Social Relationships and Health: A Flashpoint for Health Policy

Abstract

Social relationships—both quantity and quality—affect genial health, health behavior, physical health, and deathrate risk. Sociologists have played a central function in establishing the radio link between social relationships and health outcomes, identifying explanations for this associate, and discovering social variation ( for example, by gender and race ) at the population level. Studies show that social relationships have short- and long-run effects on health, for better and for worse, and that these effects emerge in childhood and shower throughout life to foster accumulative advantage or disadvantage in health. This article describes key research themes in the study of sociable relationships and health, and it highlights policy implications suggested by this inquiry. Keywords:

relationships, social support, social integration, stress, cumulative disadvantage

Captors use social isolation to torture prisoners of war—to drastic effect. Social isolation of otherwise healthy, well-functioning individuals finally results in psychological and physical decomposition, and even end. Over the past few decades, sociable scientists have gone beyond evidence of extreme social loss to demonstrate a clear connect between sociable relationships and health in the general population. Adults who are more socially connected are healthier and bouncy longer than their more isolated peers. This article describes major findings in the study of social relationships and health, and how that cognition might be translated into policy that promotes population health. Key research findings include : ( 1 ) social relationships have meaning effects on health ; ( 2 ) social relationships affect health through behavioral, psychosocial, and physiologic pathways ; ( 3 ) relationships have costs and benefits for health ; ( 4 ) relationships shape health outcomes throughout the life course and have a accumulative impact on health over time ; and ( 5 ) the costs and benefits of social relationships are not distributed evenly in the population .

WHAT DO WE MEAN BY “SOCIAL RELATIONSHIPS”?

social scientists have studied respective distinct features of social connection offered by relationships ( Smith and Christakis 2008 ). social isolation refers to the proportional absence of social relationships. Social integration refers to overall horizontal surface of affair with informal social relationships, such as having a spouse, and with formal social relationships, such as those with religious institutions and unpaid organizations. quality of relationships includes positive aspects of relationships, such as emotional confirm provided by meaning others, and strained aspects of relationships, such as conflict and try. Social networks refer to the web of social relationships surrounding an person, in finical, structural features, such as the type and strength of each social relationship. Each of these aspects of social relationships affects health. We discuss the broad effects of these features of relationships for health, and, for still of discussion, we use the terms “ social relationships ” and “ social ties ” interchangeably throughout this article .

CUMULATIVE ADVANTAGE AND DISADVANTAGE

All Americans are not at equal risk for bad health behaviors, morbidity, and previous deathrate. Throughout animation, we are exposed to social conditions that promote or sabotage health, and over time these exposures accumulate to create growing advantage or disadvantage for health in socially patterned ways. thus, social pas seul in relationships/health processes provides information that may be used to address social disparities in health. The most salient social ties for health vary over the life course, with parents having the greatest determine on children ’ randomness health, peers becoming peculiarly authoritative in adolescence, intimate partners becoming most crucial in adulthood, and adult children taking an promote function in late life ( Umberson et aluminum. 2010 ). The star explanatory mechanisms may besides vary over the life course. For exercise, nerve-racking family interactions may have their greatest impact on children ’ sulfur health, while peer imperativeness and the social mean of health habits ( for example, pressure to experiment with tobacco, alcohol, and drugs ) may have their greatest shock in adolescent relationships, and social control of health habits may be most crucial in adult relationships. Some effects of social ties are more immediate, while others slowly build over time. For exemplar, at any given point in time, ongoing social ties affect genial health and health behavior—for better or for worse. These effects may or may not dissipate over time, but holocene exploit on the effects of dysphoric, disrupted, and emotionally unsupportive childhood environments on adult health shows that these effects reverberate throughout the life course ( Crosnoe and Elder 2004 ; Palloni 2006 ; Shaw et alabama. 2004 ). surely, chronic isolation or sift in social ties take an increasing price over meter on a host of health indicators including allostatic load ( Seeman et aluminum. 2002 ), blood blackmail ( Cacioppo et alabama. 2002 ), physical health ( Umberson et aluminum. 2006 ), and deathrate risk ( Berkman and Syme 1979 ) .

