Social Factors

A gradient between socioeconomic status (SES) and health is consistently found in epidemiologic studies (Marmot, 2004). Persons with less education and income tend to have poorer health than their better-educated and richer counterparts. Interestingly, subjective SES (i.e., individuals' perceptions of where they view themselves on the social ladder) has an even stronger relationship to health than objective SES (Singh-Manoux et al., 2005). Negative affect, stress, pessimism, and a decreased sense of control are among the factors thought to contribute to the relationship between lower subjective SES and poorer health (Operario et al., 2004).

In general, social support reduces stress and contributes to more positive health outcomes. Social support refers to the process by which a social network provides psychological and material resources to enhance an individual's ability to cope with stress (Cohen, 2004). Both quantity and quality of support are important, and sources of support include spouse, lover, friends, family, co-workers, and health care professionals. A person who has many friends but no confidant may have inadequate social support in a time of need. Some people report high levels of satisfaction with just a few close friends, whereas others require larger social networks.

There are several varieties of social support (Cohen, 2004). Emotional support involves the expression of caring, concern, and empathy toward the person and typically involves opportunities for the recipient to express emotions and vent. Instrumental support involves providing some type of direct assistance, which might include financial resources, transportation, or help with daily tasks. Informational support involves giving advice or providing relevant information to an individual.

Social support appears to undergird health by buffering the person against negative effects of stress, perhaps by affecting the cognitive appraisal of stress. When people encounter a strong stressor, such as a major financial crisis, individuals with high levels of social support may appraise the situation as less stressful than will those with low levels of support. Social support may further buffer the stress by modifying people's response to a stressor as they turn to friends for advice, reassurance, or material aid. Social integration, or participating in a broad range of social relationships, benefits health and well-being by enhancing self-esteem and fostering positive health behaviors in people who believe that others count on them. Social integration is beneficial, whether or not an individual is experiencing stress (Cohen, 2004).

Relationships also can involve significant negative social exchange and be harmful to health. For example, negative interactions in troubled marriages have adverse effects on cardiovascular, endocrine, and immune system function (Robles and Kiecolt-Glaser, 2003).

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