Social Networks in Medicine

Social Networks in Human Disease: One of the many layers of Network Medicine

In the last few decades, and recently accentuated by contact tracing amid the COVID-19 pandemic, the medical and scientific community has grown increasingly attuned to the profound ways that social networks—the web of relationships connecting individuals—affect human health. Traditionally, much of medicine has focused on factors "under the skin," such as genetics, molecular mechanisms, microbes, etc. Yet, an emerging body of research underscores the importance of examining factors "above the skin"—the social environments, structures, and processes in which humans are embedded. This perspective provides a richer understanding of how diseases originate, spread, progress, resolve, or persist.

A Conceptual Model of Social Networks and Health

The connection between social relationships and health is far from a new idea. Seminal work by sociologist Émile Durkheim on social integration and suicide, as well as psychiatrist John Bowlby's attachment theory, laid foundational insights. Building on these, contemporary researchers have developed a conceptual model that illustrates the cascading influence of social networks on health outcomes.

This model begins at the macro-social level, recognizing that cultural norms, societal structures, and policies shape the nature and quality of social networks. For instance, economic inequality or structural racism and discrimination (SRD) can create stratified networks that influence health disparities. These upstream forces set the stage for the formation, structure, and function of individual social networks.

Moving downstream, the model identifies how social networks operate through four key pathways:

1. Social Support
   Relationships provide emotional, instrumental, and informational support. This can include the reassurance of a friend during times of stress or practical help, like childcare or financial assistance during illness. Social support buffers individuals against stress and may promote recovery from illness.

2. Social Influence (Peer Pressure)
   Networks shape behaviors and norms. For example, individuals embedded in health-conscious social groups are more likely to adopt healthy behaviors like exercising or quitting smoking. Conversely, networks can perpetuate harmful behaviors, such as substance abuse or sedentary lifestyles.

3. Social Engagement and Attachment
   Human beings are inherently social. Active engagement in relationships fosters a sense of belonging and purpose, reducing the risks of depression, anxiety, and other health issues related to social isolation. To put it plainly: loneliness is a well known risk factor for mental and physical health issues.

4. Access to Resources and Material Goods
   Networks act as conduits for resources. Being part of a well-connected network may offer access to nutrition, education, employment opportunities, healthcare information, or financial resources, all of which can directly impact health.

Implications for Health Research and Interventions

Understanding health "above the skin" has profound implications for public health and clinical practice. It calls for:

1. Multilevel Interventions: Addressing upstream factors, such as social and economic inequalities, while also targeting individual behaviors within networks.

2. Enhanced Assessment Tools: Employing rigorous methods to quantify and analyze the structure and function of social networks.

3. Integration Across Disciplines: Bridging sociology, psychology, and biomedicine to create holistic models of health and disease.

By embedding health research within the broader context of social networks, we can move toward a more comprehensive understanding of human health. Social networks are not blank canvases in which we live—they are dynamic and interconnected systems that profoundly shape our physical and mental well-being.

Ultimately, recognizing the power of these "above the skin" factors can inspire innovative approaches to healthcare, emphasizing the importance of community, connection, and culture in the prevention and treatment of disease.

Reference: Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000 Sep;51(6):843-57.