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Why are some societies more successful than others at promoting individual lives and the collective development of the community? Social scientists rarely ask this obvious question, partly because we fear imposing our values in our answers and partly because it is so complicated to answer. With the support of the Canadian Institute for Advanced Research, however, a diverse group of social scientists has been considering it, and here is what we've found.

A wide range of outcomes can be associated with successful societies, including open access to education, civic participation, cultural tolerance and social inclusion. However, we chose to measure societal success by elemental health indicators such as life expectancy – a goal most human beings agree is valuable.

Health outcomes pose many sets of puzzles for social scientists. Consider two examples. When the Communist regimes of Eastern Europe fell after 1989 – in a set of developments some described as the “end of history” – one might have expected daily life to improve for those people who had been given new freedoms and, for some, it did. After dipping during the transition, male life expectancy in the Czech Republic, for instance, began to improve rapidly under the new regime, reaching 72 years by 2001. Male life expectancy in Russia, however, dropped sharply during the transition and remained so low that it was barely 59 years in 2001. Why did a historic development improve collective well-being in one nation and erode it in another?

“ These gaps translate into millions of years of productive life. Why are they occurring?”

Recent movements in life expectancy in the United States and Canada are equally puzzling. In the two decades after the Second World War, Canadians and Americans gained years of life at about the same pace. Since the 1970s, however, U.S. life expectancy has been increasing more slowly than in Canada. The average Canadian now lives two years longer than an American. And although women live longer than men, they are losing their relative advantage at a faster pace in the U.S. than in Canada. These gaps translate into millions of years of productive life. Why are they occurring?

In all countries, people of lower socioeconomic status tend to have worse health than those in higher socioeconomic positions – a phenomenon so pervasive that some describe social inequality as the “fundamental cause” behind disparities in population health. We think the origins of this “health gradient” lie in the “wear and tear of daily life.” Many studies show that the emotional and physiological responses generated by the challenges people encounter in daily life condition their susceptibility to many of the chronic illnesses that have become the dominant causes of mortality in the developed world. The poor fare worst not only because they face more challenges but because they have fewer “buffers” to protect them from this wear and tear.

While some of these buffers are tied to personality and behavioural inclinations rooted in early childhood development, many others are not personal but social in character, and we examine them in a recent book, Successful Societies: How Institutional Culture and Institutions Affect Health. We argue that societies that recognize a wide range of people as full members of the community deserving of recognition and support, for instance, provide more extensive buffers than societies that stigmatize those who are different. This is also true of societies where ethnic boundaries are not strongly policed (e.g. Canada versus the U.S.) and interracial relationships not stigmatized (e.g. Brazil versus the U.S.).

Buffering societies are also ones that empower people by providing them collective narratives of empowerment and shared hope, as Barack Obama did right after the last U.S. election. They give people in all walks of life the tools they need to imagine “possible selves” that offer them routes to a more positive future. Images such as these help people resist negative messages and buffer them against the daily injuries of class and race – against the wear and tear of inequality that gets under the skin to sustain poor health, including unhealthy behaviours.

There are lessons in this for policy-makers concerned about health. Ann Swidler's chapter for Successful Societies compares AIDS prevention programs in Botswana and Uganda. Although Botswana is widely seen as better-governed, these programs have been much more successful in Uganda. Why? In Uganda, prevention campaigns were able to tap into the social imagery of the local community, invoking the obligations ordinary people feel to friends and neighbours. They were designed to resonate with the way people understand their lives. Many kinds of policies will be more effective when they are designed to build on concepts of community and shared values specific to local or national context.

Important though it is, the current U.S. debate about health care misses most of these points. Universal access to health care is crucial. But the health of a society will ultimately depend on quality of life, and quality of life has to do not only with social policy and income distribution, but also with how we treat one another, how sharply we draw the line between “us” and “them,” and what the experience of daily living feels like. In this respect, the secret of successful societies is not only in the hands of our governments and health reformers, but also in the choices we all make about how we deal with one another.

Peter A. Hall is a professor of European studies and government at Harvard; Michèle Lamont is a professor of European studies and sociology at Harvard. The authors are co-editors of Successful Societies: How Institutions and Culture Affect Health.