In this episode, Lauren explores the critical role of social connections in public health with researcher and faculty member Dr. Paul Gilbert. Dr. Gilbert discusses how social determinants of health, including the social environment and community structures, shape our well-being.

Plugged in to Public Health is produced and edited by the students in the University of Iowa College of Public Health, and views and opinions expressed in this podcast are solely those of the student hosts, guests, and contributors. They do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health.

Lauren Lavin: 

Welcome to Plugged in to Public Health, the official podcast from the University of Iowa College of Public Health. I’m your host, Lauren Lavin, and in today’s episode, we’re diving into the critical role of social connections in public health with Dr. Paul Gilbert, a researcher and faculty member in the Department of Community and Behavioral Health. 

We often hear about the impacts of genetics, healthcare access, and personal choices on our health. But what about the social structures that shape our well-being? Dr. Gilbert studies how our relationships, communities, and broader social networks influence health outcomes, particularly in the context of substance use and recovery. So in this conversation, we’re going to explore how social determinants of health shape our daily lives, why social isolation is a growing public health concern, and what we can do both individually and as a society to foster stronger, healthier communities. Whether you’re a student, public health professional, or just someone interested in how our environment impacts our well-being, this episode is packed with valuable insights. So let’s get plugged into public health together. Hello, Dr. Gilbert. Thank you so much for coming on the podcast today. I really appreciate it. 

Paul Gilbert: 

Thank you, Lauren. It’s great to chat with you, and I always enjoy talking with students and our larger community. 

Lauren Lavin: 

I always like to give people a little bit of context on who you are and how you got to where you are today, especially because a lot of students listen, and I always think everyone’s paths are so interesting. So can you start by sharing what initially drew you to research on social determinants of health and your work in public health more broadly? 

Paul Gilbert: 

Yeah, that is a great story, and I often tell it to students in my classes and my advisees, because I had no idea that public health existed for a very long time. When I was an undergraduate student, my majors were French and political science, because those were things that I liked, I studied, I was good at it, I guess, but all along I had an interest in health issues. But at the time, I thought that if you were going to do anything health related, you had to be a doctor or a nurse. And I knew that I didn’t want to be a clinician, so I thought, “Well, there’s no future health work for me. I’ve got to find something else.” 

And I did that, got through undergrad, and then decided, no, that really wasn’t what I wanted to do. I did have this interest in health. I ended up being a Peace Corps volunteer, and in fact, I was a health education volunteer in the Central African Republic, and that was where I first learned that public health even existed. And that was a big aha moment where I realized, oh, I’d found my people. I figured out how I could do something health related, but without being a clinician, without being a doctor or a nurse. And I started working for a consortium of community health, federally qualified community health centers that served primarily Asian and Pacific Islander populations. So already kind of tapping into my interest in health equity and disparities and justice issues. And I realized pretty quickly I needed more training. 

So went off to get my master’s and thought that that would just be it, get those letters after my name, come back, do the same sort of work in communities. But during my master’s, I got involved in research projects and discovered that I really liked this whole process of doing research and seemed to be pretty good at it. That was the second big aha moment and turning point in my career where, after getting my master’s, I got a job working at a university research office. Did that for about five years, realized I did in fact really like doing research, that was great. But then also realized another interest that I wanted to be the principal investigator. I wanted to be the one to design the studies, to lead the teams, to figure out what we’re going to do for our research projects. So that meant going off to get my doctorate, going off for another degree. 

And really happily, in the course of that degree, I learned about participatory and community engaged research approaches. I was able to kind of come back to that earlier interest of working in communities, with communities and still being able to do research. And that kind of united a lot of the different threads that I had, this interest in disparities in health equity and interest in the context and the social determinants of health, being able to do research but also serve communities, making sure that we take our research and translate it into something meaningful that’s going to actually improve our community’s health was kind of a long and winding process, but towards the end, things all started to come back together. I felt like there was a convergence. 

