Concepts of Health and Illness: Section 5. Social Support and Social Integration
Social science research has suggested that the relative quality of individual's and groups social relationships serve to act as psycho-social mediators in health outcomes. The quality of these relationships are seen to reflect the degree to which individuals possess or have access to a wide set of social networks & a shared set of social norms. Sociologists recognise these factors as being key characteristics of a cohesive society.
The findings from a large range of epidemiological studies have concluded that social and psychological stress is one of the major factors impacting upon an individual's ability to maintain their health (Wilkinson 1996; Marmot and Wilkinson:1999; Marmot and Wilkinson:2001). Sociological and social psychological research has concluded that whilst we all experience such stresses or 'life events', their effects are magnified for those individuals and social groups that have limited social support, a limited ability to control one's social situation / environment, poor social networks, and low levels of social integration.
Social Support
This construct focuses attention upon the importance of inter-personal relations. It encapsulates notions of emotional support, instrumental aid, information giving and personal appraisal. However, as a construct it can lack a certain amount of clarity.
Social psychologists see sources of social support as deriving from social networks. The importance of these networks lies in their function as a 'buffer' against the negative impact of stressful life events - helping people to adapt. The main source of social support in chronic illness, for example, comes from the family. Brown and Harris's (1978) classic research into clinical depression amongst working class women, recognised that differential availability of social support was a critical factor in a person's relative 'vulnerability' to stressful life events. They saw social support acting through what they termed intimacy, serving as a powerful mediator between the stressor (provoking agent) and the onset of illness (depression).
The lack of social support as negatively related to health is now recognised as a public health issue by the Department of Health. In developing its 'social exclusion' interventions, data such as that diagrammatically represented in figure 3 below (illustrating the relationship of lack of social support to mental disorder), is drawn upon in order to demonstrate the ways in which stresses associated with poverty such as social isolation and material deprivation are seen as pushing already vulnerable individuals into addictive behaviours and psychosis.
The concept of Social integration
Although the psychosocial concept of social support is clearly central to an understanding of the impact of social stresses upon health, it cannot account for the changes in social networks that have occurred in Western societies over the past century. For an explanation of these processes we have to look to sociological theory.
In his classical study of suicide written in 1899, Durkheim argued that an individual's integration into society is essential for their health and well-being. Modern societies are seen to be organised around individual differences (specialised division of labour) rather than upon their similarities. These societal developments were seen to encourage self-interest rather than `social solidarity'. Individuals learn to become less dependent on others and to recognise only their own private interests - the sociological concept of 'anomie'. In times of personal crisis, because we are less well integrated into social groups, we lack the social support required to cope with the stresses of modern life.
More recent sociological studies of mental health and illness have supported this original hypothesis. The family, religious practices, along with other `integrating institutions' such as work/employment, are recognised as binding individuals into wider social relationships and so offer a sense of belonging and meaning. This serves to protect individuals from the consequences of anomie by providing a sense of structure and social status. It follows that the events commonly associated with stresses within the family, unemployment (particularly among young men), etc, have a particularly important impact on health because they represent, " psycho-social transitions, and tend to reduce the ties that the individual experiencing them has with others ' (Stroebe andStroebe:1995).
Whilst levels of social integration and social support are related, the former is a characteristic of populations or institutions, whilst the latter is a property of individuals. The relationship between these two concepts as psycho-social mediators of social stress and its impact upon health is diagrammatically represented in Figure 4 below.
© I Crinson 2007
