ISPP 2015

Career Opportunities in Pharmacy
Social correlates of health


Why do sociologists study illness and health? Often, we think about health and illness as an individual issue that has more to do with someone’s personal characteristics than their social environment. It is true that individual genes and biology play a role in health and illness. For example, a person’s sex, ethnicity and age might affect whether someone is more susceptible to some illnesses and not others. Genetics also plays a part in determining lifespan and overall health over the life cycle. Individual health behaviours are another consideration when considering health, including alcohol consumption, smoking, lack of exercise, imbalanced diets that lack necessary nutrition, drug use and unprotected sex. However, while individual lifestyle choices do have an impact on whether a person is healthy or not, there are several other factors at play as well. International empirical studies in health have led to a growing understanding of the remarkable sensitivity of health to the social environment, and to what are known as the social correlates of health. The social correlates of health can include the social and economic environment, the physical environment, material and economic factors, as well as a person’s individual characteristics and behaviours. They may include such things as geographical location, discrimination, income, level of education, quality of relationships with friends and family, culture, healthy child development and interactions with other people in society. The health of individuals and communities are also shaped by factors such as wealth, power, and available resources, all of which are influenced by dominant social institutions, such as the government. Let’s look at some of these social determinants of health in more detail. The physical environment a person lives in is an important determinant of health, as pollution and higher population density can result in poorer health outcomes and greater propensity to diseases being spread. Clean drinking water and air and healthy, quality housing are important to good health, as are working conditions and workplaces. People in paid employment who have more control over their working conditions tend to be healthier than those who don’t. Generally speaking, higher income and social status are linked to better health. The greater the gap between the richest and poorest people in society, the greater the differences in health. Even in affluent countries like Australia, people who are less well off financially have substantially shorter life expectancy and more illnesses than those who are wealthier and financially secure. The relationship between socioeconomic status and physical and mental health, morbidity, disability, and mortality has been extensively documented. People who are socioeconomically disadvantaged usually run more than twice the risk of serious illness and premature death as the privileged do. Even among middle-class office workers, lower-ranking staff suffer much more disease and earlier death than higher-ranking staff. This is because people of different socioeconomic backgrounds may have different levels of access to medical care, healthy food, and opportunities for physical activity. Low socioeconomic status may contribute to risky health behaviours such as intravenous drug use and unprotected sex, as well as social exclusion, heightened stress, and low self-esteem. Low education levels are linked with poor health, more stress and lower self-confidence. These are all factors that can affect health and must be accounted for when studying risk of different diseases and conditions. The long-term stress generated by social and psychological circumstances is also an important factor, because this in turn makes people feel worried, anxious and unable to cope. Research shows that long periods of anxiety and insecurity and a lack of supportive friendships are damaging to health. Such risks accumulate during the life course, and increase the chances of poor mental health and premature death. These mental, emotional and psychological problems often lead to physiological changes, such as raised cortisol, altered blood-pressure response, and decreased immunity that place individuals at risk for adverse health and functioning outcomes. In contrast, greater emotional support from families, friends and communities is linked to better health. Individuals are unlikely to be able to directly control many of these determinants of health on their own. For example, early child development can have a dramatic impact on the overall health of a person as an adult. A child raised in a low socioeconomic-status household is less likely to have access to the nutritional food or health services necessary for their age, which can then shape their health over their life course. Physical and mental health can then in turn have an impact upon their socioeconomic status and their chances for social mobility. For example, bouts of serious illness may result in a significant and sustained loss of economic resources. Cultural customs and traditions, and the beliefs of the family and community also affects a person’s health, both positively and negatively. Culture influences health by shaping behaviours, such as diet, or by influencing how people relate to their environment. Other cultural aspects to consider include hygiene practices and general beliefs about the body, as well as the role they play in social life. For example, religious beliefs might influence contraception use, choices about blood transfusion, and circumcision. Cultural beliefs can lead to differential perception and treatment of mental illness. Research suggests that a cultural orientation towards focusing on oneself and one’s place within the social hierarchy, are linked to the prevalence of depression. Some of this difference comes from the orientation of different cultures to individualism or collectivism. Cultures also vary in the degree to which they rely on complementary and alternative medicine practices such as herbs, meditation and yoga when treating depression. People from some cultural groups may entirely reject Western antidepressant medications, while embracing prescriptions for herbs, acupuncture or exercise. Addressing social correlates of health is central to achieving health equity, which many argue should be a major concern for any government. Health equity exists when everyone has the opportunity to attain their full health potential, and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance. Social correlates of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities. Much of the responsibility for the social inequality that leads to different health outcomes lies with policies in sectors outside of health, such as education, community and family services, and transport. Sociologists can help policymakers to achieve health equity, then, by providing a comprehensive understanding of the social correlates of health and illness.

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