A child in India during World Toilet Day in New Delhi, 2012. Around 130 million households in India have no toilets. Photo: Getty
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Choose your friends wisely – their friends could be bad for your health

A seriously ill patient’s condition affects not just their ­immediate family and friends but the next circle out, their children’s spouses, say, and the one after that, of those spouses’ friends.

It used to be called “dying of a broken heart” but modern scientists prefer the term “the widowhood effect”. After their spouse’s death, surviving partners have an increased risk of ­dying themselves – up to 66 per cent in the first three months, according to research last year from the Harvard School of Public Health in Boston.

The effect has been noted in dozens of studies and seems to apply to both genders. The possible reasons include the stress of caring for a sick person; grief leading to bad lifestyle decisions; and social isolation, because their partner used to be their link to friends and family. As the gerontologist Kenneth Doka put it after the Harvard study: “It’s not unusual that widowers will often say no one ever stops over any more, because they didn’t realise someone else was calling and inviting them.”

But the widowhood effect doesn’t stop with the surviving partner, as a young hospice doctor called Nicholas Christakis noticed several decades ago when he first began to practise medicine. A seriously ill patient’s condition affects not just their ­immediate family and friends but the next circle out, their children’s spouses, say, and the one after that, of those spouses’ colleagues and friends.

As he got older, Christakis became more and more interested in these “social networks” – a phrase we’ve come to associate with online environments such as Twitter and Facebook, but which are deeply embedded in our offline world, too. He now works at Yale as a sociologist, collaborating with a colleague called James Fowler, championing an obscure but fascinating discipline called “network science”.

Their research uncovered some astonishing results: obesity really is an epidemic, in the sense that it is infectious. If someone you know well is obese, you are more likely to be obese. The effect can be seen – albeit at progressively dwindling intensities – as you look at friends of friends, up to four degrees of separation from the original subject. (Christakis says the possible causes are induction – your friends get fat because you are fat; homophily – you are friends because you share a lively interest in eating biscuits; and confounding – you both live in a society where fast food is cheap and many jobs involve sitting down for eight hours a day.)

When I saw Christakis explain these ­ideas in a TED talk, the political and policy implications immediately struck me. And so, while he was on a visit to London to lecture at the Cass Business School, I met him to ask the obvious question: doesn’t this vanquish libertarianism once and for all? How can anyone argue “There’s no such thing as society”? He agrees. “My favourite example is the analogy of carbon – it has a number of forms, allotropes; one of them is graphite and one of them is diamond. If you take the carbon atoms and assemble them one way, you get carbon. Assemble the same atoms another way, you get diamond. The graphite is soft and dark and the diamond is hard and clear. Softness or hardness are not properties of the carbon atoms; they are properties of the collection of carbon ­atoms.”

Society is the same: it is just as much about the connections between individuals as the individuals themselves.

In person, Christakis is bombastically ­erudite and many of his answers are delivered as mini-lectures. His research has led him to think about the perils of a laissez-faire system of government, he says. “The function of the state is, at minimum, to address collective defence, market failure – things that individuals are not equipped to do or things that individuals, acting rationally, subvert. That’s the tragedy of the commons. Everyone is grazing their cattle on the commons and the commons collapses.”

Network theory has uses far beyond giving me ammunition to argue with people with Twitter handles such as @AynRand93, however. Christakis and Fowler create complex maps of connections between individuals in a group and use algorithms to identify the most structurally influential.

The professor gives me a concrete example: in India, women are particularly badly affected by the lack of toilet provision for 500 million of the country’s citizens. Open defecation is risky, because a lone woman is easy prey for sexual assault. In rural Bihar, where about 85 per cent of households have no sanitation, one victim this summer was an 11-year-old girl, raped when she ­visited the field at night. Many women try to avoid going to the loo at all for hours on end, increasing their risk of urinary tract infections.

So how do you convince a community that toilet provision is necessary? Even when local government or an NGO provides the funds, there is often still a cultural resistance. “If you ask people, ‘Why don’t you construct a loo?’ they’ll say, ‘But all my neighbours do the same thing,’” Christakis observes. He says the same model explains widespread tax avoidance in Greece – “If you ask people, ‘Why don’t you pay your tax?’ they say, ‘My neighbours don’t pay their taxes. What am I, an idiot?’” – and risky sexual behaviour in countries with endemic HIV.

Traditionally, you might try to win over the highest status member of the community: but he and Fowler believe you should instead target the most influential as identified by their algorithm. “That way, you can target 5 per cent of the people and 80 per cent of the people change,” he says – making scarce development funds go far further.

Christakis’s work gives him many insights into human nature, sometimes with unexpected results. Take the way that his work on obesity was reported. In America, he says, the headlines read: “Are you packing it on? Blame your fat friends.” In Europe, however, the message was different. “Are your friends fat? You are to blame.” 

