EUGLOREH project
THE STATUS OF HEALTH IN THE EUROPEAN UNION:
TOWARDS A HEALTHIER EUROPE

FULL REPORT

PART III - HEALTH CAUSES, FACTORS AND DETERMINANTS

10. HEALTH DETERMINANTS

10.6. Social determinants

10.6.1. Social networks and social environment

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10.6.1. Social networks and social environment

 

 

10.6.1.1. Introduction

 

Social network refers to a set of relationships between individuals. Social networks represent both a collection of ties between people and the strength of those ties. Social networks, i.e. social connectedness, make an important contribution to health, by providing people with emotional and practical support. Gender, personality and educational level have been found to be linked to one’s individual social networks. Females tend to have stronger social networks, receiving more positive feedback, yet they also give more social support and are more concerned about the people they help compared to men (Kessler et al., 1985).

 

The significance of social networks and support to positive mental health is well acknowledged (Ganster and Victor, 1988). Poor, low quality social networks are associated with less well-being and poor physical and mental health. A classic longitudinal study from the North Carelia region in Finland shows that individuals with poor social networks have increased rates of premature death and poorer chances of survival after a heart attack, even when adjusting for known risk factors (Kaplan et al., 1988). The quality of close relations is important: Individuals experiencing negative aspects of close relationships were found to have an increased risk of coronary heart disease (De Vogli et al., 2007). A longitudinal study on the predictors of parental stress in mothers and fathers of toddlers showed an association between poor social support and parental stress (Saisto et al., 2008).

 

Social network is measured by size and quality, existence and number of intimate support network, composition of the network, the existence of a spouse, friends, relatives or belonging to associations and organisations, and the frequency of the contacts. The Scope of network scales evaluates links with family members outside the household, friends and neighbours in terms of number and frequency of contacts, for example the average number of contacts with network members over the last 12 months. Another dimension that can be measured is social involvement, for example the frequency of participation in organisations or groups.

 

The 3-item Oslo social support scale (OSS-3) has been used to quantify psychological help available in case of crisis or problem (Nosikov and Gudex, 2003). These three questions cover from neighbours, how many people the respondent can count on in case of serious problems and perceived concern by other people. Possible score range from 3 to 14. Scores 3-8 are considered to reflect poor social support, scores 9-11 moderate social support and scores 12-14 strong social support.

 

Despite some successes reported in social support interventions made to enhance health, further work is needed to deepen our understanding of the design, timing and dose of interventions that work, as well as the characteristics of individuals who benefit the most.

 

10.6.1.2. Data sources

 

10.6.1.2.1 The Mental health indicator pilot study

This pilot study, performed in 2001 (Korkeila et al., 2003), measured social network in four EU Member States (Finland, France, Germany, Greece) and Norway. Social support was measured using the OSS-3, and social isolation was measured by a four-item instrument developed by Statistics Canda (Beaudet, 1996).

 

10.6.1.2.2 The Eurobarometer 58.2 Survey

In 2002, the general population (aged 15 or over) Eurobarometer 58.2 was conducted in EU15 and candidate countries. The survey included a revised version of the OSS-3 measure of social support. The basic sampling design applied in all Member States was a multi-stage, random (probability) sampling method. The net sample sizes were about 1000 per country/region, except Luxembourg (about 600) and Northern Ireland (about 300). Response rates varied from 23% (Great Britain) to 84% (France). In 8 of the countries/regions the response rate was less than 50%.

 

10.6.1.2.3. The SHARE survey

The Survey of Health, Ageing and Retirement (SHARE) of people aged 50 or over, includes social support variables, e.g. social networks and volunteer activities (Börsch-Supan et al., 2005). The first wave of SHARE was implemented in 2004 in 11 EU Member States and 14 EU countries participated in the second data collection wave in 2006-7.

 

10.6.2.4 The HBSC study

The Health Behaviour in School-Aged Children (HBSC) study has been performed since 1982 at four-year intervals among 11, 13 and 15 year old school children. The study includes measures of social network (size of friendship groups, frequency of contacts with friends, and peer support in school). The HBSC survey covers all EU27 and candidate countries.

 

10.6.2.5 The World Values Survey

The World Values Survey, which has been performed in 1990, 1995, 2000 and 2005, has collected data on level of belonging to voluntary organisations in most European countries.

 

 

10.6.1.3. Data description and analysis

 

Data on social support in the adult population could be gathered from the Eurobarometer 58.2 (performed in 2002) only, the results of which are presented per social support categories.