And for the last 10 years, I’ve been here at the University of Iowa in Community and Behavioral Health, studying primarily substance use. Alcohol is my specialty, but I also study other substances and especially poly or multiple substance use, along with some other interests. I have that interest in disparities and equity issues. And since coming here, I’ve learned a lot about rural health and place as an often overlooked dimension of disparities. And of course, that abiding interest in sort of the social context and the social world that we move through and how that shapes our health outcomes, our risky behaviors, or our protective and healthy behaviors. And trying to figure out that puzzle of how do we set things up so we maximize everybody’s health, everybody can make healthy choices easily. What do we do to make the best sort of community, the healthiest community that we can? But in a nutshell, that’s a bit of my story and my evolution. 

Lauren Lavin: 

I love hearing that. I think it’s such a good reminder that you don’t have to know exactly what you want to do for the rest of your life immediately upon exiting college and that your path there gives you all the tools you need to maybe do something like that’s your thing later on. So I love hearing that. 

Paul Gilbert: 

I really like that. And I do try to emphasize to students and my advisees to just stay open. You never know when an opportunity will come along that will take you to a different direction than you thought. And I guess along with that, I would always recommend that folks pay attention to those gut feelings. If you’ve got something that says, “Oh, I really like this, I’m really interested in this,” then go for it. Or if you have a little hesitation or you’re like, “Oh, I’m not sure,” maybe try something else. Yeah, look for variety, look for differences, different experiences until you get that, “This is it. This is my people, or this is my passion, this is my project.” 

Lauren Lavin: 

Absolutely. And I know that you kind of mentioned this towards the tail end of your answer to that question, but when you talked about how we navigate through our social world. So how would you define social connections? We’re going to kind of talk about social determinants of health and social connections today, so we’re all on the same page. How would you define them and why is it critical to public health? Because we might not think that it is, but. 

Paul Gilbert: 

Yeah, so I think this can be overlooked a lot of times. People focus often on things like our genetic inheritance and susceptibility to diseases. That’s clearly important. Or things like access to healthcare, use of services, or the quality of services. Again, absolutely essential. But so much of what determines our health are things above and beyond our direct control. So hence the social determinants. The context that we live in. And it could be things like the city ordinances, state laws, federal laws, international treaties that shape the conditions of our lives that we don’t really have any direct control over, maybe we are not even aware of them, but that really have a big influence. 

And then there’s other things like the neighborhoods that we live in, the places that we work or go to school, the quality of housing that we live in, the quality of the food that’s available, or if there’s gaps in healthcare in our neighborhoods, in our cities. Those are all things that are going to affect us that we need to pay attention to more than just educating people to make healthy choices or guiding them to do it. We want to set the stage for healthy choices. 

Now, along with all of this focus on sort of the bigger context, the bigger environments that we live in, the social environment is a really key one. Just being human beings, we’re social creatures. We don’t all have to be extroverts, we don’t all have to be the life of the party, but we all depend on connections to other people. And what’s right for us can vary from person to person, how big our social networks might be. But it is one of those truisms that we know from years and years and years of research and noticing that people are healthier, they do better when they’re connected to other people. And most of our connections are probably within a small range, family connections, our spouses or partners, intimate connections, friendships, maybe other less tight connections, colleagues that we might work or study with, folks that we know casually in our neighborhood and so on. But all of these ties are really important for health because we’re social creatures. But also social support depends on having these connections to other people. 

There’s lots of different forms of social support from real, tangible, instrumental support. Somebody can lend you money when you need to get your car repaired, or you’ve had, whatever, something come up, an unexpected expense, or you need a ride to the airport. Those are real tangible things that help us. But we also depend on other people for things like advice, referrals, sharing knowledge, introducing us to other people, even if it’s something simple like recommending a dentist or a new apartment. Speaking of which, I like to joke that the best way that we find jobs, apartments, and people to date is through our ties, through our connections. Sure, people can stumble into all of those things on their own. They can go out looking on their own for their job, their apartment, their person to date. But so often we find those connections through people we already know. So that’s a real, I think an example of the importance of social ties that probably most of us have had some experiences with. 

