About This Literature Summary
This summary of the literature on Social Cohesion as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note: The terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the Civic Participation literature summary.
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Literature Summary
Relationships are important for physical health and psychosocial well-being.1,2,3,4,5 Relationships are conceptualized through terms such as social cohesion, social capital, social networks, and social support. Social cohesion refers to the strength of relationships and the sense of solidarity among members of a community.6 One indicator of social cohesion is the amount of social capital a community has. Social capital deals with shared group resources,6,7,8 like a friend-of-a-friend’s knowledge of a job opening.9 Individuals have access to social capital through their social networks,8 which are webs of social relationships.10,11 Social networks are sources of multiple forms of social support, such as emotional support (e.g., encouragement after a setback) and instrumental support (e.g., a ride to a doctor’s appointment).10,11 This summary will review the positive and negative health effects social cohesion has on an individual’s life.
Social capital is an important marker of social cohesion, and it has significant ramifications for health. For example, one study examined the link between 4 measures of social capital (perceived fairness, perceived helpfulness, group membership, and trust), income inequality, and mortality.12 The authors found that all 4 measures of social capital were associated with mortality. They also found that the relationship between income inequality and mortality may be partially explained by reductions in social capital as income inequality increases.12,13
Collective efficacy, an aspect of social capital and social cohesion, is grounded on mutual trust and describes a community’s ability to create change and exercise informal social control (i.e., influence behavior through social norms).14 Collective efficacy is associated with better self-rated health,15 lower rates of neighborhood violence,14 and better access to health-enhancing resources like medical care, healthy food options, and places to exercise.16 Social institutions like religion and the family are common sources of social capital and social control, as well as social networks and social support.7,17,18
Social networks spread social capital,8 but they can also spread health behaviors and outcomes, a phenomenon known as “social contagion.”19 For example, if an individual’s friend, sibling, or spouse is obese, the individual’s likelihood of also becoming obese increases.20 Similar patterns are seen for smoking21 and drinking22 behaviors.
High levels of social support can positively influence health outcomes through behavioral and psychological pathways.11,23 For example, social support may help people stick to healthier diets23 and reduce emotional stress.1 Both of these pathways can affect biological functioning in the cardiovascular, neuroendocrine, and immune systems.11,23 Social support can therefore both directly benefit people and indirectly buffer them from risk factors that might otherwise damage health.24 In a study conducted on the relationship between psychosocial factors and atherosclerosis (plaque in the arteries), social support contributed to lower atherosclerosis levels.25 The protective nature of social support may be especially important for populations that experience discrimination or exclusion. One study of first-generation immigrants found that social support acted as a barrier against the harmful physical and mental health effects of discrimination.26
While social ties sometimes transmit negative health behaviors or add stress,5,27 social isolation is usually detrimental to health and increases mortality.4,28 Social isolation is a special concern for older adults, as contact with friends decreases with age.29 Social isolation and loneliness as a result of the COVID-19 pandemic are likely to become major risk factors impacting health outcomes of older adults.30 Another study found that younger adults in their 20s reported more social isolation than did those individuals aged 50 and older during physical distancing.31 Older individuals in long-term care facilities or with conditions that interfere with daily activities, like arthritis, may suffer from loneliness and a lack of social cohesion,32,33 which may negatively impact health. For example, one study conducted among older adults found an association between reduced neighborhood social cohesion and a heightened likelihood of insomnia, which can have negative health effects.34 Similarly, during natural disasters like heat waves, elderly individuals living in neighborhoods with low social cohesion may lack social support from concerned neighbors who will check on them, and they have fewer safe communal areas where they can seek refuge.35
Given the complex nature of the association between social ties and health,1,11 social interventions designed to improve health vary significantly. These interventions can occur at multiple levels (e.g., family, group, neighborhood) and sometimes require cross-sector collaboration (e.g., education, public health, housing) to foster community building and improve health.36,37,38,39 Further research is needed to better understand how social cohesion affects health, as well as how it can be used to reduce health disparities. This evidence will facilitate public health efforts to address social cohesion as a social determinant of health.
Citations
Thoits, P. A. (2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52(2), 145–161.
Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. American journal of Epidemiology, 109(2), 186–204.
Keyes, C. L., & Michalec, B. (2010). Viewing mental health from the complete state paradigm. In T. L. Sheid & T. Brown (Eds.), A handbook for the study of mental health: Social contexts, theories, and systems (2nd ed., pp. 125–134). Cambridge University Press.
Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS medicine, 7(7), e1000316.
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Granovetter, M. S. (1982). The strength of weak ties: A network theory revisited. In P. V. Marsden & N. Lin (Eds.), Social structure and network analysis (pp. 105–130). Sage.
Berkman, L. F., Glass, T., Brissette, I., & Seeman, T. E. (2000). From social integration to health: Durkheim in the new millennium. Social Science & Medicine, 51(6), 843–857.
Berkman, L. F., & Glass, T. (2000). Social integration, social networks, social support, and health. Social Epidemiology, 1(6), 137–173.
Kawachi, I., Kennedy, B. P., Lochner, K., & Prothrow-Stith, D. (1997). Social capital, income inequality, and mortality. American Journal of Public Health, 87(9), 1491–1498.
Gilbert, K. L., Quinn, S. C., Goodman, R. M., Butler, J., & Wallace, J. (2013). A meta-analysis of social capital and health: A case for needed research. Journal of Health Psychology, 18(11), 1385–1399.
Sampson, R. J., Raudenbush, S. W., & Earls, F. (1997). Neighborhoods and violent crime: A multilevel study of collective efficacy. Science, 277(5328), 918–924.
Browning, C. R., & Cagney, K. A. (2002). Neighborhood structural disadvantage, collective efficacy, and self-rated physical health in an urban setting. Journal of Health and Social Behavior, 383–399.
Matsaganis, M. D., & Wilkin, H. A. (2015). Communicative social capital and collective efficacy as determinants of access to health-enhancing resources in residential communities. Journal of Health Communication, 20(4), 377–386.
Idler, E. L. (Ed.). (2014). Religion as a social determinant of public health. Oxford University Press.
Maselko, J., Hughes, C., & Cheney, R. (2011). Religious social capital: Its measurement and utility in the study of the social determinants of health. Social Science & Medicine, 73(5), 759–767.
Christakis, N. A., & Fowler, J. H. (2013). Social contagion theory: Examining dynamic social networks and human behavior. Statistics in Medicine, 32(4), 556–577.
Christakis, N. A., & Fowler, J. H. (2007). The spread of obesity in a large social network over 32 years. New England Journal of Medicine, 357(4), 370–379.
Christakis, N. A., & Fowler, J. H. (2008). Quitting in droves: Collective dynamics of smoking behavior in a large social network. The New England Journal of Medicine, 358(21), 2249–2258.
Rosenquist, J. N., Murabito, J., Fowler, J. H., & Christakis, N. A. (2010). The spread of alcohol consumption behavior in a large social network. Annals of Internal Medicine, 152(7), 426–433.
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Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310.
Shah, A. S., Alonso, A., Whitsel, E. A., Soliman, E. Z., Vaccarino, V., & Shah, A. J. (2021). Association of psychosocial factors with short‐term resting heart rate variability: The atherosclerosis risk in communities study. Journal of the American Heart Association, 10(5), e017172.
Szaflarski, M., & Bauldry, S. (2019). The effects of perceived discrimination on immigrant and refugee physical and mental health. In R. Frank (Ed.), Immigration and health (pp. 173–204). Emerald Publishing Limited.
Marsden, P. (1998). Memetics and social contagion: Two sides of the same coin. Journal of Memetics-Evolutionary Models of Information Transmission, 2(2), 171–185.
Berkman, L. F. (1995). The role of social relations in health promotion. Psychosomatic Medicine, 57(3), 245–254.
Van Tilburg, T. (1998). Losing and gaining in old age: Changes in personal network size and social support in a four-year longitudinal study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 53(6), S313–S323.
Wu, B. (2020). Social isolation and loneliness among older adults in the context of COVID-19: A global challenge. Global Health Research and Policy, 5(1), 1–3.
Clair, R., Gordon, M., Kroon, M., & Reilly, C. (2021). The effects of social isolation on well-being and life satisfaction during pandemic. Humanities and Social Sciences Communications, 8(1), 1–6.
Cooney, A., Dowling, M., Gannon, M. E., Dempsey, L., & Murphy, K. (2014). Exploration of the meaning of connectedness for older people in long‐term care in context of their quality of life: A review and commentary. International Journal of Older People Nursing, 9(3), 192–199.
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