Contact Us
13 July 2018
Anthony Costello On The Social Edge: The Power of Sympathy Groups For Health And Sustainable Development (David Sanders Lecture 2018)

(Published - 13 July 2018)

“An individual within a crowd of strangers is highly stressed; an individual within a smaller group of friends, much less so.”

So said Dr Anthony Costello, delivering a lecture on The Social Edge: The Power of Sympathy Groups For Health And Sustainable Development at the University of the Western Cape’s (UWC) annual David Sanders Public Health and Social Justice Lecture on 10 July 2018.

Dr Costello recently stepped down as Director of the Department of Maternal, Child and Adolescent Health at the World Health Organisation in Geneva. But he is perhaps best known for his work on improving survival among mothers and their newborn infants in poor populations of developing countries. He also founded an international charity, Women and Children First, which helped mobilise women’s groups across Africa and South Asia.

The sympathy group, following Robin Dunbar’s intriguing classification scheme, is the smallest functional social group outside the family - the approximately 15 people who share a common interest and solve challenges through facilitated conversation.

“Hunters and gatherers, farmers and faculty, the groups that gathered in coffee shops at the dawn of the industrial revolution - for almost all of human history (and prehistory), we have been drawn together in sympathy groups to accomplish what was needed,” said Dr Costello.

Working together in sympathy groups has been the basis of almost all human advancement, Dr Costello explained, and the secret of success in all areas of human endeavour: in warfare, whether the group behind 9/11 or the SEAL team that killed Osama Bin Laden; in science, e.g. the Lunar Society of the eighteenth century; and definitely in sport - like the teams that are currently contesting the FIFA World Cup.

“Groups bring people together - around a business goal, or in a workplace,” he noted. “As the saying goes, ‘Jaw-jaw is better than war-war’.”

Dr Costello has experienced the power of sympathy groups in the sphere of health firsthand.

For 20 years, he led large studies on the health effects of women groups in Asia and Africa. To his surprise, he found that functional sympathy groups cut down dramatically on maternal and newborn deaths - even in areas where health services were rudimentary.

“My biggest contribution - besides providing fantastic acronyms for complicated studies (like the Bangladesh D-Magic study) - has been to help catalyse a global network around quality of relational care, where all countries can be treated with the dignity and respect they deserve,” Dr Costello said.

Whether in the mountains of Nepal, the forests of India, or the villages of Malawi and Bangladesh, these groups of women, by themselves, built trust, and cooperated to solve their most difficult problems.

“The benefits established as the groups became rooted and proliferated led to astonishing health outcomes, way beyond anything we expected. And therein lay a lesson for the future.”

So how do we tackle 21st century problems with the power of sympathy groups?

With technology providing the means for individuals to accomplish much more online without an effective sympathy group, or to unite in groups much bigger and less cohesive in online fora and communities, we often forget the power of small groups.

“We are facing a pandemic of loneliness,” Dr Costello noted. “Studies show that while we can communicate with much more people at once, our closer relationships are ignored.”

This leads to problems that could be addressed in sympathy groups going unnoticed until it’s too late - psychosis, for example, where most symptoms could be identified in teenage years, but aren’t picked up.

Or antimicrobial resistance, a growing problem in the developing and developed world, and one that can be addressed by sympathy groups around WASH (water, sanitation and hygiene).

Then there’s corruption in health, and the challenge of climate change and sustainability, linked in many ways and perhaps the biggest challenges of the 21st century.

“Public health is a political issue,” Dr Costello noted, “and like any other part of politics, there’s corruption in health. What’s happening is that people are getting into bed with some very strange bedfellows - Big Alcohol, Big Food, Big Tobacco, Big Fuel… a lot of ‘Bigs’. To combat their harmful influence, something small might help - perhaps something like a sympathy group.”

Want to know more about the power of sympathy groups, and their growing importance in a changing world? Dr Anthony Costello’s new book, The Social Edge, will be published in September 2018. Visit to learn more - and to secure your copy!

Dr Costello’s own sympathy groups, incidentally, encompass a book circle, a soul band, and a cricket club, and his academic teams have stormed, normed and performed in many different cultures.