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Friday, 23 September 2011

Social support - the forgotten determinant of health

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How many of you have a friend that you can confide in? Someone who’s advice you can trust? Someone that you can depend upon if in a crisis?  Chances are if you are reading this blog that the rate is almost 100%.   Have you considered how your personal lifestyle protects your health and how privileged you are relative to the determinants of health?
 Up to 20% of the population are not able to respond affirmatively to the questions of who they can look to when in need.   Such social support networks were clearly identified in the 1994 Determinants of Health document, and the cross fertilization of social scientists and epidemiologists led to much better definition of what social support entailed. With this came a migration of language noticable in the  "social" determinants of health to 'social inclusion and exclusion' and 'contribution of the social economy'.  These items were detailed in two resource papers that are worth reading Social inclusion PHAC backgrounder and social policy PHAC backgrounder
Social inclusion/exclusion denotes the health impacts associated with recent immigrants, discrimination, linguistic exclusion and addressing issues related to institutional, workplace, and community ways of limiting these exclusionary barriers.  The backgrounder however does not speak to the “wellbeing” afforded by increasing communality, friendship, and collaboration.  These constructs have been interwoven into how the education system engages students and will likely redefine community, business and social relationships in the future (hopefully in a healthy fashion).
The social economy component comes from a well entrenched Quebec rhetoric and might better be translated as the “non-government (NGO) sector”.   Other terms include “voluntary” sector, the “third” sector, “non-profit” (amongst other terms).  It is the huge contribution that the social economy provides to enhancing wellbeing in the population.  While components are formalized, must of the social economy is through informal networks. 

Regrettably, Governments have looked past the contribution of this sector and over the past decade have substantively reduced funding to the NGO sector. The long term implication of such undermining of the social economy has not yet been seen, and unlikely being evaluated. Nor is there a vibrant discourse on the implications or resilience of the social economy to respond to this brutal attack.  
A challenge to any reader to try to find government statistics on total funding to any NGO sector, but most specifically to the health NGO community and how this has changed since 1990 or 2000.   Please let me know at drphealth@gmail.com   Such massive reductions desire being unmasked and the consequences of policy shifts made transparent.
The flaw in the migration to the newer "social" determinants has actually been that the population level interpretation has diluted the individual level measures.  The original determinants spoke of the protective health effects being correlated with the number of friends, with marital status, personal assistance in dealing with adversity, problem solving and mastery and control of life circumstances.  These individual level attributes have been lost and yet remain central to the discourse on determining what keeps us healthy. The background papers likely led to the inclusion of the "social environment" as one of the added determinants after 1994, but the dialogue on social support networks has disappeared.
The divergence of interpretations has added to the richness of our understanding of one of the lesser appreciated and understood of the determinants.   It begs the question of how newer technology in texting, tweeting and blogging will compromise or potentially enhance social support networks – those technologies weren’t even imagined in 1994 and emailing was still a relatively limited commodity. There is a topic for a future blog. 

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