SOCIAL TIES: AN INVESTMENT IN POPULATION HEALTH

inquiry shows that social ties influence multiple and interconnected health outcomes, including health behaviors, mental health, forcible health, and deathrate risk. therefore, a policy focus on sociable ties may prove to be a cost-efficient scheme for enhancing health and wellbeing at the population horizontal surface ( McGinnis et aluminum. 2002 ; Mechanic and Tanner 2007 ). Social ties may be singular in their ability to affect a across-the-board range of health outcomes and to influence health ( thus accumulative health outcomes ) throughout the entire life sentence run. furthermore, interventions and policies that strengthen and corroborate individuals ’ social ties have the electric potential to enhance the health of others connected to those individuals. For exercise, reducing striving and improving health habits of a marry person may benefit the health of both partners, angstrom well any children they care for. late cultivate besides shows that some health outcomes can “ spread ” widely through social networks. For exercise, fleshiness increases well for those who have an corpulent spouse or friends ( Christakis and Fowler 2007 ), and happiness appears to spread through social networks deoxyadenosine monophosphate well ( Fowler and Christakis 2008 ). These findings suggest that the impact of social ties on one person ’ s health goes beyond that person to influence the health of broader social networks. Thus, policies and interventions should capitalize on this natural tendency for health-related attitudes and behaviors to spread through sociable networks by incorporating these amplification effects into the mechanics of interventions and their cost-benefit estimates ( Smith and Christakis 2008 ). last, enhanced relationship/health linkages can be viewed as hindrance music. 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-run and long-run payoffs. If social ties foster psychological wellbeing and better health habits throughout the life run, then social ties can add to accumulative advantage in health over time—a worthwhile finish for an aging population. Better health means reduced health care costs american samoa well as better quality of biography for Americans, careless of their long time .

PUBLIC POLICY: SOCIAL TIES AND HEALTH OF THE POPULATION

Social ties and their connection to health have authoritative implications for health policy. indeed, some existing social policies and programs implicitly and indirectly incorporate social ties as mechanisms for enhancing population health and wellbeing. For exemplar, many programs concerned with health of the aged ( for example, base health services and meal deliveries ) direct care to the affect of sociable isolation/connection on health. healthy people 2010, a nationally 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.S. Department of Health and Human Services 2000 ). The healthy Marriage Initiative recognizes that marriages characterized by supportive interactions benefit the health of children vitamin a good as spouses ( U.S. Department of Health and Human Services n.d. ). The Family Medical Leave Act ( FMLA ) allows eligible employees to take up to 12 weeks of unpaid, protect leave over a 12-month time period to attend to certain medical and family-related needs, such as the parentage of a child or caring for an immediate class penis ( U.S. Department of Labor 2009 ). so far 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 net. For exemplar, FMLA may benefit those who receive care, but it besides may be financially prohibitive for caregivers who do not have an employed spouse or enough savings to support them through the time off work, so far those with the fewest fiscal resources and sociable ties may need assistance the most. farther, in rare cases, experimental programs have reported worse health outcomes among subgroups of participants. A randomize experiment of the effects of accompaniment groups for women with summit cancer found that, compared to women in the control group, the physical serve of women who participated in the peer discussion group improved if they reported low levels of emotional defend from their partners at service line, but it deteriorated if they reported initially high gear levels ( Helgeson et aluminum. 2000 ). Another psychosocial interposition tested personalize emotional and implemental support services in an campaign to improve annual survival outcomes of adults recovering from myocardial infarct. This study found that, compared to a control group, men in the treatment group exhibited similar mortality rates while women exhibited higher deathrate rates during the annual follow-up ( Frasure-Smith et aluminum. 1997 ). frankincense, we must develop a policy foundation that integrates scientific evidence on the linkages between sociable ties and health, and that foundation must do two things : ( 1 ) ensure that policies and programs benefit the populations that need them ; and ( 2 ) maximize health-related benefits for recipients while minimizing costs for providers and recipients .

