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SOCIALNETWORKSASA
HEALTHFACTOR
Theimpactofsocialandculturalfactorson(public)healthisgreatandshouldnotbe
neglected,sothemainsubjectofthisworkistheinfluenceofsocialnetworks(inthewidest
sense)onhealth,andtheyareinextricablylinkedtosocialinclusion/exclusionorsocial
resources,socialcapital,socialsupport,etc.,soitisnecessarytoexplaininmoredetail
theseconnectionsandtheirimpactonhealth.Foralongtime,povertywasconsideredto
beaproductofadiseaseinasense,sothatinthelastcenturysocialmedicinereversed
thisrelationshipandfoundthatpovertyandexploitationwouldleadtoillness(e.g.thereis
nonodoubtthatmalariaiscausingandnotcausinginsufficientdevelopment)(Turner,2000;
Beaudoin,2007).Simplyput,povertyandpoorhealthareinextricablylinked,showingthe
factthatthepoorestpeopleareatthehighestriskofvarioustypesofillness.Avery
importantprocessfrom theendofthetwentiethcenturyisthediscontinuationofpublic
healthfromthedomainofcharitableinstitutionsandcharitiesanditsestablishmentinthe
centerofworldpoliticsandstrategiesofnationalstates.Intheexceptionalcircumstances
ofpublichealth,centralizedstatesaretakingresponsibility,aswasthecasewhen
nation-nation-buildingorwhennationalterritoryanditspopulationweredefended.Insomeother
circumstancesitwasamatteroflocalpolitics,whichmeansthatithasadeeplocalroots
andthatitisnotaconcreteintellectualdiscipline,butafieldofsocialactivity.Today,there
isnopublichealthconsensus-aboutitsduties/responsibilities,competencesand
qualifications,andinthecourseofhistory,theyarerarelyclearwhencomparedto
medicine,bacteriology,epidemiologyandlabwork.Therefore,inthesecondhalfofthe
twentiethcenturythegapbetweenbiomedicalresearch,epidemiologyandpublichealthis
increasinglyincreasinglydeepening(Pollock,2007;Detels&Tan,2015)andthereisaneedfor
transdisciplinaryresearch(Brookmeyer&Stroup,2004).Essentially,publichealthisa
combinationofscience,skillandbeliefthatisaimedatmaintainingandimprovingthe
healthofallpeoplethroughcollectiveorsocialaction.Thegoaloftheseendeavorsis
alwaysthesame,regardlessofvariouschangesinpublichealthduetochangesin
technologyorvalues,whichisreducingtheamountofdiseaseinitsvariousforms.
Therefore,primary,secondaryandtertiarylevelsofpublichealthpreventioncanbetalked
aboutabout.
Primarypreventionreducesbadhealthbymeansofdrugssuchasvaccinestoprevent
disease,secondary(orearlydetection)involvesreducingthespreadofpoorhealthby
shorteningitsdurationandlimitingitspoorsocial,psychologicalandphysicaleffectssuch
asvarioustypesofscreeninginordertodetectdeteriorationintheearlystage(Carr,
Unwin,& Pless-Mulloli,2007).Finally,tertiaryprevention involvesthe reduction of
complicationsassociatedwithpoorhealthandminimizingsuffering,suchasrehabilitation
programsforpatientsafteraheartattack.Boundariesbetweenthesedifferentlevelsare
usuallyusuallyunclearandpossibleoverlaps,buttheessenceisthatpublichealthismore
concernedwithdistalsocial,physical,economicandenvironmentaldeterminantsofhealth
(awayfrompeople)thanproximal(closertohumans),suchasareriskfactors.Therefore,
itcanbesaidthatitspopulationisabasis,notanindividualpatient(Bammer,2013).