 

Table 10.6.1. Social support by country 2002: % by category

 

In EU 15, almost 22% of the citizens reported strong social support, while more than 19% reported poor social support. There was a major variation between countries, perhaps reflecting the highly varying response rates between countries. People in some countries such as Ireland, Spain, Denmark, the Netherlands and Sweden declared low levels of poor social support; people in other countries such as Belgium, France and Italy reported high rates of poor social support: 36% in Italy, 30% in France and 28% in Belgium.

 

Figure 10.6.1. Frequency of contact to the most contacted child

 

The SHARE study showed that the families remain close in respect to the frequency of contact between parents over the age of 50 and their children. When considering all age groups, daily contact took place between the parent and most contacted child in 41-86% of the cases in the EU-countries, being higher in the Mediterranean countries (Italy, Spain, Greece) and lower in Scandinavian countries (Denmark and Sweden). In all EU-countries, the contact was at least several times a week in at least 75% of the cases. Absent contact was rare in all the participating countries, applying to 1% or less of cases (Kohb et al., 2005).

 

The HBSC study offers some valuable data on social networks of school children. These include school children’s experienced quality of communication with their parents. Ease of communication with parents is considered to be an indicator of social support from parents and family connectedness (Currie et al., 2008).

 

In general, perceived easiness in communication with parents decreases with age for both girls and boys. In general, young people of all age groups and both sexes regard communication with their mother easier than with their father. Of the current EU countries, the least easy communication with the mother is reported from the French-speaking area of Belgium in all age groups between 11 and 15 years and from France in the 15 year old group. 77% of 11 year old girls, 65% of 13 year old girls and 61% of 15 year old girls in the Walloon region report easy communication with their mother. In contrast, in Greece, 96% of 11 year old girls, in Slovenia and the Netherlands, 92% of 13 year old girls, and in Slovenia, 88% of 15 year old girls report easy communication. Also for the boys, the lowest proportion reporting easy communication was found in Wallonia, together with Luxembourg. 76% of 11 year old boys, 74% of 13 year old boys, and 69% of 15 year old boys in Wallonia report easy communication (Currie et al., 2008).

 

Figure 10.6.2. 15-year old girls in the EU having three or more close friends of the same gender

 

Figure 10.6.3. 15-year old boys in the EU having three or more close friends of the same gender

 

Friendships offer acceptance and group belonging and assist in developing other relationships later on. European adolescents have three or more close friends of the same gender in more than 50% of cases, the proportion dropping slightly with age. In general, more close friends were reported in North and West Europe compared to South Europe and East Europe for girls. Boys are more likely to have three or more close friends of the same gender than girls (Currie et al., 2008).

 

Figure 10.6.4. Use of electronic media contact by 15-year-olds in the EU

 

The HBSC study shows the importance of new media in relationships. The use of electronic media, mobile telephones and internet for contact with peers was common and increasing with age, and more common in all age groups among girls than among boys. Of the EU countries, Lithuanian school children made a more often use of electronic media for daily contact (59%of the 11 year old girls and 44% of boys, 78% of the 13 year old girls and 56% of boys). The same proportion of boys using electronic media contact daily was reported in Denmark (of the 15-year old Danish school girls accounted for 83% and boys for 70%). Least electronic media contact was used by Hungarian school children. Among 11 year old Hungarian girls only 13% had used electronic contacts, among 13 year old Hungarian girls 27% and among 15 year old Hungarian girls only 33%. (Currie et al., 2008).

 

To conclude, relatively few data are available from EU on social networks, an important health determinant. Given the importance of social networks for health, data need to be collected systematically and at regular intervals using a common methodology in order to monitor how these health determinants differ between countries and develop over time.

 

Safety perception

 

The perception of safety is naturally related to the crime rates and the risk for victimization (Van Dijk et al, 2005).

 

Figure 10.6.5. Exposures to assaults and threats and their time-trends in selected EU countries

 

However, looking at the subjective perception of safety, it is especially the occurrence of physical or environmental cues in the residential environment that leads to insecurity and feelings of not being safe. Such cues can e.g. be physical incivilities such as deterioration of neighbourhoods, trash or graffiti (indicating a low community spirit and, in effect, a low social control), and social incivilities such as conspicuous youth groups or people with a strange behaviour (questioning the degree to which social norms and customs may be kept) (Austin et al, 2002).

 

Overall, people are more likely to maximize the use of outdoor space if the area is perceived as safe (Shenassa et al, 2006). Street lighting, police patrols and adequate environmental and building design improvements show crime reduction effects and increase the confidence of residents at night-time (Carter et al, 2003).

