Good health is a commodity that is arguably hard to attain and difficult to maintain. The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2019). Health has also been shown to be impacted by several social determinants of health (SDoH) that we face as individuals and as a society. According to WHO (2019), SDoH is the circumstances in which people are born, grow, work, live, and age, and the large array of systems and forces that shape the conditions of everyday life. Several SDoH influences health and wellbeing either through a direct pathway such as the effect on mental health or indirectly through the interaction of income and education on health. Due to this impact of SDoH on the overall outcome of life, this reflection paper will examine the effect of SDoH on wellbeing. More specifically using data entries from my daily logs between October 3rd and October 9th as examples and various theoretical frameworks and literature evidence to support claims, this paper will draw on three SDoH selected from the log and reflect on how they interact as a whole to affect my wellbeing. The reflection will then illustrate how my social support network, my culture, and my (un)healthy behaviors interact with each other and work as a system to impact my wellbeing.
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The effect of a social support network on health and wellbeing has been proven globally and supported by evidence to explain the bidirectional nature of the association (Gallagher, 2008). Lin et al., (1979) describes social support as a type of support that is accessible to individuals through social ties to others, groups, and the larger community. My family, friends, and peers have all played very important roles in my life not only during times of stress but also in celebratory moments. Granovetter (1978) notes that the influence any individual has on another’s behavior may depend upon the relationship between them and classifies family and close friends as strong ties while neighbors and peers form weak ties. My social support networks are often available when I need them, and they all take on different functions in my life. For example, my family is more involved when it comes to critical issues in my life such as health concerns while my friends and peers are more helpful when it comes to providing basic information on an issue of concern or helping me cope with mini stressors of life. The different effect each of them has on me is what Granovetter (1973) termed as the effect of strong ties versus the strength of weak ties in interpersonal relationships.
According to Granovetter, the strength of ties in interpersonal relationships is a combination of the emotional intensity, the intimacy, the amount of time, and the reciprocal services which characterize the tie (Granovetter, 1973). As such, in strong ties, these characteristics are more prominent to a larger extent than weak ties. Although I have a transcendent relationship with my friends and peers, they often would not be my first point of contact during a difficult moment in my life if I could just as easily reach my family. Recently while completing my daily logs, I experienced a few low points in the day and even though I was with my peers throughout the week, I did not go to them for support. Instead, I called my grandmother who lives in a different country just to have a conversation. She had a warmth that I experienced growing up and felt comfortable with any advice she offered. I also trusted that she will always know what the right to say is and as such I did not hesitate to call her during such moments.
Although I can confide in my grandmother about almost anything, there are certain conversations I will not have with her for the sole reason that she is family. These conversations may range from movie preferences to reminiscing about past social experiences with my friends. I can however comfortably engage in such conversations with my friends and peer groups. This is made possible by virtue of my weak ties operating as a bridge which Granovetter (1973) argues encourages the diffusion of behaviors, ideas, and information across individuals who under normal circumstances position themselves distant in a social network (Somma, 2009). This deduction applies to several situations I recorded in the daily logs. In one specific log entry, I discussed the process of gathering information on dental care coverage at Western University. This process required that I find information about the coverage, what it entailed and the duration of coverage. This information was all gathered from my peers who were aware of the coverage and I based my decision to make an appointment on their past experiences with the coverage, confirming Granovetter’s theory that weak ties will be more likely to trigger a positive response to a suggestion (Granovetter, 1973).
Just as there is an enormous amount of evidence that shows the influence of social support networks on health, the impact of culture and religion on wellbeing has been shown in several studies and even in mainstream media. Cambridge Dictionary defines culture as “the way of life, especially the general customs and beliefs, of a particular group of people at a particular time” (“Culture”, n.d, culture noun (way of life) section). Culture shapes the way we look at life and even influences social support networks and the coping skills we form. Growing up in a Ghanaian family that emphasized the importance of resilience from a faith-based approach, religion became a medium through which I expressed my solidarity with my family and culture. It also helped me develop healthier coping skills which often manifested as resilience (Ozbay, 2007). When reflecting on how my culture helped me cope with daily life stress, I look toward the collective nature of the Ghanaian culture and the emphasis placed on religion to facilitate this collectiveness. Religion influences social structure in a bidirectional relationship where it expresses its authority through social control and cohesion (Armet, 2009). This sense of power and unity formed serves as a place of inclusion for me and fulfills the need for belongingness.
One of the fundamental teachings of Christianity is love in terms of service to humanity. To practice this teaching, I volunteer at church during the week and on Sunday mornings. There is an association between volunteering at church and my culture as well as my coping skills. As mentioned earlier Christianity as a core aspect of culture and ties to the church in families forms a social structure in which individuals are either included or excluded based on their commitment. The sense of inclusion arises from the acknowledgment of my commitment to religious events by my strong ties and their willingness to offer encouragement and assistance throughout my life course. On the other hand, the sense of exclusion often stems from my lack of participation in church activities. Because of the high demand for my school program on my life and opportunities for socialization in general, I have not been as actively involved in church activities as I was before. In one incident recorded in my logs, I was scheduled to assist with the facilitation of "Coffee Hour" held on Thursday evenings at my church. I was however unable to attend as I spent that evening completing course assignments with my learning team members. Because I was unable to assist with the program a week prior, my church clergy was not pleased with me and I was not asked to help with the facilitation of the program after that.
