The public health response to the COVID-19 pandemic introduced the idea of bubbles to our social lives. British Columbia restricted socializing to core bubbles: immediate household members or, for those living alone, a maximum of two people who could be seen regularly.
Last summer, when “good times” were in the cards, public health guidelines provided for a “safe six” bubble of friends. The March update allows for outdoor bubbles of ten, with an emphasis on the fact that these should be a consistent set of ten people.
These strict directives to stick to our bubbles are essential to prevent the transmission of COVID-19. At the same time, this way of thinking disrupts our understanding of the kinds and quantities of social interactions needed to make healthy cities possible.
Health and social networks
In 2013-14, the Vancouver Coastal Health and Fraser Health Authorities asked 33,000 people living in the Lower Mainland of B.C. a series of big-picture questions about their health, at the individual and community level. One of these questions, a marker of physical and mental health, was:
“How many people do you have in your network that you could confide in, tell your problems to, or call when you really need help?”
Fewer than half (45 per cent) of respondents in Metro Vancouver had four or more such people in their network. Yet survey results indicated clear links between social connectedness and health: individuals with four or more confidants had 1.5 times higher odds of reporting excellent or very good general health; and two times higher odds of reporting excellent or very good mental health.
People with four or more confidants were more likely to be female, to make more than $40,000 per year and were more likely to live with a transit stop less than five minutes away.
Our research team obtained similar results in a survey we ran in summer 2020 with residents at Brightside Community Housing and Catalyst Community Development Society in B.C. Among the 308 responses (29 per cent response rate), only 41 per cent reported having four or more close friends.
Individuals with four or more confidants had 1.5 times higher odds of reporting excellent or very good mental health; conversely, those with fewer than four confidants had 2.3 times higher odds of reporting just fair or poor mental health. In the same way, those with four or more friends were 3.6 times more likely to report that they were happy or very happy, compared to those with fewer friends.
Most people tend to underestimate the importance of their social connections to their health. Only one-quarter of Canadians surveyed by Statistics Canada in July 2020 reported a concern with maintaining social ties during the pandemic.
However, the proportion of Canadians reporting excellent or very good mental health is down 13 percentage points since before the pandemic: 55 per cent in July 2020 compared to 68 per cent in 2019. The role of our social relationships is more important to our overall health than most of us acknowledge.
Social determinants of health
Our scientific understanding of the central importance of social well-being, connections, services and equity to our overall health has come a long way since the times when human health was simply considered to be the absence of disease.
From the World Health Organization to the Public Health Agency of Canada and beyond, the social determinants of health are now an internationally accepted framework for valuing the full gamut of factors that contribute to making healthy individuals, healthy neighbourhoods, healthy cities and institutions, in a healthy natural and economic environment, that function together as a whole.
Many have recognized the way in which the pandemic affects people differently, depending on social, political, cultural, environmental and economic factors. Thinking about health systemically is complicated, but does a better job of explaining our overall health.
Bubble thinking, if normalized within our cities beyond the health emergency of the pandemic, threatens the wisdom in understanding our health as socially, politically, culturally, environmentally and economically determined.
Socially, the advantages of city life are based upon premises that are antithetical to bubble thinking. Gathering together in concentrated groups can give people a sense of power, promise, inspiration and hope. Chance encounters with others in urban public space, where we witness others across social and political divides, are core to civility, civic participation and tolerance.
When it comes to improving the social determinants of health in cities, an important action may be to expand – or even burst – people’s bubbles, as soon as the pandemic situation allows. Our work with the Hey Neighbour Collective, a program designed to build connections in higher-density neighbourhoods, aims to do just this. As a group of housing providers, researchers, local governments, public health authorities and social change advocates, the Hey Neighbour Collective examines ways to build, bake and dig neighbourliness into multi-unit residential buildings in new ways, and to improve mental and physical health and well-being in so doing.
Prioritizing social connectedness was needed long before the pandemic, as we already faced a loneliness epidemic, but is ever more consequential now to combat the damage done by bubble thinking and to move forward to rethink public health, post-pandemic. With a vaccinated future beginning now to take shape, let’s remember that bubble thinking prevents disease transmission during a pandemic; however it is not what makes us or our cities healthy.