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http://www.nytimes.com/2008/11/30/books/chapters/chapter-outliers.html?pagewanted=all&_r=0
Wolf approached the mayor of Roseto and told him that his town represented a medical mystery. He enlisted the support of some of his students and colleagues from Oklahoma. They pored over the death certificates from residents of the town, going back as many years as they could. They analyzed physicians' records. They took medical histories, and constructed family genealogies. "We got busy," Wolf said. "We decided to do a preliminary study. We started in 1961. The mayor said — all my sisters are going to help you. He had four sisters. He said, 'You can have the town council room.' I said, 'Where are you going to have council meetings?' He said, 'Well, we'll postpone them for a while.' The ladies would bring us lunch. We had little booths, where we could take blood, do EKGs. We were there for four weeks. Then I talked with the authorities. They gave us the school for the summer. We invited the entire population of Roseto to be tested."
The results were astonishing. In Roseto, virtually no one under 55 died of a heart attack, or showed any signs of heart disease. For men over 65, the death rate from heart disease in Roseto was roughly half that of the United States as a whole. The death rate from all causes in Roseto, in fact, was something like thirty or thirty-five percent lower than it should have been.
Wolf brought in a friend of his, a sociologist from Oklahoma named John Bruhn, to help him. "I hired medical students and sociology grad students as interviewers, and in Roseto we went house to house and talked to every person aged twenty one and over," Bruhn remembers. This had happened more than fifty years ago but Bruhn still had a sense of amazement in his voice as he remembered what they found. "There was no suicide, no alcoholism, no drug addiction, and very little crime. They didn't have anyone on welfare. Then we looked at peptic ulcers. They didn't have any of those either. These people were dying of old age. That's it."
Wolf's profession had a name for a place like Roseto — a place that lay outside everyday experience, where the normal rules did not apply. Roseto was an outlier.
Wolf's first thought was that the Rosetans must have held on to some dietary practices from the old world that left them healthier than other Americans. But he quickly realized that wasn't true. The Rosetans were cooking with lard, instead of the much healthier olive oil they used back in Italy. Pizza in Italy was a thin crust with salt, oil, and perhaps some tomatoes, anchovies or onions. Pizza in Pennsylvania was bread dough plus sausage, pepperoni, salami, ham and sometimes eggs. Sweets like biscotti and taralli used to be reserved for Christmas and Easter; now they were eaten all year round. When Wolf had dieticians analyze the typical Rosetan's eating habits, he found that a whopping 41 percent of their calories came from fat. Nor was this a town where people got up at dawn to do yoga and run a brisk six miles. The Pennsylvanian Rosetans smoked heavily, and many were struggling with obesity.
If it wasn't diet and exercise, then, what about genetics? The Rosetans were a close knit group, from the same region of Italy, and Wolf next thought was whether they were of a particularly hardy stock that protected them from disease. So he tracked down relatives of the Rosetans who were living in other parts of the United States, to see if they shared the same remarkable good health as their cousins in Pennsylvania. They didn't.
He then looked at the region where the Rosetans lived. Was it possible that there was something about living in the foothills of Eastern Pennsylvania that was good for your health? The two closest towns to Roseto were Bangor, which was just down the hill, and Nazareth, a few miles away. These were both about the same size as Roseto, and populated with the same kind of hard-working European immigrants. Wolf combed through both towns' medical records. For men over 65, the death rates from heart disease in Nazareth and Bangor were something like three times that of Roseto. Another dead end.
What Wolf slowly realized was that the secret of Roseto wasn't diet or exercise or genes or the region where Roseto was situated. It had to be the Roseto itself. As Bruhn and Wolf walked around the town, they began to realize why. They looked at how the Rosetans visited each other, stopping to chat with each other in Italian on the street, or cooking for each other in their backyards. They learned about the extended family clans that underlay the town's social structure. They saw how many homes had three generations living under one roof, and how much respect grandparents commanded. They went to Mass at Our Lady of Mt. Carmel Church and saw the unifying and calming effect of the church. They counted twenty-two separate civic organizations in a town of just under 2000 people. They picked up on the particular egalitarian ethos of the town, that discouraged the wealthy from flaunting their success and helped the unsuccessful obscure their failures.
