Social Relationships and Health: A Flashpoint for Health Policy
Social Relationships and Health. Sheldon Cohen. Carnegie Mellon University. The author discusses 3 variables that assess different aspects of social. An essay from the Journal of Health and Social Behavior reviews evidence of the connection between social relationships and health. Science. Jul 29;() Social relationships and health. House JS(1), Landis KR, Umberson D. Author information: (1)Department of.
However, it is important to note that while good social relationships are protective of mental health, family and other relationships can at times be conflicted or even dangerous. For women, in particular, the potential for violence in partner relationships is a risk factor that must be recognised.
Rebuilding social relationships is essential to maintaining wellness and preventing relapse. Peer support and self-help groups are invaluable in this regard, because they provide a safe and non-judgemental place for social interaction Nikkel After an episode of mental illness, some people need to rebuild their basic social skills as their symptoms can interfere with these.
Self-help groups can provide a safe environment in which to do this. Support groups help in many diverse ways, but importantly they provide access to people with shared experiences, a sense of belonging, role models and inspiration see Pepper Throughout the consultations the importance of social relationships, derived from self-help groups, as well as from family and other sources, was repeatedly emphasised as essential for relapse prevention.
I don't know what I'd do without the support of the others in the group. When I get to the point where I feel like I can't cope, they come to the rescue in so many ways. Sometimes it's just a phone call, sometimes they bring over something to eat. Social scientists have studied several distinct features of social connection offered by relationships Smith and Christakis Social isolation refers to the relative absence of social relationships.
Social integration refers to overall level of involvement with informal social relationships, such as having a spouse, and with formal social relationships, such as those with religious institutions and volunteer organizations. Quality of relationships includes positive aspects of relationships, such as emotional support provided by significant others, and strained aspects of relationships, such as conflict and stress.
Social networks refer to the web of social relationships surrounding an individual, in particular, structural features, such as the type and strength of each social relationship. Each of these aspects of social relationships affects health. The most striking evidence comes from prospective studies of mortality across industrialized nations. These studies consistently show that individuals with the lowest level of involvement in social relationships are more likely to die than those with greater involvement House, Landis, and Umberson For example, Berkman and Syme showed that the risk of death among men and women with the fewest social ties was more than twice as high as the risk for adults with the most social ties.
Moreover, this finding held even when socioeconomic status, health behaviors, and other variables that might influence mortality, were taken into account. Social ties also reduce mortality risk among adults with documented medical conditions. For instance, Brummett and colleagues found that, among adults with coronary artery disease, the socially isolated had a risk of subsequent cardiac death 2.
In addition to mortality, involvement in social relationships has been associated with specific health conditions as well as biological markers indicating risk of preclinical conditions. Several recent review articles provide consistent and compelling evidence linking a low quantity or quality of social ties with a host of conditions, including development and progression of cardiovascular disease, recurrent myocardial infarction, atherosclerosis, autonomic dysregulation, high blood pressure, cancer and delayed cancer recovery, and slower wound healing Ertel, Glymour, and Berkman ; Everson-Rose and Lewis ; Robles and Kiecolt-Glaser ; Uchino Poor quality and low quantity of social ties have also been associated with inflammatory biomarkers and impaired immune function, factors associated with adverse health outcomes and mortality Kiecolt-Glaser et al.
Marriage is perhaps the most studied social tie. Recent work shows that marital history over the life course shapes a range of health outcomes, including cardiovascular disease, chronic conditions, mobility limitations, self-rated health, and depressive symptoms Hughes and Waite ; Zhang and Hayward Once the clear link between social relationships and health was established, scientists devoted themselves to explaining how this occurs.
Generally speaking, there are three broad ways that social ties work to influence health: Behavioral Explanations Health behaviors encompass a wide range of personal behaviors that influence health, morbidity, and mortality. In fact, health behavior explains about 40 percent of premature mortality as well as substantial morbidity and disability in the United States McGinnis, Williams-Russo, and Knickman Some of these health behaviors—such as exercise, consuming nutritionally balanced diets, and adherence to medical regimens—tend to promote health and prevent illness, while other behaviors—such as smoking, excessive weight gain, drug abuse, and heavy alcohol consumption—tend to undermine health.