Volunteering in church does not only serve as a means of social inclusion but also, provides an avenue for me to develop healthier coping skills and stress mitigating strategies. For example, my daily logs contained my activities with the church and the overall outcome. Greeting and welcoming members at the church took my mind off all the school assignments that were due in the coming week which were causing me stress. As I socialized with other in-group members, I felt that I belonged and cared for when the members took an interest in my life. In this case, the members of my church served as my social support network through weak ties.
Healthy behaviors and the management of stress are shaped by both internal and external factors and the intersecting aspects of our lives of which culture and social support networks play key roles. According to Schneiderman et al. (2005) stressors strongly influence our sense of wellbeing, behavior, health, and mood on a day to day basis. While daily stress becomes a normal part of our lives, the maintenance of health and wellbeing depends on the internal balance we hold in the face of the constantly changing environment (Bernard, 2018). Schneiderman et al. (2005), moreover explains the importance of acute stress and its adaptiveness in young people, causing a minute shift in the homeostasis Bernard (2018) hypothesized, however, with no impeding long term negative outcomes.
As these authors explained, my day to day life experiences encompasses acute stressors that often shake up this balance and cause a short-term impact on my hypothalamic-pituitary axis (HPA axis). Acute stressors such as missing the bus to class cause an emotional reaction of distress which then leads to biological response through the activation of the sympathetic nervous system (SNS) and HPA axis (Cohen et al., 2007). This biological response is due to the immediate activation of the SNS by the stressor to provoke an involuntary action needed to handle the stress (Chrousos & Gold, 1992). The response then activates the HPA axis with time which is responsible for either improving, repressing or compensating the effects elicited by the SNS. Even though missing the bus makes me upset and unhappy, this emotional response only lasted a short time and therefore the habituation to that stressor is marginal. This resulted in higher habituation of the HPA axis, significantly reducing the onset of physical symptoms (Kirschbaum et al., 1995) and minimal impact on vital exhaustion (Kudielka et al., 2006) and thereby mitigating chronic stress arising from missing the bus.
Even though research has shown the benefits of healthier responses to stressful events, reflecting on my daily logs, there were a lot of negative responses and reactions to these events. An ongoing stressor I recorded was the lack of a school-work-life balance. Because of the demanding nature of my program and the many deliverables that are required, I am not able to commit to working significant hours to meet my financial needs. As a result of my financial constraints, I am unable to have a balanced social life because whenever I am not working, I am focusing on completing a school assignment. In frustration with this push-and-pull battle of finding balance, I sometimes react negatively. An example of my negative reaction to stressful events I logged was losing sleep in order to complete school assignments. Evidence has shown the importance of sleep in mental health. Because of this lack of sleep oftentimes, my circadian rhythm is impacted, increasing my cortisol levels and resulting in feelings of irritation which I sometimes react negatively when faced with the least provocation which includes verbal arguments with a person of interest (Freeman, 2017). This negative reaction outburst often subsided in headaches and anxiety.
Research has provided evidence that identifies social support as one of the most effective ways that enable people to cope with stressful events (Kim et al., 2008). As an individual who comes from a collective culture, there is an unspoken assumption that there is unsolicited social support readily available to me. Even from when I was a little girl, there was the tenet that I was not required to ask for support of any kind from my strong ties. My culture emphasized that my strong ties would anticipate my needs and would be readily available to address them in the best of their capacities (Kim et al., 2008). This unsolicited support is evident in my daily logs showing my interactions with my strong ties specifically my sister and my grandmother. Even though I did not express my concerns or voice out problems I was encountering when I spoke to them, they were able to sense my distress through conversations and provided support without explicitly recognizing it. In this way, they served as a buffer against the potential adverse effect of the daily stressful events I encountered (Lin, 1985).
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Just as culture can mold religious views and affiliations, it also influences health in terms of how it shapes and frames our perception of the world (Armet, 2009). As discussed above, my culture stresses the importance of resilience and the concept of experiencing and overcoming struggles gracefully by avoiding complaints, working hard and becoming a productive member of society. While I experience the natural sense of unsolicited support from my strong ties culturally speaking, I also find myself adopting the individualistic nature of Western culture. I often feel that I have the sole responsibility and obligation to solve personal problems myself and not to seek help, emphasizing the "pick yourself up by your own bootstrap" ideology society holds. This could have stemmed from growing up in Canada, a community that promotes unity but at the same time maintains the individualistic nature of problem-solving. (Pomerleau et. al., 1997). On the contrary, developing this individualistic approach to stress management could also have come from a concern about the potentially negative relational consequences of seeking support (Kim et al., 2008). These interpersonal consequences include my fear of possibly disrupting harmony between my strong ties or receiving criticism from them. To minimize these negative social consequences, I often take the independent problem-solving approach and avoid disclosing any distress I may be facing. Oftentimes, this leads to increased stress and occasionally result in unhealthy behaviors such as eating junk foods to cope with the stress, a negative approach that affects my health and wellbeing.
Writing this self-reflection paper allowed me to pause and reflect on how the various social determinants of health interact as a system to affect my wellbeing. In detail, the paper explained how my social support including my network of friends and family influences my ability to cope with stressful events. The reflection further identified the effect my culture and religion have on my (un)healthy behavioral practices and how it loops back in a connection with my social support network. Using various theoretical frameworks, the paper provided literature evidence to support claims made and demonstrated the intersectionality of biological, social and environmental underpinnings that contribute to my overall health and wellbeing. As Public Health officials, understanding the effect of various social determinants of health on wellbeing is critical to identify areas that threaten population health and critically address the gaps that exist. By extension, understanding the effect of SDoH on health and wellbeing will enable the application of a more comprehensive and holistic approach when developing strategies to improve population health and wellbeing.
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