Social networks are typically seen as conduits for the spread of disease and disease risk factors. However, social relationships also reduce the incidence of chronic disease and potentially infectious diseases. Seldom are these opposing effects considered simultaneously. We have shown how and why diarrheal disease spreads more slowly to and in rural Ecuadorian villages that are more remote from the area’s population center. Reduced contact with outside individuals partially accounts for remote villages’ relatively lower prevalence of diarrheal disease. But equally or more important is the greater density of social ties between individuals in remote communities, which facilitates the spread of individual and collective practices that reduce the transmission of diarrheal disease.