Many studies provide evidence that social ties influence health behavior see a review in Umberson, Crosnoe, and Reczek Being married Waitehaving children Denneyand ties to religious organizations Musick, House, and Williams have all been linked to positive health behaviors although, notably, as we will discuss below, marriage and parenthood have also been associated with behaviors that are not beneficial to health—including physical inactivity and weight gain.
Religious ties also appear to influence health behavior, in part, through social control Ellison and Levin Social ties can instill a sense of responsibility and concern for others that then lead individuals to engage in behaviors that protect the health of others, as well as their own health.
Social ties provide information and create norms that further influence health habits. Thus, in a variety of ways, social ties may influence health habits that in turn affect physical health and mortality. Psychosocial Explanations Research across disciplines and populations suggests possible psychosocial mechanisms to explain how social ties promote health.
Social relationships and health.
Mechanisms include but are not limited to: While most studies focus on only one or two of these mechanisms, it is clear that connections between mechanisms are complex, and that these interconnections may explain the linkage between social ties and health better than any single mechanism Thoits ; Umberson et al.
Social support refers to the emotionally sustaining qualities of relationships e. Hundreds of studies establish that social support benefits mental and physical health Cohen ; Uchino Social support may have indirect effects on health through enhanced mental health, by reducing the impact of stress, or by fostering a sense of meaning and purpose in life Cohen ; Thoits Supportive social ties may trigger physiological sequelae e.
Social ties may enhance personal control perhaps through social supportand, in turn, personal control is advantageous for health habits, mental health, and physical health Mirowsky and Ross ; Thoits Many studies suggest that the symbolic meaning of particular social ties and health habits explains why they are linked. For example, meanings attached to marriage and relationships with children may foster a greater sense of responsibility to stay healthy, thus promoting healthier lifestyles Nock ; Waite Studies on adolescents often point to the meaning attached to peer groups e.
The meaning of specific health behaviors within social contexts may also vary. For example, Schnittker and McLeod argue that racial-ethnic identity may correspond with the meaning of certain health behaviors, such as consuming particular foods or avoiding alcohol, in ways that promote and sustain those behaviors. Mental health is a pivotal mechanism that works in concert with each of the other mechanisms to shape physical health Chapman, Perry, and Strine For instance, the emotional support provided by social ties enhances psychological well-being, which, in turn, may reduce the risk of unhealthy behaviors and poor physical health Kiecolt-Glaser et al.
Moreover, mental health is an important health outcome in and of itself. The World Health Organization identifies mental health as an essential dimension of overall health status World Health Organization However, the prevalence of mental disorders and their consequences for individuals and societies are often underappreciated by policy makers and private insurers.
Data from the National Comorbidity Survey Replication indicate that As the leading cause of disability in both low- and high-income countries, mental disorders account for over 37 percent of the total years of healthy life lost due to disability Mathers et al.
Physiological Explanations Psychologists, sociologists, and epidemiologists have contributed a great deal to our understanding of how social processes influence physiological processes that help to explain the link between social ties and health. For example, supportive interactions with others benefit immune, endocrine, and cardiovascular functions and reduce allostatic load, which reflects wear and tear on the body due, in part, to chronically overworked physiological systems engaged in stress responses McEwen ; Seeman et al.
These processes unfold over the entire life course, with effects on health. Emotionally supportive childhood environments promote healthy development of regulatory systems, including immune, metabolic, and autonomic nervous systems, as well as the hypothalamic-pituitary-adrenal HPA axis, with long-term consequences for adult health Taylor, Repetti, and Seeman Social support in adulthood reduces physiological responses such as cardiovascular reactivity to both anticipated and existing stressors Glynn, Christenfeld, and Gerin Indeed, continuously married adults experience a lower risk of cardiovascular disease compared with those who have experienced a marital loss, in part due to the psychosocial supports conferred by marriage Zhang and Hayward For example, marriage is the most salient source of both support and stress for many individuals Walen and Lachmanand poor marital quality has been associated with compromised immune and endocrine function and depression Kiecolt-Glaser and Newton Sociological research shows that marital strain erodes physical health, and that the negative effect of marital strain on health becomes greater with advancing age Umberson et al.Social Well Being - Importance Of Social Connections - Social Life - Social Interactions
Relationship stress undermines health through behavioral, psychosocial, and physiological pathways. For example, stress in relationships contributes to poor health habits in childhood, adolescence, and adulthood Kassel et al.
