The Surprising Thing That Builds Trust Among Neighbors

Having health insurance has some pretty obvious benefits: You’re able to go to the doctor, get flu shots and screenings, and you’re protected, at least partially, against sky-high medical bills in the event of an emergency. Now, a new study suggests another reason why health insurance is good for society as a whole. In communities where more residents are insured, people are more likely to trust their neighbors and feel connected to their community.

This relationship holds true even after factors such as income, racial and ethnic makeup, employment status, crime, and poverty levels are adjusted for, say researchers from Vanderbilt University and UCLA. Their results were published this month in the Journal of Health and Science Behavior.

To study the connection between insurance rates and community togetherness, the study authors looked at data from a long-running survey in Los Angeles that asked residents about their health, family, socioeconomic status, and how they felt about their communities—whether they felt safe, how well they knew their neighbors, and whether they belonged to a book club, for example.

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Using responses from more than 2,500 surveys conducted from 2000 to 2002, and about 1,200 follow-ups conducted from 2006 to 2008, the researchers analyzed the data to determine which individual factors played a role in what they call social cohesion—feelings of trust, mutual obligation, and reciprocity among community members.

“Essentially it’s a measure of how you feel about your neighbors,” says lead author Tara McKay, PhD, assistant professor of medicine, health, and society at Vanderbilt University. “If they needed money or needed you to look after their kids for half an hour, would you do that for them? Would they do it for you? Do you share the same values, do you understand each other, things like that.”

Their findings weren’t surprising, says McKay. In neighborhoods where more than half of people were uninsured, residents’ perceptions of social cohesion were 34% lower than in neighborhoods where almost everyone was insured.

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When they plugged their findings into a computer model to simulate the effects of expanding insurance coverage, the researchers made another finding. “We saw that a big intervention like the Affordable Care Act would have substantially increased social cohesion in those neighborhoods, just by making more people insured—not by changing anything else about them.” (The Affordable Care Act, which is now facing a repeal under the Trump administration, was not yet implemented when the survey responses were collected.)

McKay speculates that there are several reasons why low insurance rates can hurt neighborhood unity. “When you have a community where people don’t have access to health insurance, those people are going to pay more out of pocket for their health care—which can increase income inequality,” she says.

Questions about how to pay for medical costs incurred by the uninsured can cause tension at the local policy level, while those without insurance might feel left behind and excluded from society. “It can be a blow to their identity and to their dignity,” McKay says.

In other words, people aren’t making conscious judgments about their neighbors based on whether they have insurance or not. But the psychological and economic consequences of not having affordable care can clearly spillover and affect community morale.

In their paper, McKay and her co-author conclude that expanding insurance coverage “has the potential to reverberate beyond healthcare access and improve community functioning.” Because of this, they say, insuring more members of a society can have benefits for everyone living there—not just those who need insurance.