Join the Club

How Peer Pressure Can Transform the World

Tina Rosenberg

• Publisher: Icon Books
• Year: 2011
• ISBN:
  9781848313361
• Topic: Psychology
• Subtopic: Social Psychology
• Index: Psychology

In the style of Nudge or The Spirit Level - a groundbreaking book that will change the way you look at the world. Tina Rosenberg has spent her career tackling some of the world's hardest problems. The Haunted Land, her searing book on how Eastern Europe faced the crimes of Communism, was awarded both the National Book Award and the Pulitzer Prize in the US. In Join the Club, she identifies a brewing social revolution that is changing the way people live, based on harnessing the positive force of peer pressure. Her stories of peer power in action show how it has reduced teen smoking in the United States, made villages in India healthier and more prosperous, helped minority students get top grades in college calculus, and even led to the fall of Slobodan Milosevic. She tells how creative social entrepreneurs are starting to use peer pressure to accomplish goals as personal as losing weight and as global as fighting terrorism. Inspiring and engrossing, Join the Club explains how we can better our world through humanity's most powerful and abundant resource: our connections with one another.

Chapter Ten

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THIS BOOK IS THE HISTORY OF AN IDEA, ONE CREATED over and over again by pioneers in various fields. Together, their stories show how the social cure works: what kinds of problems are susceptible; which part of each problem is vulnerable; what steps to take first, and after that, and after that; what tools to use; which outside resources are necessary; and how to defend the idea when the problem fights back. The resourceful entrepreneurs described in this book had no blueprint for using the social cure—but they have helped to write one.

The social cure no longer is a strategy that would-be entrepreneurs must stumble onto. People wrestling with an important issue can now sit down and think through whether a join-the-club solution might help. We can ask ourselves: Is this a problem where it might be possible and fruitful to provide people with a new peer group that can encourage them to think of themselves in a new way?

To begin, it is useful to do a thought experiment. Let us look at a few ways one might go about applying a join-the-club solution to a new problem.

One avenue is to begin with the stories in this book. They vary in every possible way. They use the social cure for both intimate personal problems and sweeping political dramas, among teens and adults, poor and rich, in South Africa and South Carolina, Serbia and suburbia. Each example is different in the way it introduces people to a new peer group and the mechanism through which that peer group brings about identity change. They differ in the essence of the change they seek.

One characteristic they have in common, however, is that each of these cases is part of a family: other problems share enough DNA to be able to use the social cure in a similar way. The most direct way to expand the social cure to new problems is to look for those related to ones we already know.

The logical place to begin is with the most personal set of issues, those that deal with temptation. The behavior change necessary in these cases is a shift from present to future orientation: the ability to postpone pleasure today in order to be healthier (or happier) tomorrow. Different groups achieve this through different kinds of identity change: loveLife, for example, uses peers to help South African youth think of themselves as people with a future, people with a reason to say no to risky sex. The Rage and SWAT antismoking groups offer teenagers clubs that allow them to see themselves as rebellious and cool. Alcoholics Anonymous creates a peer group that holds a member accountable for changing from a deceitful drinker into a respectful and honest citizen, and it gives the satisfaction of helping others to do the same.

Risky sex, smoking, and drinking are not isolated behaviors. Plenty of other temptations can be addressed with the same forms of the social cure. Some already are—there are “Anonymous”-branded twelve-step support groups for compulsive eaters, compulsive gamblers, drug users, and debtors. These groups, however, offer a particular kind of rehabilitation, one that depends on making amends to others, trusting in a Creator, and changing many aspects of one’s personality. They are not for everyone. While Alcoholics Anonymous is widespread, with two million members worldwide, its kin are much less so.

The essence of an AA group, however—a small group of people who gather regularly with the common goal of overcoming a personal addiction or temptation—might be adapted to almost every kind of important personal problems of the “I’ll-be-sorry-later” type. One test is whether the problem could be on your list of New Year’s resolutions—such as to spend less, go to church more, become a vegetarian, be faithful to your spouse, give more to charity, reduce your carbon footprint, stop yelling at your kids, or exercise five times a week. With any such personal-behavior goal, your chance of success greatly increases if you use the social cure.

Of all our personal struggles with temptation, diet and exercise are by far the most widespread. They are everybody’s New Year’s resolutions. Yet while AA is the first response for dealing with the daily struggles of a drinking problem—so much so that people only believe you’re serious if you join AA—very few people think of joining a group to lose weight. When they do, it is often in the form of corporate-sponsored meetings at Weight Watchers. There are strong indications, however, that the social cure can be a powerful factor for weight control. It’s intuitive that having friends who drink contributes to an alcohol problem, but it seems that something similar is true for overeating. Nicholas Christakis,¹ a professor of medicine and medical sociology at Harvard, and James Fowler, a political science professor at the University of California, San Diego, looked at happiness, health, and weight patterns in a well-established social network of 5,000 people. They found that weight is socially contagious. If your friends are overweight, you are also likely to be overweight, even controlling for other factors. The contagion also works in the other direction; people with thin friends are more likely to be thin. Oddly, the connection also skipped a link—in the study, participants were significantly more likely to gain weight if a friend of a friend did, even if the friend who connected them gained no weight at all.