Stress contributes to psychological distress and physiological arousal e. The propensity to engage in particular risky health behaviors in response to stress appears to vary over the life course. For example, stress is associated with more alcohol consumption in young adulthood and greater weight gain in mid-life Umberson et al.
Relationship stress also undermines a sense of personal control and mental health, both of which are, in turn, associated with poorer physical health Mirowsky and Ross It may seem obvious that strained and conflicted social interactions undermine health, but social ties may have other types of unintended negative effects on health.
For example, relationships with risk-taking peers contribute to increased alcohol consumption, and having an obese spouse or friend increases personal obesity risk Christakis and Fowler ; Crosnoe et al.
One key mechanism is social norms. Perceived social norms about drinking behavior influence alcohol consumption among young adults Thombs, Wolcott, and Farkashand friendship norms about dieting influence unhealthy weight control Eisenberg et al.
Unsupportive social ties may also present barriers to improving health behaviors and outcomes. For example, Nagasawa and colleagues found that negative social environments and their perceived barriers predicted poor compliance to medical regimens among diabetes patients. For example, providing care to a sick or impaired spouse imposes strains that undermine the health of the provider, even to the point of elevating mortality risk for the provider Christakis and Allison Caring for a sick or impaired spouse is associated with increased physical and psychiatric morbidity, impaired immune function, poorer health behavior, and worse health for the provider Schulz and Sherwood Moreover, the recipient of care may be negatively affected by interpersonal interactions with stressed caregivers Bediako and Friend Middle-aged adults, particularly women, often experience exceptionally high caregiving demands as they contend with the challenge of simultaneously rearing children, caring for spouses, and looking after aging parents Spain and Bianchi The combination of smaller families to share in the care-giving of aging parents and an aging population mean that the multigenerational demands of social ties may become more pronounced in the future.
Throughout life, we are exposed to social conditions that promote or undermine health, and over time these exposures accumulate to create growing advantage or disadvantage for health in socially patterned ways.
The principal explanatory mechanisms may also vary over the life course. Some effects of social ties are more immediate, while others slowly build over time. For example, at any given point in time, ongoing social ties affect mental health and health behavior—for better or for worse.
Social relationships and health.
These effects may or may not dissipate over time, but recent work on the effects of distressed, disrupted, and emotionally unsupportive childhood environments on adult health shows that these effects reverberate throughout the life course Crosnoe and Elder ; Palloni ; Shaw et al. Certainly, chronic isolation or strain in social ties take an increasing toll over time on a host of health indicators including allostatic load Seeman et al.
Regarding size, women tend to have larger confidant networks than men, as do whites compared with blacks, better-educated adults compared with less-educated, and, to a lesser extent, younger adults McPherson, Smith-Lovin, and Brashears Moreover, the diversity of social ties varies in patterned ways with, for example, better-educated adults engaged in more diverse personal networks McPherson et al. Sociodemographic variation in quantitative aspects of social ties may partly explain parallel variation in health disparities because both size Brummett et al.
People with a greater number of ties have a larger pool of confidants from which to connect and to receive social support and health-relevant information. In general, we know little about how the benefits and costs of social ties vary across sociodemographic groups, but some evidence suggests that there is variation. Most attention has been devoted to gender differences, particularly in the context of marriage.
- WHAT DO WE MEAN BY “SOCIAL RELATIONSHIPS”?
Historically, marriage has conferred more health gains for men than for women. The availability, costs, and benefits of social ties may also vary by race. For instance, blacks are less likely to be married than whites.
Yet evidence regarding costs and benefits is mixed. African Americans may experience more marital strain Broman ; Umberson et al. Kiecolt, Hughes, and Keith and receive fewer economic gains from marriage compared to whites Willsonyet some studies find African Americans have historically received more health benefits from marriage than whites Kiecolt et al.
Disparities in the quantity and quality of social ties exist across socioeconomic statuses as well. More educated adults have a larger number of close confidants and may experience less stress in their relationships.
Notably, differential access, benefits, and costs to social ties across sociodemographic groups are not immutable; recent work shows that these differentials have changed significantly over time Liu and Umberson ; McPherson et al. Thus, a policy focus on social ties may prove to be a cost-effective strategy for enhancing health and well-being at the population level McGinnis et al.