But I think we don’t always realize it, or maybe don’t always value it, don’t recognize how important these connections to other people are because of what flows through those connections, the resources, the information, the advice, the introductions to other people. So that is part of the whole context of our health. One of those important social determinants of health are connections to other people. That’s a bit long-winded, but I hope that answers your question. 

Lauren Lavin: 

No, that definitely answers it. Anyone that’s been in the job market knows how important your social ties are. 

Paul Gilbert: 

Oh, for sure. Yeah. 

Lauren Lavin: 

And I’m even realizing that now, how many jobs are gotten through those specific connections. So I think we can all relate to that. So then the converse of that would be how does social isolation and loneliness impact physical and mental health? And that’s even probably more prominent in vulnerable populations? 

Paul Gilbert: 

Yeah. And you know what, I’m going to tell you a little bit about my alcohol research. One of my lines of research is focused on recovery from alcohol problems. And I look at the different pathways that people take, whether they go off to get treatment, or maybe they go to a 12-step group, a mutual help group. But the majority of folks, and we’ve known this for a long time, the majority of folks with substance use problems tackle it on their own. They kind of take this independent pathway. And that’s been a real mystery. Like how do people resolve some of these really complicated, difficult problems on their own? We’ve known for a long time that specialty services like treatment are underutilized, and we need to make them more available, but somehow people are successful. 

And in a couple of recent research studies, two different studies I’ve done, one of the really consistent findings, things that people in recovery from alcohol problems have told me, is that social ties have been so important to their recovery. And this is especially true for folks not getting any kind of formal professional help. So the folks taking that independent pathway, they rely on spouses or friends, or even sometimes just knowing somebody else in recovery, somebody who’s overcome a problem, that is a big, big help. So that really was one of the things that intersects with my interest in substance use and interest in social determinants of health and social ties. It really, for me, underscored the importance of this. 

Now, the converse of that, the social isolation and loneliness, there are lots of people who study this, that’s their specialty focus, in public health, in psychology and sociology, some of our other kind of sister disciplines. There’s been a lot of work on that. And in fact, people over the last probably decade or two, have started raising the alarm that we seem to be more and more isolated from each other. People are less and less connected, or at least connected across the whole full range of our social ties. People may still have their intimate partners, spouses, close relationships, and then they have their friendships, and especially ties to people that are facilitated through social media. We can be connected virtually to lots of people, but they may not have the same depth of just the people that we know and see in person regularly. 

And there’s even been some calls that we’re losing, I think I’ve heard people call it the sense of the village or the community, the folks that we’re not necessarily friends with, but we see, our neighbors in our communities, or these sort of casual acquaintances that actually can be very important ties. It’s these people that we’re maybe not necessarily really close to but we do know, where a lot of the key information can flow, or you can find a connection to the person you’re looking for to date, the employer, the apartment to rent, through these casual, informal, kind of not terribly close connections. And we seem to be losing a lot of those casual ties to people. 

So, boy, I don’t have the answer to that, but like I said, I know that this has been a hot topic that a lot of other people in the social sciences broadly have been studying. But what we do know from, boy, probably the whole last century of public health work is that this is one of the really consistent findings that being tied to others, being connected to others in our social relationships is good for health. And being isolated or having a gap in these meaningful ties, or having a low number of ties often is associated with poorer health outcomes across all sorts of health outcomes. So it’s just a very consistent, very regular finding. Being connected to other people is good for health in lots of ways, and if we’re not connected or not sufficiently connected to people, it can undermine our health. 

Lauren Lavin: 

That was even brought to maybe more of the public awareness during COVID because I think maybe even people who felt like they were really connected socially had to isolate whether that was because of COVID or their community rules or whatever it was. And so I think maybe we all got a little flavor for what that felt like, and we’re like, maybe we don’t like that. And it also brought attention to then people who are experiencing that on a regular basis, that even increased kind of the awareness of that topic. 

