the poor.

Dr. Dean Ornish suggests in Escape Fire that 70% of healthcare costs are driven by lifestyle choices. Furthermore, he asserts that many disease processes can not only be slowed, but actually reversed by “changing what we eat, how we respond to stress, how much we exercise and how much love and support we have in our lives.” The latter point is consistent with much research in recent years that suggests that the quality and number of family and friend relationships is a significant predictor of emotional and physical health across the life span. It is commonly accepted that increased levels of stress proportionally compromise one’s immune system. If we ask about the source of most persons’ stress, the answer that is most commonly accurate is one’s closest relationships. This idea, I think, should be especially intriguing to Anabaptist Christians with our historic conviction that faithful discipleship in the way of Jesus is most profoundly expressed in how we conduct ourselves in the day to day relationships in our families and communities.

As I was reflecting on this documentary the story of Roseto, Pennsylvania came to mind. First reported in various scholarly journals, I was reminded of this story when it appeared in the “Introduction” of Malcolm Gladwell’s New York Times bestseller, Outliers: The Story of Success. Roseto, PA became an enclave in the 1950s for a number of Italian Catholic families who had immigrated together and had established an extraordinary quality of cross-generational and extended family life in Roseto, the town they founded together. Significant to the life of this town was their common faith heritage sustained and shaped by their remarkable parish priest.

The nature of this town would have likely gone unnoticed except for a local physician who began to wonder how it was that the people of Roseto had few of the diseases common to those from other surrounding towns. His curiosity stimulated a research project. Findings revealed that virtually no one under fifty-five had died of a heart attack or showed any signs of heart disease. For men over sixty-five, the death rate from heart disease was roughly half that of the U.S. as a whole. The death rate from all causes in Roseto, in fact, was 30 to 35 percent lower than expected.

A sociologist brought in to guide the research reported in amazement what he found. “There was not suicide, no drug addiction, and very little crime. They didn’t have anyone on welfare…these people were dying of old age. That’s it.” Seeking an explanation, the researchers had to rule out the conventional factors of genetics, diet, exercise and quality of healthcare. They began to hypothesize about the “mysterious and magical benefits of people stopping to talk to one another on the street and of having three generations under one roof.”

Gladwell described the challenge these Roseto researchers had in communicating their  hypothesis. “No one was used to thinking about health in terms of community…they were not able to understand why someone was healthy if all they did was think about an individuals’ personal choices or actions in isolation. They had to look beyond the individual. They had to understand the culture he or she was a part of, and who their friends and families were, and what town their families came from. They had to appreciate the idea that the values of the world we inhabit and the people we surround ourselves with have a profound effect on who we are.” As the unique communal culture of Roseto broke down through the sixties and the next generation moved on and joined mainstream American culture, disease rates in the following generations reflected that of general society.

What might we learn from the story of Roseto? It would be reasonable to suggest that recreating such a world would be unthinkable. Probably so. However, “outliers” can serve to point toward what is proximately possible—they can point in a direction. Furthermore, we now have an increasing body of science that helps explain what was observed. Recent science and Roseto confirms that we need to look beyond diet and exercise—as important as they are—if we would address the issue of health holistically. Roseto offers the idea that life in community that includes meaningful inter-generational extended family life can make a difference for health. At the same time much recent research suggests that “loving relationships” are at least one component of a health-promoting lifestyle.

One such report that I found particularly intriguing appeared in the New York Times on March 15 and was entitled, “Family Ties that Bind.”  Included in the article was a brief summary of research done at Emory University stimulated by the observation that children who knew a lot about their families tended to do better when they faced challenges than children who knew little. To test this hypothesis they developed a measure called the “Do You Know?” scale that asked children from a random sampling of families to answer 20 questions. Examples included: Do you know where your grandparents grew up? Do you know where your mom and dad went to high school? Do you know where your parents met? Do you know an illness or something really terrible that happened in your family? Do you know the story of your birth?

They then compared the children’s results to a battery of psychological tests the children had taken, and reached an overwhelming conclusion. The more children knew about their family’s history, the stronger their sense of control over their lives, the higher their self-esteem and the more successfully they believed their families functioned. The “Do You Know?” scale turned out to be the best single predictor of children’s emotional health and happiness. They then conducted a similar research project with this group of children after the Sept. 11 attack. Though the families they studied had not been directly affected by the events, all the children had experienced the same national trauma at the same time. The researchers went back and reassessed the children. “Once again,” the lead researcher observed, “the ones who knew more about their families proved to be more resilient, meaning they could moderate the effects of stress.” The researchers concluded that “…the single most important thing you can do for your family may be the simplest of all: develop a strong family narrative…The answers have to do with a child’s sense of being part of a larger family.”

Escape Fire challenges to viewer to engage the effort to find a way forward through the crisis of health that our society faces. What might be the “escape fires” that will allow this firestorm to sweep over us without doing us all in? We are challenged to think outside the box—to think creatively and boldly for a way forward. What if we researched how the quality of community and relationships served health as deeply as we have researched the potential of pharmaceuticals and surgical interventions? What if we believed that the science of community and relationships demanded as much research, insight, and skill as brain surgery? Who better to embrace this challenge than Anabaptist Christians?

We have a word for the effort of growing in knowledge and wisdom and love after the manner of Jesus–discipleship. Perhaps we might have within the repository of our theology and history some answers that could show the way. The role of faith as a resource for shaping community and family life also has the effect of serving health. Might we offer this as an escape fire for ourselves and our society?

About the author

Kenton T. Derstine, D.Min. is an ACPE Supervisor serving as Director of the Field Education and Clinical Pastoral Education (CPE) programs of Eastern Mennonite Seminary.  As an accredited CPE Center, EMS has chaplain interns serving retirement communities and hospital systems in both Virginia and Pennsylvania. Prior to coming to EMS in 2000, he had served three different hospital systems, first as Chaplain Resident, then as CPE Supervisor, for eleven years. Kenton is a past president of Mennonite Chaplains Association and is a member of the Mennonite Healthcare Fellowship Board of Directors.