In transplanting the paesani culture of southern Italy to the hills of eastern Pennsylvania the Rosetans had created a powerful, protective social structure capable of insulating them from the pressures of the modern world. The Rosetans were healthy because of where they were from, because of the world they had created for themselves in their tiny little town in the hills.
Real Food Dudes: The Roseto Paradox - A Diet Based Outlier?
It should also be noted that Wolf followed up with his research with a report 25 years later. It appears the health of Rosetans no longer remains an outlier. Heart and other chronic disease has caught up with the town of Roseto. Again, this is attributed to the fact that Roseto's community no longer remains as socially tight knit as standard American values have crept in. New generations no longer stick around past childhood, fancy cars now cruise the streets, and swimming pools have popped up in back yards. However, in Wolf's 25 year review he does note that Roseto began consuming less animal fat. I would bet on the fact that if one were to closely look at the Rosetan diet of today it would look much more like the standard American diet (processed, imported and vegetable-based fats), in stark contrast with their more traditional way of cooking during the 1950s and earlier.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376462/pdf/tacca00088-0118.pdf
ROSETO,PENNSYLVANIA - 25 YEARS LATER-HIGHLIGHTS OF A MEDICAL AND SOCIOLOGICAL SURVEY
Dr. Rock Positano: The Mystery of the Rosetan People
A relatively recent (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 careless dismantling of the social ties between family and community, the return to 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.
In a recent book, The Power of Clan, authors Stewart Wolf and John Bruhn covered the town from 1935-1984: their conclusions dovetailed with the other studies. The magic of Roseto was the total avoidance of isolated individuals crushed by problems of everyday life. Rosetans didn't feel isolated or crushed, rather they avoided the internalization of stress. Stability and predictability...hardly Americanized virtues...even in the early years, was life soothing, hence life lengthening.
Consumer pressure was vitiated by a total taboo against showing off wealth. But the townspeople did work harder than most. Toward the goal of "a better life for the kids."
But so much for the oasis of healthy living. In the 1970's, there was suburbanization of the region, including the town. Single family homes, fenced yards, country clubs were brought in. But the social ties weakened and then started to fail. They failed with a significant event.
It took until 1971 for the first person under age 45 died of a heart attack took place in Roseto.
Wolf approached the mayor of Roseto and told him that his town represented a medical mystery. He enlisted the support of some of his students and colleagues from Oklahoma. They pored over the death certificates from residents of the town, going back as many years as they could. They analyzed physicians' records. They took medical histories, and constructed family genealogies. "We got busy," Wolf said. "We decided to do a preliminary study. We started in 1961. The mayor said — all my sisters are going to help you. He had four sisters. He said, 'You can have the town council room.' I said, 'Where are you going to have council meetings?' He said, 'Well, we'll postpone them for a while.' The ladies would bring us lunch. We had little booths, where we could take blood, do EKGs. We were there for four weeks. Then I talked with the authorities. They gave us the school for the summer. We invited the entire population of Roseto to be tested."
The results were astonishing. In Roseto, virtually no one under 55 died of a heart attack, or showed any signs of heart disease. For men over 65, the death rate from heart disease in Roseto was roughly half that of the United States as a whole. The death rate from all causes in Roseto, in fact, was something like thirty or thirty-five percent lower than it should have been.
Wolf brought in a friend of his, a sociologist from Oklahoma named John Bruhn, to help him. "I hired medical students and sociology grad students as interviewers, and in Roseto we went house to house and talked to every person aged twenty one and over," Bruhn remembers. This had happened more than fifty years ago but Bruhn still had a sense of amazement in his voice as he remembered what they found. "There was no suicide, no alcoholism, no drug addiction, and very little crime. They didn't have anyone on welfare. Then we looked at peptic ulcers. They didn't have any of those either. These people were dying of old age. That's it."
Wolf's profession had a name for a place like Roseto — a place that lay outside everyday experience, where the normal rules did not apply. Roseto was an outlier.