Paul Gilbert: 

Right. I think you’re right. And I think in the pandemic, we started to realize, at least I think more in the general public, that we might have thought we were connected to lots of people because we have lots of friends on social media or connections. But then when it came to that sort of crunch time, it’s like, “Oh, those weren’t very satisfying.” They didn’t have the depth, or we may be connected to a lot of people, but yeah, without the depth that helped us, and a lot of people struggled with that sense of isolation and loneliness when we couldn’t see people in person or yeah, the ties online, all those times on Zoom calls, even getting together with family, it just was not the same as… 

Lauren Lavin: 

Not the same. 

Paul Gilbert: 

No, just not the same. Yeah. 

Lauren Lavin: 

Then what role do you think public health professionals can play or should play in fostering these stronger social connections if we know how important they are? 

Paul Gilbert: 

I think one of the really helpful things is that public health can help guide our planning, sort of setting up the environment to maximize healthful opportunities. So this might mean working with the people that we don’t always think about. We probably always think about partnering with clinics and healthcare providers, and we’re really lucky in Iowa City that we’ve got a great medical center here, but we should also be talking to urban and regional planners, the city council and the county supervisors to say, “Hey, are we setting up our physical environment, our community structures in ways that will make it easy, that might facilitate connecting with other people?” 

So thinking about, well, how we build neighborhoods, do we have places for people to just get together, sidewalks rather than just parking lots, or setting up events that can bring people together. Again, we’re really lucky in Iowa City that we have so much going on, from things like the farmers market most of the year to a summer full of all sorts of different weekend festivals. There’s all these opportunities to get out and to be with your neighbors, to be with other residents. 

It’s a little tougher in the winter sometimes to get out, but I think from public health, we could push all our play cousins in the city, the county, even the state, to be thinking about how are we making it easy to stay connected with people? How are we facilitating meaningful connections? And it’s probably going to look different in every different community, if that makes sense. Responding to the local needs of the community, what they prefer, how they would want to be connected, what sort of social environment they have, whether resources that exist or gaps that we need to build up, they’ll probably look a little bit different. But I think the same principles of trying to make the environment the healthiest. We want to make the healthy choice the easiest choice. We want to make it easy to see, to meet, to connect with other people in whatever way we want. 

Lauren Lavin: 

I love that framing of drawing people out into the community. Like we all exist in these little bubbles, but if we can facilitate drawing everyone into one bigger bubble, that is beneficial for increasing [inaudible 00:19:45]. 

Paul Gilbert: 

Yeah. Yeah. 

Lauren Lavin: 

Turning a little bit towards the social determinants of health. Obviously that encompasses a wide range of factors. Which determinants do you think have the most profound impact on social connections and maybe even just health at large? 

Paul Gilbert: 

Boy. 

Lauren Lavin: 

That’s a big question. 

Paul Gilbert: 

Yeah, that’s a good question. I don’t know if I can single out anything, kind of because as I was saying just a moment ago, I think it often will vary from town to town, city to city, state to state, depending on the local populace, what they want, what they’ve got in place, what might be the best. There’ve been a couple of attempts to kind of break down the categories of the determinants of our health outcomes, the things that drive our health, broadly speaking, on average in general. And some of the things that I already mentioned, things like our genetic makeup, our genetic inheritance, access to healthcare, our individual behaviors, the things we do or don’t do, those are all key, well-recognized determinants. 

But in the couple of studies that I like to cite when I teach about social determinants of health, altogether those are estimated to make up maybe a half of all the forces that shape our health outcomes. So what’s the other half? The whole social, physical, built environment, policy environment, all of these other social determinants make up about the other half, the other 50% of all these drivers, all these determinants of our health outcomes. Trying to pin it down on a particular aspect of social determinants, getting narrower than that is really tough. If you want, I can send you a couple of citations, the ones that I use in classes that I show, if you want to put them in show notes or anything, if people- 

Lauren Lavin: 

Yeah, absolutely. 

Paul Gilbert: 

… listening to this are interested in looking it up, because it is really, really fascinating. It’s also not really new. We’ve known this for decades, that roughly half, probably the earliest paper that I like to cite comes from the, I want to say 1990s sometime. Can’t remember the exact date. But we’ve known this for a while that the social, political, environmental, built environment context is a major force that shapes our health outcomes that we need to attend to it. 

