Social Health – Another Piece of the Health Puzzle

“Social relationships, or the relative lack thereof, constitute a major risk factor for health—rivalling the effect of well-established health risk factors such as cigarette smoking, blood pressure, blood lipids, obesity and physical activity”

—House, Landis, and Umberson; Science 1988

In the last half-century, we have come leaps and bounds with technology. So much so, that we’re now able to connect virtually with anyone across the globe right this second – granted they have a stable internet connection. With around 4.5 billion internet users and 3.8 billion people on social media (We Are Social, 2020), we can make friends, find work and even find love at the click of a button (or a cheeky swipe right).

While we can certainly make more connections in today’s day and age, there is much more to healthy social relationships than the number of followers you have or the number of people sliding into your DM’s. 

The role of social relationships in one’s health is such a fascinating area of research. But, similar to mental health, it hasn’t really garnered the attention of many when it comes to considering one’s overall wellbeing. Social health can be analogous to Michelle Williams of popular girl group Destiny’s Child, they’re part of the band, but no one really takes much notice. This article will therefore take a brief dive into social health, highlighting how it relates to both our physical and mental wellbeing.

So, how do our social ties influence something as complex as health?

There are two main models that look into how social factors interact with health and well-being (Holt-lunstad et al 2010): 

1. Stress buffering model: this hypothesis suggests that the social relationships we hold actually provide us with resources that allow us to cope better with acute or chronic stressors. These resources may be informational, emotional or tangible. The idea here is that these social ties and resources create a buffer zone between yourself and other potentially maladaptive stressors.

2. Main effects model: this paradigm proposes that social relationships have a more direct influence on health effects through cognitive, emotional, behavioural and biological means even if resources provided aren’t meant to explicitly help us. An example used in the paper is that social relationships may directly/indirectly model healthy behaviours e.g. if you’re part of a group that takes physical health seriously, there’s a good chance you will conform to that specific social norm, therefore participating in an activity that is beneficial for your physical health.

Some pretty interesting takes. Even with this, it can still be a bit confusing to determine what constitutes social health. How exactly do you measure social connections? 

It seems like there are two main measures:

1. Social support: The real or perceived availability of social resources.
   – Real – social interactions that are intended to be supportive
   – Perceived – beliefs and perceptions of support availability held by the individual
2. Social integration: This represents the structural aspect of social relationships and the broad range of relationships one would participate in (Cohen & Lemay, 2007). Think marital status, relationship with family, work relationships, etc.

We can simplify social health broadly as the support we receive and the quantity/quality of the relationships we hold. I suppose the next question becomes, how do these two measures actually influence things like physical and mental health? 

In the Uchino (2006)review, they saw that social support was linked with physical aspects of health, influencing cardiovascular, neuroendocrine and immune systems. Uchino breaks down how social support can do so by influencing two distinct (but not independent) pathways. The first is through behavioural processes, where social norms may facilitate actions. This can result in either positive or negative actions. 

The second is through psychological processes, which relates to appraisals, emotions, moods and feelings of control. Like I said before, both aren’t independent of one another. In previous articles, we’ve also discussed how high stress may directly influence the practice of health behaviours, and conversely how things like physical activity can influence stress levels. 

See Uchino’s breakdown below (I do love a good diagram):

Uchino (2006) 

While the above diagram is very simple and broad, it does provide some insight into how the bio, psycho and social arms of health all relate to one another. 

One of the more cited papers in the social health realm is that of Holt-lunstad et al (2010). They conducted a review on 148 papers, totalling 308,849 participants, to see the relationship of social factors on the risk of death. What they found was that mortality risk was actually comparable to other well-established risk factors like smoking and alcohol consumption. On average, there was a 50% increased likelihood of survival as a function of stronger social relationships. They even seemed to have an even greater influence on health when compared to risk factors such as physical inactivity and obesity. 

What we also see is that people heavily underestimate the importance and influence of social factors on health and mortality, which isn’t overly surprising. Haslam et al (2018)conducted an online survey with 502 participants and found that people were able to accurately estimate the impact of most popular health behaviours on mortality. What they also found was that people had a tendency to dramatically underestimate how important social factors were with mortality. No surprises here. Even with social factors being among the top predictors of health outcomes, they’re still rated the lowest.

Haslam et al (2018), used the ranking figures for the Holt-Lunstad study and compared them to the perceived ranks that were found in the online survey. You can see below the wild difference in True vs Perceived ranks when it comes to major risk factors:

Haslam et al (2018)

Turns out that social factors have similar or even greater influence on mortality risk when compared to other major risk factors we commonly think about such as smoking, alcohol intake, physical activity or obesity. While social health is much less understood compared to other risk factors, the relationships you have and the support you have access to can truly make a difference to your overall health and wellbeing. Hyper focusing on other areas of health (or life), and disregarding the importance of your relationship ties does come with some possible consequences. Conversely, focusing on building solid relationships does provide some worthwhile benefits.

Don’t think of social relationships as the Michelle Williams of the group when it comes to health. Creating and improving deep, quality relationships with others is an underestimated and highly valuable consideration when looking to improve one’s overall health.