Social Health

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SOCIAL HEALTH

The concept of social health is less intuitively familiar than that of physical or mental health, and yet, along with physical and mental health, it forms one of the three pillars of most definitions of health. This is partly because social health can refer both to a characteristic of a society, and of individuals. "A society is healthy when there is equal opportunity for all and access by all to the goods and services essential to full functioning as a citizen" (Russell 1973, p. 75). Indicators of the health of a society might include the existence of the rule of law, equality in the distribution of wealth, public accessibility of the decision-making process, and the level of social capital.

The social health of individuals refers to "that dimension of an individual's well-being that concerns how he gets along with other people, how other people react to him, and how he interacts with social institutions and societal mores" (Russell 1973, p. 75). This definition is broad—it incorporates elements of personality and social skills, reflects social norms, and bears a close relationship to concepts such as "well-being," "adjustment," and "social functioning."

Formal consideration of social health was stimulated in 1947 by its inclusion in the World Health Organization's definition of health, and by the resulting emphasis on treating patients as social beings who live in a complex social context. Social health has also become relevant with the increasing evidence that those who are well integrated into their communities tend to live longer and recover faster from disease. Conversely, social isolation has been shown to be a risk factor for illness. Hence, social health may be defined in terms of social adjustment and social support—or the ability to perform normal roles in society.

Definitions of social health in terms of adjustment derive from sociology and psychiatry. Poor social adjustment forms a common indicator of neurotic illness, and adjustment may be used to record the outcome of care, especially for psychotherapy. Adjustment may be rated subjectively, or it may be judged in terms of a person's fulfillment of social roles—how adequately a person is functioning compared to normal social expectations. Role performance can also indicate the impact of disability, bringing the concept of social health close to that of handicap, which refers to the social disadvantage resulting from impairments or disabilities (World Health Organization, 1980). As norms vary greatly between cultures, however, a challenge lies in selecting an appropriate standard against which to evaluate roles.

Mutual social support is also commonly viewed as an aspect of social health. Support attenuates the effects of stress and reduces the incidence of disease. Social support also contributes to positive adjustment in children and adults, and encourages personal growth. The concept of support underlines the theme of social health as an attribute of a society: a sense of community—or the currently fashionable concept of social capital, which refers to the extent to which there is a feeling of mutual trust and reciprocity in a community—is an important indicator of social health.

Ian McDowell

(see also: Assessment of Health Status; Community Health; Health; Social Assessment in Health Promotion Planning; Social Determinants; Social Networks and Social Support )