Lauren Lavin: 

Can you compare and contrast the social determinants of health versus a built environment? Are those the same thing for our listeners? Is there differences? 

Paul Gilbert: 

Yeah. I would say that, the way I think of it is the social determinants of health are probably the big umbrella of all these other things, like I said, the other 50% of things that shape our health besides our genetics, our health-related behaviors, our use of healthcare services. And we tack that word social determinants onto it, but it doesn’t always mean just social ties. So the social determinants, I like to think of it as the things that we can create, the context that really are within our control, but speaking collectively, not that any one of us, we can’t any individual decide what laws we’re going to live under usually, but collectively we can shape that. 

But these are things that are slow moving. They do change, but they take time to change. I think of the built environment as one very specific aspect of it. So like the physical structures, how we plan things like roads and where we put industry versus housing, or how do we protect our water supply and our air and things like that, that really are related to literally that physical environment that we move through every day, the streets we walk down or drive down, the buildings that we work or study or live in. All of those other things. But I think of that as more of a more tightly focused subset of these overall determinants of health that we just happen to label social determinants of health. 

Lauren Lavin: 

As just a regular person listening to that, is there a way to influence the social determinants of health as an individual, or do you see that more happening at a collective level? 

Paul Gilbert: 

I think the change happens at the collective level, but absolutely there’s a role for individual folks, and this is where I get excited. Maybe this comes back to my old undergrad studying political science, but having folks in their community, at minimum, it could be like voting in your local elections, even things like school board or school bonds or city council elections. Those are important. Having people, regular residents of the community, willing to talk to these leaders. Anybody in a leadership position, so could be your neighborhood school principal or the city council, county supervisors, all the way up that hierarchy. I think those are really effective ways that individuals can contribute to that collective process of shaping the conditions that we live in. 

It’s hard oftentimes to see much progress when we’re just acting as individuals, but I think that’s the magic of a population approach. Individuals speaking up, paying attention to what’s happening, contacting leaders in their community, they may not always see an immediate result, but it does add up over time, and I think engaged communities will often, you’ll notice it in health outcomes, that they just simply have better outcomes when they have an engaged, active community. The other thing, thinking about social determinants of health and communities, I’ll make a little plug here for the County Health Rankings, I think a lot of our students are familiar with that. It comes up in classes very often. 

Lauren Lavin: 

I’m not familiar with that. 

Paul Gilbert: 

Oh, okay. So this is a great project. You can Google or use any sort of online search tool, county health rankings, and there’s a website that’s managed by the University of Wisconsin that basically aggregates all sorts of health data for us and creates nice summaries of the health status of different communities, and they do have sections on what we call social determinants of health. So the proportion of high school graduates in the community, or unhoused people, or preterm births, or boy, economic conditions, I can’t remember what all the indicators are. It’s a great resource, and you can drill down to some pretty fine-grained details, but it’s available for every single county in the United States, and it’s a great resource if you’re looking for, say, a profile of a place or early in the planning stages of a project, this is a great first step to review that, to see, okay, what are the strengths? Where do the resources seem to be? What’s good in the community that you might build on? 

And then also, where are some gaps or deficiencies, or where are areas that we need to focus on? Say if there’s a high level of students who don’t complete high school, that might be something to focus on. Where are we losing students? Because we know education is another one of those really regular relationships. The more education you have on average, generally speaking, the better your health outcomes across all sorts of health outcomes, and that holds true for individuals and communities. When we see communities with higher levels of education, they tend to be healthier. Anyway, that was a bit of a tangent. That was a bit of an aside. 

Lauren Lavin: 

That’s a great resource that people interested in this field would be interested in looking at. 

Paul Gilbert: 

Yeah, and I often, I do a summer session with undergraduate students to introduce them to the health professions, and one of the regular assignments that they get is to do a little research project on their home communities, and this is a resource that I recommend, the County Health Rankings. So they’re tasked with coming up with sort of a health profile and needs assessment of their community, and then making a pitch for what would improve their community’s health. Such a great starting point. I can send you the link as a follow-up in case you want to include it in the- 

Lauren Lavin: 

Absolutely. That’d great. 