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.

This article first appeared in the 29 October 2014 issue of the New Statesman, British jihadis fighting with Isis

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The 8 bits of good news about integration buried in the Casey Review

It's not all Trojan Horses.

The government-commissioned Casey Review on integration tackles serious subjects, from honour crimes to discrimination and hate crime.

It outlines how deprivation, discrimination, segregated schools and unenlightened traditions can drag certain British-Pakistani and Bangladeshi communities into isolation. 

It shines a light on nepotistic local politics, which only entrench religious and gender segregation. It also charts the hurdles faced by ethnic minorities from school, to university and the workplace. There is no doubt it makes uncomfortable reading. 

But at a time when the negative consequences of immigration are dominating headlines, it’s easy to miss some of the more optimistic trends the Casey Report uncovered:

1. You can always have more friends

For all the talk of segregation, 82 per cent of us socialise at least once a month with people from a different ethnic and religious background, according to the Citizenship Survey 2010-11.

More than half of first generation migrants had friends of a different ethnicity. As for their children, nearly three quarters were friends with people from other ethnic backgrounds. Younger people with higher levels of education and better wages are most likely to have close inter-ethnic friendships. 

Brits from Black African and Mixed ethnic backgrounds are the most sociable it seems, as they are most likely to have friends from outside their neighbourhood. White British and Irish ethnic groups, on the other hand, are least likely to have ethnically-mixed social networks. 

Moving away from home seemed to be a key factor in diversifying your friendship group –18 to 34s were the most ethnically integrated age group. 

2. Integrated schools help

The Casey Review tells the story of how schools can distort a community’s view of the world, such as the mostly Asian high school where pupils thought 90 per cent of Brits were Asian (the actual figure is 7 per cent), and the Trojan Horse affair, where hardline Muslims were accused of dominating the curriculum of a state school (the exact facts have never come to light). 

But on the other hand, schools that are integrated, can change a whole community’s perspective. A study in Oldham found that when two schools were merged to create a more balanced pupil population between White Brits and British Asians, the level of anxiety both groups felt diminished. 

3. And kids are doing better at school

The Casey Report notes: “In recent years there has been a general improvement in educational attainment in schools, with a narrowing in the gap between White pupils and pupils from Pakistani, Bangladeshi and African/Caribbean/Black ethnic backgrounds.”

A number of ethnic minority groups, including pupils of Chinese, Indian, Irish and Bangladeshi ethnicity, outperformed White British pupils (but not White Gypsy and Roma pupils, who had the lowest attainment levels of all). 

4. Most people feel part of a community

Despite the talk of a divided society, in 2015-16, 89 per cent of people thought their community was cohesive, according to the Community Life Survey, and agreed their local area is a place where people from different backgrounds get on well together. This feeling of cohesiveness is actually higher than in 2003, at the height of New Labour multiculturalism, when the figure stood at 80 per cent. 

5. Muslims are sticklers for the law

Much of the Casey Report dealt with the divisions between British Muslims and other communities, on matters of culture, religious extremism and equality. It also looked at the Islamophobia and discrimination Muslims face in the UK. 

However, while the cultural and ideological clashes may be real, a ComRes/BBC poll in 2015 found that 95 per cent of British Muslims felt loyal to Britain and 93 per cent believed Muslims in Britain should always obey British laws. 

6. Employment prospects are improving

The Casey Review rightly notes the discrimination faced by jobseekers, such as study which found CVs with white-sounding names had a better rate of reply. Brits from Black, Pakistani or Bangladeshi backgrounds are more likely to be unemployed than Whites. 

However, the employment gap between ethnic minorities and White Brits has narrowed over the last decade, from 15.6 per cent in 2004 to 12.8 per cent in 2015. 

In October 2015, public and private sector employers responsible for employing 1.8m people signed a pledge to operate recruitment on a “name blind” basis. 

7. Pretty much everyone understand this

According to the 2011 census, 91.6 per cent of adults in England and Wales had English as their main language. And 98.2 per cent of them could speak English. 

Since 2008-2009, most non-European migrants coming to the UK have to meet English requirements as part of the immigration process. 

8. Oh, and there’s a British Muslim Mayor ready to tackle integration head on

The Casey Review criticised British Asian community leaders in northern towns for preventing proper discussion of equality and in some cases preventing women from launching rival bids for a council seat.

But it also quoted Sadiq Khan, the Mayor of London, and a British Muslim. Khan criticised religious families that force children to adopt a certain lifestyle, and he concluded:

"There is no other city in the world where I would want to raise my daughters than London.

"They have rights, they have protection, the right to wear what they like, think what they like, to meet who they like, to study what they like, more than they would in any other country.”


Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.