Social Determinants, Social Support and Health: a Critique

Abstract

The two principal lines of research in the social determinants program focus on the association of socioeconomic status and networks/affiliations to health. This paper critiques the ‘network’ approach as summarized in a recent comprehensive statement by Berkman et al. An analytic review concludes that this programmatic statement is just that; it is not the causal explanation that it claims to be. A second analysis examines the specific social support explanation and finds that it too has no causal relevance. At best social support is an ‘effect modifier’ hypothesis, but a fundamental mistake in measurement weakens that claim. The remaining argument for causality is undermined by the part for the whole fallacy. Personal ties are simply one type of response that superior problem-solving individuals employ. The responding person, not a particular kind of interaction, is the more plausible locus of causality. The consequences of abandoning the network/affiliations explanation of health are considered and the claims of an alternative theory, one that explains both the SES and the social support findings, is referenced.