However,whenitcomesto"health",thefirstassociationislikelytobethehealthof
individualsandsomebiologicalaspectsofhealth,althoughtodaythereismuchevidence
thatalargepercentageofmortalityisassociatedwithsocialandbehavioralfactorssuch
asassmoking,eating,alcoholuse,sedentarylife,narcoticsconsumption,andthelike.Also,
biologyandgeneticstellusthatasmallnumberofdiseasesareonlytriggeredbygenetic
factors,thatis,thatthegreatestnumberofdiseasesaretheresultofinteractionbetween
geneticfactorsandenvironmentalfactors(Remais&Jackson,2015).However,itisvery
difficulttoqualifyforhealth,soalargenumberofvariablesareusedforindicatorsofthe
conceptofhealth.Priortothetwentiethcentury,negativeindicatorswereused,suchas
mortalityandrateofdisease,wherelowermortalityratesmeantahealthierpopulation.
TToday,theseindicatorscontinuetobeused,butonlyinthewidersense,whenpopulation
iscompared,becausehealthissomewhatwiderthanthemereabsenceofdisease-
considerationshouldincludetheenvironment,lifestyle,humanbiology,medicalcareand
healthcareasthemaindeterminantofhealth.Inotherwords,asubtleandverycomplex
relationofbehavioralandbiologicalresponsestothesocialandphysicalenvironmenthas
tobeanalyzed,whichmeansthatamodelofdeterminantsshouldbedevelopedthat
shows how individualcharacteristics (biology,life course,lifestyle,behavioraland
illnesseillnesses,personality,motivation,valuesandpreferences)andthecharacteristicsofthe
environment(social,cultural,economic,political,physical,geographical,butalsohealth
andsocial)affectthequalityoflifeassociatedwithhealth(symptoms,functionalstatus,
perceptionofhealthandopportunity).Simplyput,healthandwell-beingareunderthe
influenceofinteractionbetweenbiology,behavior,andenvironmentandcanbesaidtobe
anecologicalmodel(Hernandez&Blazer,2006).
Whenanalyzingthepublichealthproblem,socialandculturalfactorsareveryimportant,
inadditiontogeneticinheritance,personalbehavior,accesstohealthcareandthe
physicalexternalenvironment(e.g.airquality,water,housingconditionsandthelike).For
sometypesofsocialvariables,suchassocioeconomicstatusorpoverty,thereisvery
clearevidenceoftheirconnectiontohealth,similartoothersocialorculturalvariables-
socialnetworksandsocialsupportorstressfuloccupations,theseevidenceaccumulated
onlyinthelastfortyyears.Inaroughway,thesocialenvironmentistherelationship
betbetweenpeopleorsocialrelationships,whilegeneticfactorsarewhatgenetics(the
influenceofgeneticinheritanceonbehavior)isgenerated,andthisindicatesthatthereis
alinkbetweengenesandhealth.Ultimately,behavioralfactorsincludetwocomponents-
oneofthepossiblebehaviorsthataffecthealth(smoking,narcoticsuse,nutrition,exercise,
etc.),while others constitute psychologicalcharacteristics,including cognitive and
emotionalfunctionsandresilience.Alltheseinteractionsofsocial,behavioralandgenetic
factorsshouldbestudiedfrom theperspectiveofthelifecourse.Socialdeterminantsof
healthhealthcanbeconceptualizedthroughinfluencesonmulti-levelhealthinlife(Blane,2006).
Thus,forexample,povertycanaffectthehealthofindividualsatdifferentlevelsof
organization-withinthefamilyorwithintheneighborhoodinwhichindividualslive.
Moreover,thesedifferentlevelsofinfluencemayoccursimultaneouslyandinteractand
produce"health".Thus,theinfluenceofsocialandculturalvariablesonhealthincludes
timedimensions(criticallifestagesandcumulativeexposureeffects),aswellaslocations
(multiplelevelsofexposure).Contextsinwhichsocialandculturalvariablesactand
influenceinfluencehealthoutcomescanbegenericallycalledsocialandculturalenvironment.
Specifically,thisencompassessocioeconomicstatus,"race"/ethnicity,genderand
genderroles,immigrantstatusandoccupation,povertyanddeprivation,socialnetworking
andsocialsupport,andpsychosocialworkenvironment,andtheaggregatecharacteristics
ofsocialenvironmentssuchasarerevenuedistribution,socialcohesion,socialcapitaland
collectiveefficiency.Today,itisknownthattheexpectedlifeexpectancyisshorterforlower
sociallevels,asthefrequencyofcertaindiseasesisnotthesameintheentirepopulation.
