What Keeps People Healthy

Two very different types of research came out last week that are about keeping people healthy. In one, the genes of a group of people in Ecuador are used as a guide to treating cancer. In the other, it’s found that living where there’s lots of small businesses makes people less likely to fall ill.

The cancer research describes how brief periods of fasting makes chemotherapy more effective. The idea came from the study of a small community of people in Ecuador who don’t get cancer. Researchers who have been studying these people for the last 30 years identified a specific gene that is unique to these folks. The gene is responsible for the protein that forms the cell receptor for growth hormone. Because the gene is abnormal, the receptor is abnormal, and so the cell signaling is abnormal.

As a direct result, the Ecuadorans have low levels of a hormone-like protein called insulin-like growth factor 1 or IGF-1. At low IGF-1 levels, cells under stress tend to self-destruct rather than persist and divide into more damaged cells. This is what attracted the attention of cancer researchers.

In addition, diabetes is unknown among the Ecuadorans. The low level of IGF-1 is a likely contributor to the low insulin, low blood sugar, and high insulin-sensitivity in these Ecuadorans’ tissues.

One important element in this research is the view that the effect of the Ecuadorans’ abnormal gene is similar to the effect of a calorie restriction diet. That’s why the cancer researchers intermixed fasting with chemotherapy—the calorie restriction induced low IGF-1 causing damaged (that is, cancer) cells to self-destruct.

Of course, the other thing that having an abnormal growth hormone receptor does is affect a person’s growth. And so it is with the Ecuadorans who are all under 4 feet tall.

Researchers and drug companies are excited about this research because it promises to reveal a pharmaceutical pathway to reproducing the effects of the abnormal growth hormone receptor in order to increase people’s life span and reduce the incidence of diabetes and cancer, two of our most costly diseases.

So this is one approach to health: find a condition of health or disease in a special case, unravel the mechanisms, and then reproduce those mechanisms in any case. In other words, apply the biological mechanism to anyone and everyone.

Not only are the Ecuadorans under 4 feet tall, they also have a life span that is less than the national average. Wait a minute! Didn’t the researchers say that these people hold the key to longevity? They don’t get diabetes. They don’t get cancer. Why don’t they live longer?

The Ecuadorans have a higher than average death rate because of alcoholism and accidents. Could social conditions have something to do with this?

Sociologists at Baylor University, in the spirit of the times, asked whether small business has a positive or negative effect on health. “Small business” for these researchers really means small: four or fewer employees.

On the one hand, they speculated, small business is less likely to provide medical insurance, more likely to provide lower wages, and more likely to be less secure for employees. On the other hand, small businesses are more invested in their local communities and help create what the researchers refer to as social capital and collective efficacy.

Social capital is the willingness of people to work together in solving social problems, which could range from crime to parks. Collective efficacy is the ability of people to work together toward achieving those social goals.

The researchers at Baylor used three measures of health: mortality (the chance that someone will die), incidence of obesity, and incidence of diabetes. They examined every county in the United States and found that each of these measures of health was positively associated with the concentration of small business.

If you live in a county where the economy has lots of small businesses, you’re less likely to die at any given age, less likely to be obese, and less likely to be diabetic. And it’s not just small business that’s associated with lower risks of death and disease.

  • Greater ethnic diversity is associated with better health.
  • Lower income inequality is associated with better health.
  • Having a greater number of professional and creative people is associated with better health.

What was associated with worse health?

  • The number of big box stores and large retailers
  • The percentage of people without medical insurance

In this way of thinking, improving health, preventing disease, and treating the sick are served by what we do together as human beings. I hasten to add that this is not either-or. We don’t have to choose between mechanistic and social thinking either as individuals nor as a community,. But the contrast highlights that the money and glory are showered on the mechanistic. As with too much, to create the human and humane foundation for how we care for each other, we’ll have to do it for ourselves.