Social ties may be unique in their ability to affect a wide range of health outcomes and to influence health thus cumulative health outcomes throughout the entire life course. For example, reducing strain and improving health habits of a married person may benefit the health of both partners, as well any children they care for. For example, obesity increases substantially for those who have an obese spouse or friends Christakis and Fowlerand happiness appears to spread through social networks as well Fowler and Christakis Thus, policies and interventions should capitalize on this natural tendency for health-related attitudes and behaviors to spread through social networks by incorporating these amplification effects into the mechanics of interventions and their cost-benefit estimates Smith and Christakis While social ties may serve to improve health outcomes for those who develop serious health conditions, social ties may help prevent these conditions from developing in the first place.
Policies that promote and protect social ties should have both short-term and long-term payoffs. If social ties foster psychological well-being and better health habits throughout the life course, then social ties can add to cumulative advantage in health over time—a worthwhile goal for an aging population. Better health means reduced health care costs as well as better quality of life for Americans, regardless of their age.
Indeed, some existing social policies and programs implicitly and indirectly incorporate social ties as mechanisms for enhancing population health and well-being. For example, many programs concerned with health of the elderly e. Healthy Peoplea nationwide health promotion plan developed by the Department of Health and Human Services, recognizes that social ties play an important role in influencing health habits U.
Department of Health and Human Services The Healthy Marriage Initiative recognizes that marriages characterized by supportive interactions benefit the health of children as well as spouses U. Department of Health and Human Services n. The Family Medical Leave Act FMLA allows eligible employees to take up to 12 weeks of unpaid, protected leave over a month period to attend to certain medical and family-related needs, such as the birth of a child or caring for an immediate family member U.
Department of Labor Yet in some cases these policies and programs do not benefit the populations that need them the most, or they unintentionally undermine the health of the target population and others in their social network.
For example, FMLA may benefit those who receive care, but it also may be financially prohibitive for caregivers who do not have an employed spouse or enough savings to support them through the time off work, yet those with the fewest financial resources and social ties may need assistance the most.
Further, in rare cases, experimental programs have reported worse health outcomes among subgroups of participants. A randomized experiment of the effects of support groups for women with breast cancer found that, compared to women in the control group, the physical functioning of women who participated in the peer discussion group improved if they reported low levels of emotional support from their partners at baseline, but it deteriorated if they reported initially high levels Helgeson et al.
Another psychosocial intervention tested individualized emotional and instrumental support services in an effort to improve one-year survival outcomes of adults recovering from myocardial infarction. This study found that, compared to a control group, men in the intervention group exhibited similar mortality rates while women exhibited higher mortality rates during the one-year follow-up Frasure-Smith et al.
Thus, we must develop a policy foundation that integrates scientific evidence on the linkages between social ties and health, and that foundation must do two things: Solid scientific evidence establishing the causal impact of social ties on health provides the impetus for policy makers to ensure that U. Scientific evidence supports the following premises, and it is from this empirical footing that we can build a policy foundation for promoting both social ties and health: Although social ties have the potential to benefit health, policy efforts must recognize that social ties also have the potential to undermine health, and that the link between social ties and health may vary across social groups.
For example, gender, race, and age are associated with different levels and types of responsibilities, strains, and resources in social ties that then influence personal health habits as well as the health of significant others. In order to be effective, policies and interventions must account for the ways in which social constraints and resources influence health across social groups House et al.
Moreover, care must be taken to develop strategies that increase the power of social ties to enhance individual health without imposing additional strains on care providers. Thus, we suggest two additional policy components for the basic foundation suggested above: They can begin by addressing six fundamental goals.
Promote Benefits of Social Ties Support and promote positive features of social ties e. This initiative uses a multifaceted approach, including public awareness campaigns on responsible parenting and the value of healthy marriages, as well as educational and counseling services delivered through local organizations such as schools and faith-based organizations.
This goal should also speak to policies that deny marriage to same-sex couples. The absence of legal marriage may reduce the benefits of committed partnerships for the health of individuals in gay and lesbian relationships Herek ; King and Bartlett ; Wienke and Hill Do No Harm Avoid policies, programs, and interventions that increase relationship burdens and strains or that undermine positive features of relationships.
For example, many programs for the sick and elderly increase caregiving responsibilities for family members—responsibilities that may impose stress on caregivers and on family relationships. This problem is exacerbated by hospital and insurance policies that force family members to provide medical care at home. These costs are borne more heavily by women, minorities, and those with fewer socioeconomic resources.
Policy efforts should recognize that specific programs may benefit some groups but harm others.