Bowling Alone...

Putnam warned over 10 years ago that we had become more disconnected from family, friends and neighbors, and he thought we could revitalize our civic and religious engagement and rebuild our social capital. 
Pantell and colleagues reported in the September issue of the AJPH that social isolation is a predictor of mortality comparable to traditional clinical risk factors such as hypertension and smoking!  They imply that clinicians and their staff, health plans should screen for social isolation asking 4 questions such as:
1. Marital status
2. In a typical weeks, how many times do you talk on the phone with family, friends or neighbors?
3. Do you attend church or religious services 4 or more times per year?
4. Do you participate or belong to a club or organization such as a church group, union, fraternal or athletic group, or school group?
 It is questionable whether these are easily modifiable risk factors and whether interventions will result in reduction in mortality.  There was a study (and probably more since) which showed impaired transcription of glucocorticoid response genes and increased activity of pro-inflammatory transcription control pathways providing a functional genomic explanation for elevated risk of inflammatory disease in individuals who experience chronically high levels of subjective social isolation.  Would health plans reward members for activities that decrease their social isolation?

On a separate topic and totally my venting regarding the government shutdown: under the rules of the federal government shutdown, members of Congress will continue to receive their salaries--even as hundreds of thousands of government workers are furloughed without pay!  talking about fairness and inequality!!!