Blog Center for Community Health Partnership & Research

On relationships and public health

Written by Jason Q. Purnell, PhD, associate professor in the Brown School

Several years later, I am still disappointed by how my brief interaction with a talented young man at one of St. Louis’s most challenged high schools ended. I heard him speak passionately of his career plans at a meeting on tackling high school dropout in our region.

After the meeting was over, I gave him my card and encouraged him to reach out if there was any way that I could help. A few days later he did, but his request was narrowly focused on potential job prospects. Though I didn’t then have a job to offer him or know of any openings, I told him I’d be happy to meet with him to navigate his course and think about options. I didn’t hear back from him. Several days later I sent him another message with the friendly advice that it would be a good idea to at least respond with thanks for such an offer. I never heard from him again.

That story continues to make me sad. But it also illustrates how young people from various backgrounds, but especially young people most in need of help, fail to appreciate the art of relationships.

I have learned that relationships quite literally make everything in life happen. Think about it. It was a relationship, however brief or enduring, that led to your being born. Relationships with a series of teachers formed the basis of your education. Fascinating research on social networks tells us relationships relatively few degrees away from you in your social network will determine who you date or marry, where you get a job, and even your tastes and habits. So, when we fail to nurture relationships, we curtail opportunity and possibility. We quite literally stop the flow of life.

That fact has been made even clearer to me as the last two years have found me leading an effort called l, focused on improving the health and well-being of African Americans in St. Louis—and telling the story of why doing so matters for everyone in our region. Just the process of engaging the broad cross-section of our community that has been involved in For the Sake of All has required managing multiple relationships, with all of the complexity this essential human endeavor entails. I have called on old friends and colleagues and met new ones, but I remain convinced that being involved in efforts prior to this project was crucial to mobilizing the actors who have come to support this important work. We couldn’t have had the success we’ve had without relationships.

At a deeper level, though, I have noticed what a lack of relationships can mean. It can mean the difference between health and illness, between life and death. Resources are distributed through networks of relationship. And resources like jobs, which translate into income, have a considerable impact on health. A job, it turns out, is a health intervention—not just because of income, but all of the benefits that can accompany a job, like sick leave, health insurance, retirement savings, and even a sense of control over one’s life. We reported in our first policy brief the considerable number of deaths attributable to poverty among African American adults in a single year. Add low levels of education to that, and it comes to 1 in 6 deaths. African Americans have almost 4 times the unemployment rate of whites in St. Louis. As one of the most racially segregated metropolitan areas in the country, St. Louis is a difficult place to make the kinds of connections that lead to advancement for those who are left out of networks of opportunity. The chasms that often separate us by income are equally daunting, and they too impact economic mobility. St. Louis ranks 42nd out of 50 large metropolitan areas in economic mobility—or the probability that a child born at the lowest rung on the income ladder will reach the top rung.

Until I see myself as involved in your experience, until we truly become “we,” there is no adequate answer to, “Why should I care?”

And there is yet another sense in which relationships are important. It has to do with caring. I’ve been asked more than once why anyone who doesn’t perceive him- or herself to be directly impacted by disparities in opportunity and health should care. After all, if they’re working hard to provide for their own families and having relative success at it, what’s in it for them to make sure others have the same opportunity—particularly if it comes at some cost to them? The answer to that question, it turns out, also has to do with relationships. In any real and meaningful relationship, an interesting thing happens: a “you” and a “me” becomes a “we.” All the data presentations and methods of persuasion fail in the face of that most basic of social phenomena, the relationship. Until I see myself as involved in your experience, until we truly become “we,” there is no adequate answer to, “Why should I care?” When we fail to nurture relationships, we curtail opportunity and possibility. We quite literally stop the flow of life.