Social and community networks
Definitions and concepts
How do they networks relate to health?
Case studies
Session outcomes
• To outline the nature of social and community
networks
• To define the concepts of social support and
social capital
• To examine how these networks influence
health
What are networks?
• Social and community networks are primarily
concerned with interactions between groups
of people and/or organisations & institutions.
• Social networks can be analysed in terms
structure ie number of people, frequency of
contacts and diversity as well as the quality of
the network and types of support given.
What is social support- definition
• Social support is defined “as information leading to
the subject to believe [they are] cared for and loved,
is esteemed and valued and belongs to a social
network of communication and mutual obligation”
(Cobb, 1976 p 301).
• Tends to be used when examining more an individual
level network
• Reciprocity emphasises an extremely important
element of social support for health where you not
only receive social support but also give social
support (Stansfeld, 2005).
• This reciprocity has important implications for
building connected communities and enhancing the
health of communities.
Elements of social support
• House (1981) characterises four types of social
support which also assess the quality of the
network.
• emotional ( eg love, trust, empathy);
• appraisal (eg affirmation and feedback);
• informational (eg advice )
• instrumental (eg tangible help money and
time).
How does social support work ?
Adapted from Uchino (2006)
Behavioural elements
Healthy behaviours & advice
Compliance of treatment plans
Health
Biological processes:
Low blood pressure
Social support
Hormonal regulation
Immune function
Psychological processes
Affirming and coping
Control etc.
outcomes
Pathways of social support
• Behavioural- social networks can promote
healthy behaviours such as physical activity &
relaxation
• Psychological – social network can promote sense
of belonging and be valued leading to strong selfesteem. It can also facilitate coping strategies in
response to difficulties.
It is hypothesised these pathways can lead to
physiological changes that improve health
outcomes
Evidence of importance of social
support for health
• Berkman and Syme (1979) found that people
who were less socially integrated had higher
mortality rates consistently over a nine year
period and concluded that social support
protected to some extent against premature
death.
• The strongest evidence is between social
support and coronary heart disease
(Brummett et al., 2001).
Examples
• People in the social network provided support
that lead to psychological adjustment in people
with HIV (Turner-Cobb et al., , 2002)
• Social support associated with well-being in
young people (Po Sen Chu et al., , 2010)
• Theorell et al., (1995) investigated how higher
levels of social support predicted higher counts of
CD4 cells in the blood (these are the cells in the
immune system that HIV infect and destroy)
What is social capital – definition ?
• definition of social capital is “features of social
organisation such as networks, norms, and
social trust that facilitate co-ordination and
collaboration for mutual benefit” (Putnam,
1995 p 67).
• More of a meso/ecological-level of
communities level concept emphasising
institutional networks.
Types of social capital
(Office of National Statistics, 2003)
• Bonding social capital- based on enduring, relationships between
similar people with strong mutual commitments such as among
friends, family and other close-knit groups.
• Bridging social capital - formed from the connections between
people who have less in common, but may have overlapping
interests, for example, between neighbours, colleagues, or between
different groups within a community. “It acts like a sociological
superglue, binding together groups in the community and so can
facilitate common action” (McKenzie and Harpham, 2006 p15)
• Linking social capital - between people or organisations cutting
across status and similarity and enabling people to exert influence
and obtain resources outside their usual networks. This type of
social capital is important for accessing services such as welfare
benefits
Measurement of social capital
• No consensus although many researchers
focus on aspects of trust between social and
community networks but also on trust we
place in institutions.
Amounts of social capital
• Health Development Agency UK (2004) measured
social capital and found .
 People in more disadvantaged groups were
generally more likely to know and speak to
their neighbours but less likely to trust them.
 Nearly 60% of respondents felt well informed
about local affairs
 A quarter felt that they could personally
influence decisions in their area
Summary of mechanisms adapted from Berkman et al.,
(2000)
How social capital work ?
Not well elucidated hypotheses include:
• In communities that trust each, other
relations between people are likely to be more
co-operative and less stressful.
• More egalitarian societies tend to engender a
spirit of reciprocity fostering closer bonds and
bridges, greater spirit of social support leading
to direct physiological process that shape our
health.
• Seeing inequalities may lead to both
discontentment and feed into both psychological
and biological pathways.
“A house may be large or small as long as the
surrounding houses are equally small it satisfies all
social demands for a dwelling. But if a palace arises
beside a little house the little house shrinks to a
hovel ………more dissatisfied and cramped” (Marx,
nd cited in Marmott and Wilkinson, 2001p 1234).
Examples of social capital and health
• Membership in voluntary groups and higher
levels of social trust had a more equal income
structure and had lower total and disease specific
mortality rates (Kawachi, et al., 1997).
• Men with low social capital were nearly twice as
likely to have a psychiatric disorder (Rose, 2000)
• The prevalence of poor self-rated health was
higher in neighbourhoods with more family ties,
less integration into the wider society, and lower
levels of trust (Stafford et al., 2004)
Settings for generating social support
and social capital
• Family although strong family bonds can
weaken bridging and linking social capital.
• Neighbourhoods and local areas
• Faith-based organisations
• Schools
Implications for policy and practice
Influences the nature and methods of action
• Favours community development, bottom up
and empowerment approaches of action.
• Promotes civic engagement and belonging to
community groups
• Promotes spirit of volunteerism
• Consideration of how communities are
networks and how these networks may be
built.
Summary
• Social support and social capital are
interlinked conceptually
• Clear evidence of links between social support
and social capital have been found.
• Mechanisms linking social support and social
capital to health outcomes are hypothesised
but not well elucidated
• Social support and social capital for
practitioners work with communities.