Voices From The Community
Health as a social phenomenon
Story by Connie Bryson/Photo by Veer
Research shows that our health is affected by some things we might not expect.
On the face of it, health would seem to fit squarely in the field of medicine. After all, most of us go to a doctor when we get sick. But ground-breaking work done in Canada in the 1980s showed how factors other than access to and use of healthcare services determine the health of populations. A multidisciplinary research team sponsored and organized by the Canadian Institute for Advanced Research (CIFAR) developed the model of the determinants of health. The determinants include the social and economic environment, the physical environment, and a person's individual characteristics and behaviours. Their work influenced researchers and policy-makers around the world to look beyond health care to the social and economic determinants of health.
This was the jumping-off point for CIFAR President Dr. Chaviva Hošek's recent talk in Edmonton on Health as a Social Phenomenon. CIFAR is a not-for-profit organization that brings together leading researchers from across Canada and around the world to work collaboratively on complex advanced research projects. A number of CIFAR programs are health related, and they provide a wealth of examples that illustrate how health is much more than healthcare—it is a social phenomenon. There is mounting evidence to suggest that better health may largely depend on factors beyond the direct control of the healthcare system.
One striking example is the strong association between the health of a population and the size of the social distance between members of the population. CIFAR researchers called this the "gradient effect." What it means is that societies with sharp social and economic differences among individuals in the population (a steep socioeconomic gradient) have a lower overall level of health and well-being than societies where these differences are less pronounced (a shallow gradient). As a result, countries with highly unequal income distributions have poorer health status than those with more equitable income distributions. Interestingly, this gradient holds for a wide variety of outcomes, such as literacy, mathematics achievement, and behavioural and emotional issues.
Another example of health as a social phenomenon comes from studies of the after-effects of the fall of communism in the Czech Republic and Russia. Male life expectancy in both countries fell immediately after the transition. But in the Czech Republic, male life expectancy soon began to improve, reaching 70 years in the 1990s. In Russia however, concurrent male life expectancy remained very low—57 years.
"The end of communism had a different effect in these countries because the event was not actually the same," notes Dr. Hošek. "In Russia, the fall of communism was about loss of empire, loss of hegemony, loss of organizing myth, and loss of economic structure. In the Czech Republic, the cultural narrative was very different—the fall of communism was about regaining cultural control, identity, a return to mastery of their own society and of their own future. The same event had a very different meaning in each country ... and meanings matter."
While these kinds of studies produce interesting results, there has always been an underlying question about how social and economic influences actually register in an individual's biology—how do they get "under the skin", as Dr. Hošek calls it. The answers are beginning to come from a variety of biological analyses, including epigenetics—the study of how social experiences and other environmental factors affect the way genes behave. In particular, early childhood experiences can turn genes on and off or alter their level of activity; this change in activity is called "gene expression".
A number of CIFAR researchers are involved in work on epigenetics. For example, research at McGill University has shown that suicide victims with a history of childhood abuse show systematically different gene expression than that of the general population, with particular differences in genes that regulate stress hormones. This work stemmed from earlier research on rats, which showed that newborn rats that are neglected by their mothers grow up to be more anxious. The neglect had altered an important stress-regulation gene.
"So if you ever wondered why bad experiences stick around to affect peoples' lives forever, this research shows some of the ways it happens," says Dr. Hošek. "The research results show the total inadequacy of thinking about this as nature versus nurture. There's no such thing. There's constant interaction between genes and their environment.
The interaction continues on the larger scale as well, notes Dr. Hošek. "Economic and social inequality damages the health of both individuals and populations. The relationship between health and material deprivation, economic relations, social status, social networks, and cultural narratives is complex and multifaceted. It is vital to pursue these questions."