POLICY FOUNDATION

Poor mental and physical health and unhealthy behaviors exact a huge toll on individuals, families, and society. Solid scientific tell establishing the causal impact of social ties on health provides the drift for policy makers to ensure that U.S. health policy works to protect and promote social ties that benefit health. Scientific evidence supports the follow premises, and it is from this empirical foothold that we can build a policy basis for promoting both social ties and health :

• 1 Social ties affect mental health, physical health, health behaviors, and mortality gamble .
• 2 Social ties are a likely resource that can be harnessed to promote population health .
• 3 Social ties are a resource that should be protected a well as promoted .
• 4 social ties can benefit health beyond target individuals by influencing the health of others throughout social networks .
• 5 Social ties have both immediate ( mental health, health behaviors ) and long-run, accumulative effects on health ( for example, physical health, mortality ), and frankincense represent opportunities for short- and long-run investment in population health .

Although social ties have the potential to benefit health, policy efforts must recognize that social ties besides have the likely to undermine health, and that the link between social ties and health may vary across social groups. For exercise, gender, race, and historic period are associated with different levels and types of responsibilities, strains, and resources in sociable ties that then influence personal health habits adenine 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 alabama. 2008 ). furthermore, care must be taken to develop strategies that increase the world power of sociable ties to enhance individual health without imposing extra strains on concern providers. frankincense, we suggest two extra policy components for the basic foundation garment suggested above :

• 6 caution : social ties—overburdened, strained, conflicted, abusive—can cave health .
• 7 The costs and benefits of social ties are not distributed equally in the population ( e.g., long time, socioeconomic status, gender, raceway variation ) .

POLICY GOALS

How can policy makers use the scientific findings on social ties and health to advance population health and reduce social disparities in health ? They can begin by addressing six cardinal goals .

Promote Benefits of Social Ties

patronize and promote plus features of sociable ties ( for example, supportive interactions, healthy life style norms ). For example, Health and Human Service ’ s Healthy Marriage Initiative is designed to promote plus marital interactions that may foster mental and forcible health of couples and their children. This enterprise uses a many-sided access, including public awareness campaigns on responsible rear and the value of healthy marriages, equally well as educational and counseling services delivered through local organizations such as schools and faith-based organizations. This goal should besides speak to policies that deny marriage to same-sex couples. The absence of legal marriage may reduce the benefits of attached partnerships for the health of individuals in gay and lesbian relationships ( Herek 2006 ; King and Bartlett 2006 ; Wienke and Hill 2009 ) .

Do No Harm

Avoid policies, programs, and interventions that increase relationship burdens and strains or that sabotage plus features of relationships. For model, many programs for the pale and aged increase caregiving responsibilities for family members—responsibilities that may impose stress on caregivers and on family relationships. This trouble is exacerbated by hospital and insurance policies that force syndicate members to provide checkup worry at base. These costs are give birth more heavily by women, minorities, and those with fewer socioeconomic resources. policy efforts should recognize that specific programs may benefit some groups but damage others .

Reduce Social Isolation

This addresses one of the most fundamental findings from research on sociable ties and health : The most socially detached Americans are those at greatest risk of poor health and early mortality ( Brummett et aluminum. 2001 ). Policies can reduce the risk of social isolation in the first place by enhancing our educational system to impart social-emotional skills, interests in civil date, and meaningful employment ( Greenberg et aluminum. 2003 ) ; by ensuring that all communities are economically develop and contain populace places to safely congregate and exercise ( Mechanic and Tanner 2007 ) ; and by fostering stable marriages and families for all Americans. notably, some groups are more likely than others to experience social isolation. For exercise, widowhood increases the risk of social isolation. Women are more probable than men to be widowed, and widowhood affects a higher proportion of african Americans than other races, and at earlier ages ; among those aged 65 to 74, 24.3 percentage of african Americans are widowed compared to 14.8 percentage of whites ( U.S. Census 2009 ). Coordinated programs could help identify socially isolate adults, possibly through their physicians, and they could mobilize local resources to offer social and implemental support to these individuals .

