Category Archives: Case Study

Case Study: The Roseto Effect

It would not occur to anyone to question the statement that we ‘need’ iodine or Vitamin C. I remind you that the evidence that we ‘need’ love is of exactly the same type.

– Abraham Maslow, Toward a Psychology of Being

This is the first of a series of Case Study posts. The Story of Progress would have us believe that things have never been better than they are now. While modern living does have advantages, I would contend that they are less and fewer than many believe. These Case Studies will highlight things we have lost as we have pursued modernity.

In the 1960’s the small town of Roseto, PA offered a puzzle to the U.S. medical establishment. The residents of Roseto did everything you’re not supposed to do, and yet were far healthier than the U.S. in general and neighboring towns in particular.

In 1964 a study published in the Journal of the American Medical Association examined a population of recent Italian immigrants in Roseto, a small town in the state of Pennsylvania. The study was instigated because the town doctor was completely baffled by the Rosetans’ near immunity to heart disease. He reported his observation and an extensive statistical population study funded by American State and Federal governments was conducted.

The study compared health statistics of Rosetans to neighbouring towns and the initial results were astonishing. During the seven year period of study from 1955-1961:

  • No-one in Roseto under the age of 47 died of a heart attack; there was a complete absence of heart disease in men under the age of 55
  • The rate of heart attacks in men over 65 was half the national average
  • The death rates from all causes was 35% lower than anywhere else
  • The study confirmed the town doctor’s findings and went on to examine the factors that gave the Rosetans such improved health. It became known as the ‘The Roseto Effect’.

So what gave the Rosetans a near imperviousness to heart disease?

Well, the researchers asked the same question and first looked at the most obvious factor – diet. Being Italian immigrants, the researchers thought that the Rosetans must be eating a healthy ‘Mediterranean’ diet of fish, olive oil and fresh vegetables. Not so – in fact the researchers discovered that the Rosetans did not have enough money for fish and ate high fat meatballs and sausages, with an average fat intake of up to 40% of their entire diet! And the fats weren’t your ‘healthy’ types of fat, for the Rosetans liked to fry all of their food in good old lard.

The researchers then thought that surely if diet was not the contributing factor than it must be lifestyle, so they looked at how the Rosetans spent their leisure and work time. It turns out that the Rosetans were very hard workers but mostly worked in slate quarries or mines, which were renowned for having extremely harsh working conditions with high rates of on-site accidents. As for leisure time, the Rosetans loved their wine and cigars and consumed both with reckless abandon.

So let’s get this straight – the Rosetans had extremely low to no heart disease, yet they ate red meat deep-fried in lard, smoked and drank heavily, and worked in toxic slate mines? Yep.

This also had the researchers totally stumped as well and they studied all other possible factors such as ethnicity, water supply, environment, you name it. In the end, the researchers concluded that the unusually low incidence of heart disease in the town could not be attributed to any of these factors.

While living in the town to conduct the study however, the researchers observed several major differences as to how the Rosetans related to others in their community. They noticed a remarkably close-knit social pattern that was cohesive and mutually supportive with strong family and community ties, where the elderly in particular were not marginalised, but revered. Put simply, the Rosetans lived in brotherhood with one another.

So the researchers instead suggested that “the quality of family relationships and the social milieu may be pertinent to the occurrence of or protection against death from myocardial infarction.”

When investigators sought to unravel Roseto’s secret they conclusively determined it to be the ties of family and community in Roseto. What made Roseto different than neighboring towns and America in general was that it was peopled exclusively by close knit Italian American families who still practiced their Old Country ways.

Each house studied contained three families, or three generations. The elderly were neither institutionalized nor marginalized, but were “installed” as informal judges and arbitrators in everyday life and commerce. 80% of Rosetan men were members of at least one community organization.

Rosetans, regardless of income and education, expressed themselves in a family-centered social life. There was a total absence of ostentation among the wealthy, meaning that those who had more money didn’t flaunt it. There was nearly exclusive patronage of local businesses, even with nearby bigger shops and stores in other towns. The Italians intermarried in Roseto, from regional cities in Italy. Families were close knit, self-supportive and independent, but also relied…in bad times…on the greater community for well-defined assistance and friendly help.

Because they supported each other, they did not need outside assistance. There was no crime rate and few applications for social assistance (then called Relief). That’s not a typo… there was a zero crime rate (meaning no reported crimes) and no files for any emergency relief. “Back then everybody knew everyone else,” said Michael Romano, 62, the borough council president. “If you walked down the street and you were doing something wrong, the parents didn’t have a problem disciplining someone else’s child. It’s not that way today.”

In 1963, the investigators made a prescient observation: they believed that as Rosetans became more Americanized (meaning less close, less modest, and less interdependent), they would also become less healthy. The wearing off of the now famous “Roseto” effect would be apparent within a generation. And so it was.

In the 1970’s, the region was suburbanized, including Roseto. Single family homes, fenced yards, and country clubs were brought in. The social ties weakened and then started to fail. A 1992 survey, as published in the American Journal of Public Health, confirmed this sad prediction. The officials of the AJPH, no doubt beguiled by Roseto’s fate, descended on the town yet again. Again the investigators rifled through the death records of Roseto, and again they compared them with the surrounding towns of Nazareth and Bangor. The result: the Rosetans now suffer equally from the ravages of heart disease as every other town does, in the vicinity or not.

In fact, the wearing away of intra-marriages (Italian to Italian), the dismantling of the social ties between family and community, the adoption of conspicuous consumption by wealthy Rosetans, and ignorance of common values, could be charted with precision from decade to decade. Lo and behold, there is an almost perfect correlation between Americanization and heart disease death rates.

We humans are social animals. We evolved in close knit bands of relatives, knowing those around us intimately. This is necessary for our health. There are countless articles detailing the dangers of loneliness. In particular are highlighted the Lonely American and the Lonely Man. This is due to the breakdown of family and community in modern society and its attendant separation and isolation.

One-in-six Americans are prescribed psychiatric drugs. Are that many of us born with abnormal brain chemistry? Or is there perhaps something crucial lacking from our society that is making us sick?