Association, of course, doesn’t mean causality.² Theoretically, the phenomenon could be sparked by people seeking out fat friends because they are already fat, or the opening of a Pizza Hut in the neighborhood that all the friends go to. Christakis and Fowler did find proofs of causality, but these have been challenged by other researchers. Even some of these researchers, however, say that although the authors may not yet have convincing evidence of causality, they still believe it is true.

Christakis and Fowler’s explanation for the social contagion of weight is peer pressure. Having a friend who is heavy affects your own views about what normal weight is. That gives you permission to gain weight, and you, in turn, give permission to other friends. Having overweight friends releases you from accountability, a social norm you then pass on to others. The authors believe that the viral nature of these behaviors likely stems from the evolutionary advantage of tight social connections.

Research on diets and groups tends to bear out the importance of a social network on weight. Studies show³ that Weight Watchers’ biggest asset is its group meetings—they help participants stick to the plan. Other research shows that people who diet or exercise in groups, or even with a partner or spouse, keep it up longer and lose more weight.

This is the theory behind the Triwomen group. In late January 2010, about ninety women met one evening at the YMCA in Scotch Plains, New Jersey. All were interested in competing in a triathlon—a race involving running, biking, and swimming—sponsored by the women’s apparelmaker Danskin. They listened to three speakers, all triathletes who had completed the race in 2009. One was Peggy Brown, a forty-seven-year-old middle-school earth sciences teacher and mother of three in Scotch Plains. She weighed 240 pounds.

The meeting was the idea of Amy Carow, who also lives in Scotch Plains. She is a competitive swimmer and all-around athlete whose mission is to get the women in her community to exercise. She structures the program around the Danskin Triathlon, held in Sandy Hook, New Jersey, each September. Although it takes only six weeks to train for a beginner’s triathlon of this type—a half-mile swim, three-mile run, and 12.5-mile bike ride—Carow starts in January. She knows that some of the women have never been on a bike, or are afraid to put their heads in the water.

Carow knew that, as an athlete and race veteran, she was the right person to provide advice on how to train for the race and a structure for getting in shape. But she was not the right person to inspire women who viewed a three-mile run as being on the same order of difficulty as a moon landing. For that, Carow turned to people like Brown.

When a fellow teacher at her school invited Brown to train for the race the year before, she had not exercised in twelve years. She had spent those years attending to her children and her husband, never finding the time to do things for herself. Her family was shocked that she was trying and skeptical it would happen. “Let us know if you make it,” they said. But she did make it. Brown finished the 2009 triathlon in the bottom 3 percent—but she finished.

She was, in other words, the perfect speaker for motivating the women who most desperately needed to start exercising. Brown gave a funny, self-deprecating speech about her triathlon adventure—talking about her fears of jellyfish and spandex and the fact that she walked instead of running at the I Hate Running Club training sessions every Sunday. She also spoke about how she had set a goal of finishing the race—and, with the help of the group, she achieved it. After the meeting, people came up to her and said, “If you can do this, I can do this,” she told me later.

Brown succeeded because of the group. On Saturday mornings, she would ride her bike alone. She did all her other workouts—three a week at first, then four, then five, then six—with fellow Triwomen. “I would have made a date to go swim at 8:30 at night,” she said. “I was tired, it was cold out, I worked all day. But I had to go because Bonnie was going.” She went with other rookie Triwomen to buy a bike and to get new running shoes. She went to the meetings to learn about training strategy.

A healthy-living social cure does not have to be done under the umbrella of a corporation. All it requires is a group of neighbors who meet to exercise or to weigh each other, offer support, and hold each other accountable. But do-it-yourself groups of friends do pose one danger: they can quickly degenerate into permission-giving. If everyone clucks sympathetically when a member returns from a vacation five pounds heavier, the social norm of the group has shifted and has now become a force for weight gain, much worse than no group at all: even my weight loss group says it’s okay. Sympathetic understanding is counterproductive; what’s needed is ruthlessness.

No one would claim that weight loss is straightforward, but adapting the social cure to weight loss is. Christakis and Fowler’s study also offers other fruitful avenues for social-cure solutions, as they found that the chance that you smoke or drink and your level of happiness were also linked to those of your friends, and friends of friends.

PERSONAL STRUGGLES WITH TEMPTATION are not the only candidates for a broader application of the social cure. Many of the other join-the-club strategies used by the innovators described in this book can also be applied more widely.

One such social cure is DOTS—the strategy of having a neighbor, family member, or health worker observe as tuberculosis patients take their medicine. DOTS greatly increases the chance that patients will take their pills correctly and complete their course of treatment. As we saw in chapter 6, DOTS has slowed the development of strains of TB resistant to antibiotics and has limited the disease’s spread.

DOTS works by boosting adherence. People do not want to disappoint their pill partner. Very often that partner is someone who has already had tuberculosis, or has other things in common with the patient, and can provide crucial encouragement and incentive to restore a patient’s will to get better.

We already know that the DOTS model can help with other diseases. The use of accompagnateurs is now widespread in AIDS programs in Haiti and Africa, and has shown success with hard-to-treat patients in Boston.