Wolf's first thought was that the Rosetans must have held on to some dietary practices from the old world that left them healthier than other Americans. But he quickly realized that wasn't true. The Rosetans were cooking with lard, instead of the much healthier olive oil they used back in Italy. Pizza in Italy was a thin crust with salt, oil, and perhaps some tomatoes, anchovies or onions. Pizza in Pennsylvania was bread dough plus sausage, pepperoni, salami, ham and sometimes eggs. Sweets like biscotti and taralli used to be reserved for Christmas and Easter; now they were eaten all year round. When Wolf had dieticians analyze the typical Rosetan's eating habits, he found that a whopping 41 percent of their calories came from fat. Nor was this a town where people got up at dawn to do yoga and run a brisk six miles. The Pennsylvanian Rosetans smoked heavily, and many were struggling with obesity.
If it wasn't diet and exercise, then, what about genetics? The Rosetans were a close knit group, from the same region of Italy, and Wolf next thought was whether they were of a particularly hardy stock that protected them from disease. So he tracked down relatives of the Rosetans who were living in other parts of the United States, to see if they shared the same remarkable good health as their cousins in Pennsylvania. They didn't.
He then looked at the region where the Rosetans lived. Was it possible that there was something about living in the foothills of Eastern Pennsylvania that was good for your health? The two closest towns to Roseto were Bangor, which was just down the hill, and Nazareth, a few miles away. These were both about the same size as Roseto, and populated with the same kind of hard-working European immigrants. Wolf combed through both towns' medical records. For men over 65, the death rates from heart disease in Nazareth and Bangor were something like three times that of Roseto. Another dead end.
What Wolf slowly realized was that the secret of Roseto wasn't diet or exercise or genes or the region where Roseto was situated. It had to be the Roseto itself. As Bruhn and Wolf walked around the town, they began to realize why. They looked at how the Rosetans visited each other, stopping to chat with each other in Italian on the street, or cooking for each other in their backyards. They learned about the extended family clans that underlay the town's social structure. They saw how many homes had three generations living under one roof, and how much respect grandparents commanded. They went to Mass at Our Lady of Mt. Carmel Church and saw the unifying and calming effect of the church. They counted twenty-two separate civic organizations in a town of just under 2000 people. They picked up on the particular egalitarian ethos of the town, that discouraged the wealthy from flaunting their success and helped the unsuccessful obscure their failures.
In transplanting the paesani culture of southern Italy to the hills of eastern Pennsylvania the Rosetans had created a powerful, protective social structure capable of insulating them from the pressures of the modern world. The Rosetans were healthy because of where they were from, because of the world they had created for themselves in their tiny little town in the hills.
Real Food Dudes: The Roseto Paradox - A Diet Based Outlier?
It should also be noted that Wolf followed up with his research with a report 25 years later. It appears the health of Rosetans no longer remains an outlier. Heart and other chronic disease has caught up with the town of Roseto. Again, this is attributed to the fact that Roseto's community no longer remains as socially tight knit as standard American values have crept in. New generations no longer stick around past childhood, fancy cars now cruise the streets, and swimming pools have popped up in back yards. However, in Wolf's 25 year review he does note that Roseto began consuming less animal fat. I would bet on the fact that if one were to closely look at the Rosetan diet of today it would look much more like the standard American diet (processed, imported and vegetable-based fats), in stark contrast with their more traditional way of cooking during the 1950s and earlier.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376462/pdf/tacca00088-0118.pdf
ROSETO,PENNSYLVANIA - 25 YEARS LATER-HIGHLIGHTS OF A MEDICAL AND SOCIOLOGICAL SURVEY
Dr. Rock Positano: The Mystery of the Rosetan People
A relatively recent (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 careless dismantling of the social ties between family and community, the return to 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.
In a recent book, The Power of Clan, authors Stewart Wolf and John Bruhn covered the town from 1935-1984: their conclusions dovetailed with the other studies. The magic of Roseto was the total avoidance of isolated individuals crushed by problems of everyday life. Rosetans didn't feel isolated or crushed, rather they avoided the internalization of stress. Stability and predictability...hardly Americanized virtues...even in the early years, was life soothing, hence life lengthening.
Consumer pressure was vitiated by a total taboo against showing off wealth. But the townspeople did work harder than most. Toward the goal of "a better life for the kids."
But so much for the oasis of healthy living. In the 1970's, there was suburbanization of the region, including the town. Single family homes, fenced yards, country clubs were brought in. But the social ties weakened and then started to fail. They failed with a significant event.
It took until 1971 for the first person under age 45 died of a heart attack took place in Roseto.
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