Dr. Shawna Beese: Neighboring Is Preventive Medicine

 

In most conversations about health, we start in the wrong place. We start with doctors, medications, and insurance systems — the places we go after something has already gone wrong.

Shawna Beese, a rural health researcher and Extension specialist in Washington State, flips that order. Her work explores a simple but disruptive idea: Health is not primarily created in healthcare systems. It is created in neighborhoods.

Her research treats neighboring not as a nice social habit, but as a population-level health intervention — a practical way to reduce chronic disease, mental illness, and despair before treatment is needed.

Beese’s central insight is that health operates at the scale of everyday life.

Where you spend most of your hours — home, street, workplace, local relationships — determines your long-term biological stress load far more than occasional medical visits. 

Her research focuses on how neighborhood characteristics influence well-being and resilience in both rural and urban communities.

That leads to a powerful conclusion: We don’t experience life county-wide. We experience life block-wide.

A person’s body responds daily to predictability, trust, safety, and social support. When those are present, stress hormones stabilize and health improves. When they are missing, the body shifts into chronic threat mode.

Healthcare treats symptoms. Neighborhoods shape exposure.

Beese describes neighboring as a prevention strategy because it alters three major drivers of illness.

1. Stress Regulation

Reliable relationships lower what researchers call “allostatic load” — the accumulated wear-and-tear from chronic stress. Warm neighborhood connections reduce risk for chronic disease by calming the body’s threat response.

A wave across the driveway is not trivial biologically. It signals safety.

Repeated thousands of times, that signal changes blood pressure, sleep, and inflammation levels.

2. Early Detection and Support

When neighbors are connected and engaged they are often the first to notice behavior changes, depression, grief, substance misuse and mobility decline.

Not because they are trained professionals, but because proximity creates awareness.

Public health systems call this “protective surveillance.” Communities simply call it “keeping an eye out.”

3. Behavior Shaping

Health spreads socially. People copy norms around them. In disconnected environments unhealthy coping escalates, routines disappear, and risk tolerance rises.

In connected environments daily structure stabilizes, help is offered earlier and hope remains visible.

Engaged-neighbor strategies can mitigate multiple health problems simultaneously because they restore social regulation. 

Neighboring and Diseases of Despair

Modern health crises — overdose, suicide, alcoholism — rarely originate in medical failure alone. They emerge from disconnection.

Beese’s framework recognizes that despair grows when people lose three experiences: predictable relationships, meaningful roles, and belief in future belonging.

Healthcare intervenes late in this cycle. Neighboring intervenes early.

When someone knows they are noticed, needed, and expected, destructive coping becomes less attractive. Community doesn’t eliminate hardship, but it lowers the probability that hardship becomes hopelessness.

Belonging Is a Biological Condition

One of the most important implications of Beese’s work is that belonging is not merely emotional — it is physiological.

Humans were created for cooperative groups. The brain interprets isolation as danger. Long-term disconnection triggers the same threat pathways as physical insecurity.

So when a neighborhood functions — people greet each other, share tools, help during crises — the body reads stability. This is why Beese calls neighboring a health promotion strategy, not just community building.

What This Means for Communities

Her premise shifts how communities approach well-being.

Instead of asking: “How do we treat more illness?” The better question becomes: “How do we create daily life conditions where illness is less likely?”

That includes social interaction, shared responsibility, visible contribution, mutual awareness, and repeated contact. These are not soft outcomes. They are upstream determinants of mental and physical health.

The Quiet Public Health Infrastructure

Hospitals save lives. But neighborhoods sustain them.

Shawna Beese’s work reframes neighboring as a form of civic infrastructure — as essential as roads or water systems, but easier to overlook because it lives in habits rather than buildings.

A healthy society is not built only through medical innovation. It is built through ordinary people recognizing each other.

Health, in the end, grows where life is shared.

See Beese's presentation in this video online.

WRITTEN BY

David L. Burton

Take the Engaged Neighbor pledge and become part of a movement! The pledge outlines five categories and 20 principles to guide you toward becoming an engaged neighbor. Sign the pledge at https://nomoregoodneighbors.com. Individuals who take the pledge do get special invitations to future events online and in person. Contact the blog author, David L. Burton via email at dburton541@yahoo.com.