ThisThisisoneofthemostimportantreasonswhypublichealthconsiderationsmusttakeinto
accountitssocialdeterminants.Poorsocialandeconomiccircumstancesaffecttheir
healththroughouttheirlives,andunderthem theyarethinkingoflesswealthorpoverty,
weakereducation,insecureemployment,pooremploymentandriskyemployment,poor
livingconditions,familycareindifficultcircumstances,andinadequatepensioninsurance.
Thesecharacteristicsaremainlyconcentratedonthesamepeopleandtheseeffectsare
accumulatingthroughouttheirlives.So,iflifeisshorterwhenitsqualityispoorer,itmeans
thatpoverty,relativedeprivationandsocialexclusionhaveagreatinfluenceonhealthand
prematuremortality.Absolutepoverty,orabsenceofbasicmaterialresourcesforlife,is
stilltodayintheworld,andatthehighestriskofpovertyareunemployed,migrants,people
withdisabilities,refugeesandhomelesspeople.Relativepovertyismorewidespreadand
nomatterhowwedefineit,itisclearthatpoorpeopleinaveragelivelessthanthosewho
arearebetterpositionedinthesocialhierarchy.Socialexclusionmaybetheresultofracism,
discrimination,stigmatization,unemployment,etc.,andexcludeddonotparticipateinthe
processesofeducationandsociallifeatall.
REFERENCES
Turner,B.S.(2000).TheHistoryoftheChangingConceptsofHealthandIllness:OutlineofaGeneralModel
ofIllnessCategories.In:Albrecht,Fitzpatrick,andScrimshaw2000,9-23.
Beaudoin,S.M.(2007).PovertyinWorldHistory.LondonandNewYork:Routledge.
Pollock,J.(2007).Epidemiologyfor21stCenturyPublicHealth.In:J.Orme,J.Powell,P.Taylor,andM.Grey
(eds.),PublicHealthforthe21stCentury:New PerspectivesonPolicy,ParticipationandPractice,2nd
Edition.BerkshireandNewYork:OpenUniversityPress,269-286.
Detels,R.&Tan,C.C.(2015).TheScopeandConcernsofPublicHealth.In:R.Detels,M.Gulliford,andQ.
AbdoolKarim,andC.C.Tan(eds),TheOxfordTextbookofGlobalPublicHealth,6thEdition.NewYork:
OxfordUniversityPress,3-18.
BrookmBrookmeyer,R.&Stroup,D.F.(eds)(2004).MonitoringtheHealthofPopulations:StatisticalPrinciplesand
MethodsforPublicHealthSurveillance.NewYork:OxfordUniversityPress.
Carr,S.,Unwin,N.&Pless-Mulloli,T.(2007).AnIntroductiontoPublicHealthandEpidemiology,2ndEdition.
BerkshireandNewYork:OpenUniversityPress.
Bammer,G.(2013).ScopingPublicHealthProblems.In:C.Guest,W.Ricciardi,I.Kawachi,andI.Lang(eds),
OxfordHandbookofPublicHealthPractice,3rdEdition.Oxford:OxfordUniversityPress,2-10.
RemaiRemais,J.V.&.Jackson,R.J(2015).DeterminantsofHealth:Overview.In:R.Detels,M.Gulliford,andQ.
AbdoolKarim,andC.C.Tan(eds),TheOxfordTextbookofGlobalPublicHealth,6thEdition.NewYork:
OxfordUniversityPress,81-88.
Hernandez,L.M.&Blazer,D.G.(eds)(2006).Genes,Behavior,andtheSocialEnvironment:MovingBeyond
theNature/NurtureDebate.Washington:TheNationalAcademicPress.
Blane,D.(2006).TheLifeCourse,theSocialGradient,andHealth.In:MarmotandWilkinson,54-77.

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