 

10.6.1.4. Control tools and policies

 

Social networks play an important role in determining mental health and well-being, but also have a strong influence on general health. Social cohesion -defined as the quality of social networks and the existence of trust, mutual obligations and respect in the society -protects health.

 

The renewed EU Sustainable Development Strategy, adopted by the Council in 2006, stresses the need to promote a democratic, socially inclusive, cohesive, healthy, safe and just society with respect for fundamental rights and cultural diversity. This creates equal opportunities and combats discrimination in all its forms. Actions to promote social inclusion in Europe have already been envisaged. Moreover, the implementation of the social inclusion strategy will support social networks among EU citizens.

 

10.6.1.5. Future developments

 

Social networks protect physical and mental health. Their importance has often been underestimated and neglected in epidemiological research and health policy making. Social networks and connectedness should be included in health surveys and epidemiological data analysis, so that their influence will be understood better and used for a better targeting of detection, health promotion, prevention and treatment measures.

 

10.6.1.6. References

 

Austin DM, et al (2002): The effects of neighborhood conditions on perceptions of safety. In: Journal of Criminal Justice 30: 417-427.

 

Beaudet M (1996). Depression. Health Rep 7:11-22.

 

Börsch-Supan A, Jürges H. (2005). The Survey of Health, Aging, and Retirement in EuropeMethodology. Mannheim: Mannheim Research Institute for the Economics of Aging (MEA), 2005. Available at http://www.share-project.org/new_sites/Documentation/TheSurvey.pdf

 

Carter SP, et al, (2003): Zoning out crime and improving community health in Sarasota, Florida: “crime prevention through environmental design”. In: American Journal of Public Health 93(9): 1442-1445.

 

Currie C, Gabhainn S, Godeau E, Roberts C, Smith R, Currie D, Picket W, Richter M, Morgan A, Barnekow V (Eds.). HBSC international report from the 2005/2006 Survey. Copenhagen, WHO Regional Office for Europe, 2008 (Health Policy for Children and Adolescents, No. 5). Available also online at: http://www.euro.who.int/eprise/main/WHO/InformationSources/Publications/Catalogue/20080617_1.

 

De Vogli R, Chandola T, Marmot MG (2007). Negative aspects of close relations and heart disease. Arch Intern Med 167(18):1951-7.

 

Ganster DC, Victor B (1998). The impact of social support on mental health and physical health. Br J Med Psychol 61(1):17-36.

 

Kaplan GA, Salonen JT, Cohen RD, Brand RJ, Syme SL, Puska P (1988). Social connections and mortality from all causes and from cardiovascular disease: prospective evidence from Eastern Finland. Am J Epidemiol 128(2):370-80.

 

Kessler R, McLeod J, Wethington E. The cost of caring: a perspective on the relationship between sex and psychological distress. In: Social support: Theory, research and applications. Editors Sarason et Sarason. Martinus Nijhoff Publishers, the Netherlands, 1985.

 

Kohb M, Künemund H, Lüdicke J. (2005): Family Structure, Proximity and Contact. In: Health, Ageing and Retirement in Europe - First Results from SHARE. Edited by Axel Börsch-Supan, Agar Brugiavini, Hendrik Jürges, Johan Mackenbach, Johannes Siegrist, and Guglielmo Weber, Mannheim: MEA, 2005. Available at: http://www.share-project.org/t3/share/index.php?id=69

 

Nosikov & Gudex (eds.). EUROHIS: Developing Common Instruments for Health Surveys. IOS Press, WHO, 2003.

 

Saisto T, Salmela-Aro K, Nurmi JE, Halmesmäki E (2008). Longitudinal study on the predictors of parental stress in mothers and fathers of toddlers. J Psychosom Obstet Gynaecol. Mar 29:1-10. [Epub ahead of print]

Shenassa, E., Liebhaber, A., Ezeamama, A. (2006): Perceived Safety of Area of Residence and Exercise: A Pan-European Study. In: The American Journal of Epidemiology 2006;163:10121017

Van Dijk J, Manchin R, Van Kesteren J, Hideg G, Nevala S (2005): The burden of crime in the EU. A comparative analysis of the European Survey of Crime and Safety (EU ICS) 2005.
Available at: (http://www.unicri.it/wwd/analysis/icvs/pdf_files/EUICS%20%20The%20Burden%20of%20Crime%20in%20the%20EU.pdf)

 

10.6.1.7. Acronyms

 

HBSC

Health Behaviour in School-Aged Children

OSS-3

The 3-item Oslo social support scale

SHARE

The Survey of Health, Ageing and Retirement