Task 2 - Social determinants of health

Any process whereby a person´s attitudes, opinions, beliefs, or behaviors are affected by others incl.

• Conformity
• Compliance
• Peer pressure
• Influence of social norms

1. Structural - quantity & quality of social ties (networks we live in), feed into functional influence
2. Functional - emotional, instrumental (financial) or informational support
3. Normative - social norms provide context in which individuals make decisions about their behavior

• Inner circle/ primary social ties - significant others, persons to whom we are emotionally tied and whom we view as important and influental, the ones closest to us, chosen ones, informal & no hierarchy
• Outer circle/ secondary social ties - larger group, more formal, rules & regulations, hierarchy, less personal knowledge about other members; also often chosen voluntarily
• People outside also have influence on us

Our social relationships...

1. Directly (and positively) affect out physical and mental health
2. buffer against stress exposure and as such indirectly affect our health

1. Icecold water - ppl had to name social groups they consider themselves a member of; the more groups they could name, the longer they could put their hand in icecold water --> amount of social categorizations/ group memberships buffers against pain
2. Extreme athletes - those who can list more social categories have quicker heart rate recovery back to normal

YES! Study found that satisfaction derived from interactions with friends is pos related to self-reported health (potentially as sharing helps regulate emotions)

Loneliness has negative effect on health

• Affects phyiscal and mental health, sleep quality, academic achievements
• Found to double the risk of developing Alzheimers disease

NO! even more common among young people (16-24 year, 40%) than in old (75+ years, 27%)

Norms (different types)

1. Descriptive norms - what I think others do
2. Injunctive norms - what I think others will approve/ disapprove of me doing
3. Subjective norms - whatI think that significant others expect me to do

To compare ourselves we look at ppl who are similar & close to us --> likely for example peers

Social control also influences out health behavior

--> depending on which groups or individuals are considered important to an individual and which (health) norms are salient in that group, such social influence can be damaging or encouraging for ones health behavior

• Social facilitation
• Modeling
• Impression management
• Norms

The mere presence of others influences us largely outside of our awareness; examples are:

• eating behavior in children - more and faster when in larger groups
• peer support and positive relations facilitates physical activity & exercising while bullying/ criticism reduce it
• risk taking - more effect social facilitation on risk taking among males; mere present of a male passenger doubles rate of car crash being deathly

Individuals form beliefs and attitudes about the behaviors they see in others which in turn shapes their own behavior

more direct/ explicit form of influence on our behavior than facilitation

• the more ppl like each other, the more they synchronize their food intake bahvior (bites in synchrony)

Starts in early childhood

• Bobo doll experiments - practice what you preach!!

Peer influence

• peers have influence on our physical activity through modeling and socialization processes --> more active friends, more active yourself; however also social selection (selecting similar friends)
• peer education can be useful for health promotion (effective, cheap)

Attempts to consciously/ unconsciously control the impressions other people form of us by regulating info we provide to them & strategic self-presentation

Can impact us negatively e.g. by

• not wanting to be seen buying condoms or morning after pill
• tanning indoors to be tanned and look good
• occasional (social) smoking to not say that you are a smokers & therefore feel immune to health risks of smoking
• alcohol use greatly influenced by peers - wanting to fit in

(Peer) norms influence out behavior

Often we even have misperceptions about other ppls attitude (peer injunctive norms) or their behaviors (peer descriptive norms) which influence our behavior --> correcting these misperceptions change (problematic) behavior

No; peer influence doesn´t need to be negative

Non-medical factors that influence ppls health outcome; the conditions in which ppl are born, grow, work, live and age and the wider set of forces and system incl. economic policies and sysrems, development of agendas, social norms, social policies, political system --> can lead to unstable housing, low income, unsafe neighborhoods, substandard education --> leads to inequties between (groups of) individuals

1. social gradient
2. stress
3. early life
4. social exclusion
5. work
6. unemployment
7. social support
8. addiction
9. food
10. transport

Structual determinants - socioeconomic political contexts (things individuals hardly have any influence on) translate into social class, gender... influencing education, occupation, income which then influence intermediary determinants

Intermediary determinants - material circumstances (living and working conditions, availability of food), behavior (smoking, exercising, diet choices) and biological factors (genetic predispositions and physiological responses to stress), psychosocial factors (stress, social support, community engagement)

Social cohesion and social capital bridge between intermediary and structural determinants and can act as buffer

Example: social excluion because of ethnicity, religion, sexual prefernece, gender.... affect living and working conditions and as a result ones psychological and physical health

People have two or more of the characteristics (structural determiantns of health inequity) --> e.g. have a different ethnicity and sexual preference

Equality - everyone gets the same

Inequality - everyone gets something different

Equity - everyone gets what they need

Inequity - people do not get what they need

Changing structural determinants

• Provide basic income
• provide good infrastructure
• Provide education for all children and adults
• Provide accessible healthcare
• equal pay for men and women

We can also target intermediary determinants

• focus on individuals psychological and social strength
• reserve capacity model

Proximal - directly influencing the problem; mostly target intermediary determinants such as giving people money or better food

Distal - target mediating factors, mostly focusing on structural determiants such as ensuring equal pay or basic income

Explains how socioeconomic position explains health outcomes

SES --> Stress --> pos & neg emotions --> health bheaivor and physiological reactions --> health outcome

People have reserve capacity = psychological (optimism, self esteem...) and social resources (support from family, friends...) that can buffer the negative effect of SES on health outcomes

Explains how unequal social and economic conditons lead to disproportionate exposure to harmful factors and consequently poorer health outcomes for disadvantages groups

Sense of having positive relationships with others --> fundamental human need

Members of stigmatized groups may be more uncertain about their social belonging in mainstream institutions like school and work

Goal of intervention was to enhance college freshmens sense of social belonging (particularly african american students)

Intervention was delivered to students during transition to college (where ppl may face social setbacks)

Ppl randomly assigned to control or belonging treatment condition

• in belonging treatment condition students were provided with narrative framing social adversity as shared and short lived (not due to deficits in them or their ethnic group but common and transiet aspect of college adjustment process) --> could look at survey of seniors who did it in first year and indicated feeling same
• ppts asked to write essay about how own experiences echoed experiences summaried in survey & had to turn this essay into speech delivered to video camera --> encouraged to self-generate messages that framed social adveristy as common and transient

• in control condition same procedure but survey adressed different topic

--> AA who participated in study show sig increase in GPA over time; those in control group didn´t

--> buffered ppts against daily adversity & reduced negative impact of such experiences on their sense of belonging

--> self reported improvements of health and well-being in AAs; less doctor visits

--> positive impact stayed (still there after 3 years)

--> enhancing feelings of social belonging can sig affect academic and health outcomes