Paul Gilbert: 

… show notes. Yeah. 

Lauren Lavin: 

Okay. Two questions. 

Paul Gilbert: 

Sure. 

Lauren Lavin: 

Final one. For students and young professionals that are in public health or want to be practitioners in public health, what advice would you give on incorporating social determinants of health and social connection frameworks into their future work? 

Paul Gilbert: 

If they’re able, I would encourage folks to take one of the classes that we offer in the college. We have a social epidemiology course in epidemiology. I can’t remember the course number or the title, but Dr. Platt teaches that class, Jonathan Platt. And then in my department, Community and Behavioral Health, we have a course taught by Dr. Shannon Watkins on health equity disparities and social justice in public health. Very similar topics that they cover, different approaches slightly, but both of those are good to kind of add to your training if you’re interested in this whole issue of social determinants of health and how that social world or all these contextual factors might affect your health. 

The other thing is, if it is an interest, I think just having your eyes open, looking out for opportunities to bring this up to kind of nudge people. We often fall into this automatic habit of looking at, do people have access to healthcare? Are they making smart choices? And that’s all good, appropriate, necessary work, but as I mentioned a couple of times, that isn’t the full picture. We also need to look at things beyond it. So being ready to kind of push your co-workers, your group project, maybe even asking your instructors to think more broadly about these broader determinants of health. I think that’s what I would recommend. 

Lauren Lavin: 

I love that. Those are very tangible and very relevant to our students. Final question. It doesn’t have to have anything to do with what we talked about, but what are you currently reading or watching, and would you recommend it? 

Paul Gilbert: 

Oh, that’s a great question. So I just finished watching a series, I think it was on Apple TV, called Bad Sisters, and it’s set in Ireland, five sisters who were orphans, who kind of grew up taking care of each other, and it’s, I guess I’d call it a bit of a dark comedy. In the first season the sisters are trying to murder their brother-in-law, who is a real jerk, who, I got to say, they’re probably justified. And then in the second season, the complications continue. But it was a really great distraction from all the end of semester, end of fall semester stresses and busy work and everything. So I don’t have anything new to watch, so I’ll be listening to the podcast, see if any of your other guests, what their recommendations are, but that was one that I really enjoyed that I just finished watching, Bad Sisters. 

Lauren Lavin: 

Okay, noted. I love Ireland, so anything really I am down on. Thank you so much for being on the podcast today. You were a great guest. I hope our listeners learned as much as I did. And we’ll be sure to include some stuff in the show notes if they want to follow up. 

Paul Gilbert: 

Thank you. Thank you for inviting me. This is great, and I love talking about this topic, so feel free to hit me up if you ever have any questions or any of the listeners. If they want to find me, you can just Google Paul Gilbert, University of Iowa, and I’ll probably pop up right away. You can find all my contact info on the CBH webpage, but I’d be glad to speak to anybody else about this. 

Lauren Lavin: 

Perfect. Thank you so much. 

Paul Gilbert: 

All right, thank you. 

Lauren Lavin: 

That wraps up today’s episode of Plugged in to Public Health. A huge thank you to Dr. Paul Gilbert for joining us and sharing his expertise on social connections and public health. His insights reminded me that fostering strong communities isn’t just about policy or infrastructure, but it can be about the everyday relationships that shape our lives and well-being. So I need to make sure to be seeking those out on a regular basis. If you’d like to learn more, we’ll include resources in the show notes, including links to the County Health Rankings and other tools that Dr. Gilbert mentioned. 

If you enjoyed this conversation, be sure to subscribe to Plugged in to Public Health and share it with your friends, colleagues, or anyone interested in how we can build healthier communities together. This episode was hosted and written by Lauren Lavin and edited and produced by Lauren Lavin. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health. Have a suggestion for our team, you can reach us at CPH-GradAmbassador@uiowa.edu. This episode is brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and of course, take care.