The possibilities for a DOTS model should not be limited to communicable diseases in poor countries or among the poverty-stricken in the United States. Since adherence is an enormous problem for all diseases everywhere, DOTS can be a solution. If it is not necessary or feasible to provide a patient with daily in-person encouragement, then a weekly visit or meeting might be enough. The peer can be a community health worker with a similar background or a more direct peer—a fellow patient. In chapter 6, we saw that pilot programs using both have been successful in the United States, showing they can help people of all social classes to manage chronic diseases. They deserve to be expanded.

DOTS is also a microversion of the small-group social cures that could prove effective for all those New-Year’s-resolution–style personal struggles. A DOTS strategy is more adaptable and easier to follow than going to a formal meeting. Your impatience with your young children may not rise to a level of toxicity where you will actually go to meetings about it (a high threshold for anyone with young children), but it could certainly help if you and another parent would agree to call each other when you are about to explode. Students who resolve to double the amount of time they spend studying don’t have time to go to meetings, which are not necessary anyway—they just have to find someone else with the same goal and study together. If you wanted to cut down on your family’s consumption of fast food, you could get together with one or two like-minded people each weekend and spend a few hours preparing three different big pots of food to split. You would end up with meals for three days, an enjoyable afternoon, many new chili recipes—and a positive new identity as a person in control of your family’s eating.

Any problem that requires consistent adherence—which a good proportion of life does—can benefit from this kind of social cure. Since there is ample evidence that the greater impact comes when you help others rather than when they help you, the benefits are likely to be notable.

The calculus clubs described in chapter 5 are another join-the-club strategy that could be broadened effectively. It is helpful to look again at the essence of this social cure: Students are trying to master a challenging subject. Whether or not they succeed depends on more than their previous preparation and talent. Their learning is also impeded by a reluctance to risk asking questions, low math confidence, and lack of context. Faced with a problem they can’t solve, they don’t know whether their own skills are deficient or the problem is exceptionally difficult. Students in typical classes also don’t have the benefit of being forced to think through a solution thoroughly enough to be able to teach it to someone else. They must also overcome the perception that it’s not cool to be interested in math or spend a lot of time on it. Small-group learning, in which students help each other solve advanced-calculus problems, helps knock over all these barriers.

The description of the hurdles in the way of calculus success could also apply to many other learning situations—perhaps most of them. Other college courses that require mastery of tough skills are obvious candidates: there could be organic-chemistry clubs (a few universities have these) and Arabic-language clubs. But there’s no reason that small-group study should be limited to college students. At the other extreme, even five-year-olds learning to read deal with problems of self-confidence and worry about looking dumb and uncool in front of the class. They suffer from overcrowded classrooms where high student-to-teacher ratios condemn them to be passive listeners. Kindergarteners are not going to meet after school for study dates, but it could be a useful part of every reading lesson in school to have children sit in groups of three or four and help each other read.

The Jamkhed-program model described in chapter 6 could also be applied to many more problems than village health. Many of the reasons people cannot escape poverty in the developing world share a common root: the services enjoyed by middle-class people in big cities are not available to village-dwellers in remote areas. In the majority of poor countries, rural people don’t have medical care, decent schools, training in the most modern practices in agriculture or other livelihoods, access to credit and safe savings, or many other advantages their fellow citizens in towns and cities enjoy.

Let us examine the essence of this social cure. When Raj and Mabelle Arole set up the Jamkhed program, they were trying to solve the problem of a lack of health care in rural villages. Professionals—doctors and nurses—were of little help. They wouldn’t come to villages, their unfamiliarity with local customs led to a lack of trust among villagers, they did not prioritize working with the people who needed them most, and they used a health-care model that emphasized expensive cures—a system that did not help people take responsibility for their own well-being through preventive health care.

The Aroles solved the problem by gathering members of exactly the group they wanted to reach and training them in the skills most needed to improve village health. The illiterate village women easily learned the material and skills. Helping them acquire the necessary persistence and confidence was more difficult, however. For that, the Aroles turned to the social cure.

Poor countries are in desperate need of low-cost rural health care. This is especially true in English-speaking poor countries, where nurses and doctors are being poached to fill vacancies in Britain’s National Health Service and rural areas of the United States, Australia, and Canada. The numbers are staggering. About one in five African-born⁴ physicians were working in a wealthy country in 2000—each doctor representing several hundred thousand dollars in medical aid Africa sends to Britain, Canada, or the United States.

Those who stay in Africa, moreover, remain in cities. Health conditions in rural areas are worsening. Tuberculosis is rising, in some places AIDS is widespread, and climate-change–induced drought has increased malnutrition and water scarcity, leading to serious illness. Someone needs to be addressing public health—and in the countryside, it isn’t going to be doctors or nurses. The world urgently needs many more Jamkheds.

Health care is not the only service in scarce supply in the world’s villages. Uneducated farmers could be trained as agricultural extension agents. The men in the village can learn to plant drought-resistant corn just as their wives learned to purify drinking water. Women with a little education, just a step ahead of their students, can teach middle school and high school in communities where students have no other possibility of ed...