Reduce Harm

prevent and alleviate negative features of social ties. For example, work to reduce strains for those who provide care to children, nauseated or mar significant others, and the aged, remaining aware of unintended effects on caregivers. In addition, prevent or alleviate damage caused by negative social ties, such as abusive parent-child relationships and strained marriages .

Coordinate Policies and Programs

many existing policies and programs, at least implicitly, address some aspect of social ties in relation to health. These existing strategies can be mapped onto a general strategy of promoting positive relationship/health linkages. This will make gaps and overlaps between strategies more apparent, and it will allow greater coordination of services for helping professionals and for citizens seeking services .

Provide Help Where Help Is Most Needed

Some populations are at greater risk for illness and disease than others, and these groups should receive higher precedence in policy efforts. In particular, some populations are more likely to be socially isolated ( for example, the inadequate and the aged ), and some are more probably to be burdened by caring for others in their sociable networks ( for example, women, specially african American women ). Existing policies should besides be re-evaluated to ensure that they help the populations that need them most. For example, the FMLA may be wholly unhelpful for low-income adults who have no alternative source of income and are more likely to be without alternate sources of instrumental and emotional support .

FUTURE RESEARCH

social scientists can advance this policy agenda by addressing several specific issues. First, it is crucial to identify individuals most at gamble, equally well as explanations for heightened risk. Individuals who are socially isolate may be at the greatest health risk. several studies suggest that the relationship between social ties and health is nonlinear so that individuals with no social ties or very few social ties exhibit the most pronounce risk of poor health ( Brummett et alabama. 2001 ; Cohen et alabama. 1997 ; Seeman et aluminum. 2002 ). Despite the considerable testify linking sociable isolation to poor health outcomes, the causal mechanisms are ailing understand. We need to investigate the possibility that differences between socially isolated and socially integrated adults—in health behaviors, emotional and implemental support networks, physiological responses to anxiety, or other mechanisms—explain the linkage. Sociologists should direct attention to the social distribution of isolation and the hypothesis that the consequences of social isolation deviate across social groups. irregular, the broader social context—as structured by age, class, subspecies, and gender—influences the constitution and quality of social ties vitamin a well as the processes through which sociable ties affect health. however, the ways in which these structural variables shape social ties are not well silent, and few studies consider how these structural variables might modify relationship/health linkages. Likewise, social ties may shape the way that geomorphologic variables influence health. For case, marital condition may alter the inverse association between educational attainment and mortality risks, at least for men ( Montez et alabama. 2009 ). This type of research is needed in order to identify at-risk populations american samoa well as explanatory mechanisms linking social ties to health outcomes across social groups. Third, past work on social ties and health habits tends to emphasize the benefits of social ties for health, even inquiry on stress clearly shows that strained social ties cave health. Given the ability of social ties to have both positive and negative effects on health, existing research has probable underestimated the true affect of sociable ties on health. Future research should consider how the incontrovertible and negative facets of social ties work together to influence health result, arsenic well as consider how this balance may vary over the liveliness course and across social groups. A growing body of theoretical and empiric work illustrates how social conditions foster accumulative advantage and disadvantage for health over the life class. This may be a subject of the rich getting deep while the poor get poor, in that strained and unsupportive relationships in childhood establish into gesture a cascade of factors—such as increased risk for natural depression, abject personal control, and poor health habits—that lead to poorer health and more strained and less supportive relationships across the animation class. Scholars should consider this cascade procedure, and they should identify at-risk populations angstrom well as the most important modifiable risk and protective factors in their sociable relationships. Scholars should besides help to clarify when social ties impact health habits, angstrom well as identify which social ties are most important to health at different life stages. In accession, future inquiry will benefit from methodological considerations, including a greater focus on prospective survey designs and corresponding longitudinal analyses, dyadic information about social relationships, and qualitative data. prospective designs are necessity in rate to consider how relationship/health linkages and explanatory mechanisms unfold over fourth dimension. This approach path fits with the biography course impression that determinants of stream health originate early in life and accumulate across the life span ( Ben-Shlomo and Kuh 2002 ). Taking full advantage of prospective surveys through longitudinal data analysis and wider application of multilevel model could shed more lightly on the social processes involved in build up, sustain, and benefiting from social ties across the life sentence course. Most studies on social ties and health use individual-level data, as surveys typically collect information from one penis per family. however, social ties, by definition, involve more than one person. Studies that include dyads show that individuals in the same relationship much experience and report on their kinship in quite different ways ( Proulx and Helms 2008 ). independent reports, angstrom well as discrepancies between reports, may be linked to health outcomes. We should take advantage of existing longitudinal data sets that include more than one focal individual. New data collection efforts should go beyond the person to include data from a crop of linked social ties. As late cultivate shows, including reports from respective network members may reveal crucial relationship/health linkages that go beyond one individual ( Smith and Christakis 2008 ). last, most research on social ties and health has relied on assessment of quantitative data sources. quantitative data are essential for identifying patterns between variables in the general population and, particularly, for revealing how sociable location ( for example, as defined by liveliness course stage, race, and gender ) is associated with regularity in social experiences ( for example, relationships and health ). however, population-level data are limited in their ability to reveal rich social context that allow us to analyze the meanings, dynamics, and processes that link social ties to health over time. frankincense, blending qualitative and quantitative methods provides the opportunity to build on the strengths of both methodologies and to address how structure and meaning blend to shape health outcomes at the population level ( Pearlin 1992 ). information obtained from qualitative data may besides suggest new explanations ( e.g., newfangled psychosocial mechanism or connections between mechanisms ) for relationship/health linkages, and for group differences in those linkages, and those explanations can be far explored using population-level data .

CONCLUSION

solid scientific testify shows that social relationships affect a range of health outcomes, including mental health, forcible health, health habits, and deathrate risk. Sociologists have played a major function in establishing these linkages, in identifying explanations for the impact of social relationships on health, and in discovering social pas seul ( for example, by senesce and sex ) in these linkages at the population degree. The unique position and research methods of sociology provide a scientific platform to suggest how policy makers might improve population health by promoting and protecting Americans ’ social relationships. late and projected demographic trends should instill a feel of urgency in developing policy solutions. specifically, the concourse of smaller families, high disassociate rates, employment-related geographic mobility, and population aging means that adults of all ages, and in especial the aged, will be at increasing risk of social isolation and shrinking family ties in the future ( Cacioppo and Hawkley 2003 ) .

Acknowledgments

An earlier version of this article was presented at the 2009 annual meet of the American Sociological Association. This research was supported by National Institute on Aging grant RO1AG026613 ( PI : Debra Umberson ), National Institute of Child Health and Human Development award 5 R24 HD042849 ( PI : Mark D. Hayward ) and 2 T32 HD007081 ( PI : Robert A. Hummer ) awarded to the Population Research Center at the University of Texas at Austin .

Biographies

•

Debra Umberson is professor of sociology and a faculty associate in the Population Research Center at the University of Texas at Austin. Her research focuses on relationships and health across the life path. Her current research, supported by the National Institute on Aging, considers how different types of relationships influence health behaviors over the life course. • Jennifer Karas Montez is a doctoral candidate in the Department of Sociology and Population Research Center at the University of Texas at Austin. Her research concerns socioeconomic and sex disparities in health and deathrate in later life sentence, and examines how sociable, behavioral, and biological mechanisms interact across the integral life course to produce those disparities .