Strategy for Equitable Change: Building Social Cohesion

This is part of the Salud America! Achieving a Cohesive Culture for Health Equity in Latino and All Communities: A Research Review»

Why Social Cohesion is Important

The far-reaching effects of poverty have been well documented; the material hardships associated with poverty, including food insecurity and difficulty meeting basic medical and housing needs, lead to worse health outcomes.86

An inability to provide for family members leads to parental stress, which compromises marital and parent-child relationships due to a reduced capacity for warm and responsive interactions. The chaotic home lives and the community conditions characteristic of low SES areas — such as community violence and substandard housing — are linked to worse socioemotional outcomes for children. Poorer quality schools, high levels of unemployment, social isolation, and a lack of positive peer influences are common in high-poverty areas.87

Those living in poverty are often socially excluded due to the financial inability to participate in social activities.

Diverse neighbors social cohesion intergroup contact cohesive culture research review2Social networks, including family, friends, work-based, and community relationships, whether face-to-face or remote, are important. Interaction with others does affect outcomes, as relationships can facilitate the sharing of resources, help increase opportunities, and improve livelihood. In general, high levels of social capital in a community are associated with lower crime rates, better health, and overall well-being.87

People who are more satisfied with life and who have a greater sense of well-being are more likely to be socially engaged, manage their health problems better, and live longer than those with high levels of negative emotion. The concept of positive health posits that people desire well-being above and beyond even the relief of their suffering.88

In a cross-sectional analysis of data from 2,554 Latino participants in the National Latino and Asian American Study, Alegria89 investigated the relationships between family support, friend support, family cultural conflict, and neighborhood social cohesion with self-reported physical and mental health to determine how the three domains of social connection — family, friends, and community — were associated with the physical and mental well-being of Latinos. The social connection variables were measured using various scales, including a social cohesion scale assessing neighborhood characteristics, including the ability to trust and rely on neighbors; a family support scale assessing the ability to rely on family members for emotional support; a friend support scale; and a family cultural conflict scale. Physical and mental health were rated on a five-point scale from poor to excellent.89

The study found that physical health was significantly associated with both social cohesion and friend support (P < 0.001); there were also associations with the family support and cultural conflict scales, though these were less significant.

Mental health, however, was significantly associated with all four scales, and had the strongest associations with friend and family support (P < 0.01). Household income was significantly associated with all scales except family cultural conflict, and social cohesion was significantly associated with family and friend support (P < 0.001). These results suggest that family, friends, and social cohesion have significant effects on the physical and mental well-being of Latinos.89

In a review of the literature on social cohesion, Schiefer and van der Noll90 note a pervasive ambiguity in the research. This ambiguity involves both the definition of social cohesion and the parameters by which it is assessed and measured. In reviewing the literature, Schiefer and van der Noll identified three essential dimensions of social cohesion: social relations, identification with the geographical unit, and orientation toward the common good. The authors provide a somewhat broader definition of social cohesion as a descriptor of the quality of collective togetherness and, as such, social capital is also an important part of social cohesion, and includes measures such as perceived fairness, perceived helpfulness, group membership, and trust. This quality of a society changes gradually over time.90

The Decline of Social Cohesion

Social cohesion has declined in the U.S. in recent decades, due in large part to the deprivation and inequality experienced by those in poverty as the gap between the rich and the poor continues to widen.

Social erosion is a term that may be applied to the degradation of social cohesion.91,92 Participation in social events and acting in favor of the common good become particularly difficult when income and resources are low. An unequal distribution of resources isolates the less fortunate, excluding them from sociocultural life.90,93

How Increasing Social Cohesion Can Help People of Color and Those in Poverty

Conversely, when individuals or groups have equal access to resources, this allows for equal participation and networking, promoting a sense of trust and belonging, security and self-worth.

This in turn strengthens the desire for social participation and fosters social cohesion.

An increase in social cohesion can create feelings of solidarity, and this manifests as eagerness to help others, on an individual level, and enhanced social welfare systems, on an institutional level. A cohesive society is an inclusive one; a society without significant disparities in health, wealth and income, one that values individuals’ backgrounds, integrating those from different backgrounds in such a way that everyone can relate to one another.

Studies by Uslaner94 and Stolle et al.95 have found that while increased neighborhood or community diversity has a negative effect on trust and social cohesion, this negative effect is mediated by direct contact between in-group and out-group members. This suggests that it is the development of out-group hostility, isolation, and segregation (both socioeconomic as well as racial/ethnic) as a response to increased diversity, rather than the increase in diversity itself, that erodes social cohesion. Social cohesion should therefore represent the capacity of a society to ensure the long-term physical and psychological well-being of its members.90,94,95

A survey of population samples in 10 cities across the U.S. found that city mortality rates were significantly correlated with mean hostility scores in each city; additionally, measures of interpersonal trust were strongly correlated with both mortality and income inequality, and income inequality was significantly associated with violent crime and homicide. These correlations suggest a robust and systematic association between income inequality, social relations, and the social environment within a society.93

Diverse crowd group people wearing medical masks protection coronavirus epidemic cohesive culture social cohesionFurthermore, state mortality rates are more closely related to income distribution than median income, suggesting that, when income is a measure and determinant of social status, it has an impact on health.96 In a study of associations between the measures of social capital — perceived fairness, perceived helpfulness, group membership, and trust — and income inequality and mortality, all four measures were associated with mortality. Additionally, the relationship between mortality and income inequality was moderated by reduced social capital as income inequality increased.93

Social status and social relationships are important influences on population health. Early emotional trauma, poor attachment, and domestic conflict, which are common among those living in and raised in poverty, also create stress in similar ways as low social status and lack of social support, negatively impacting health due to insecurity, fear of inadequacy, and lack of confidence. The social hierarchy as it stands is essentially a hierarchy of human worth, with the most successful and competent at the top. Friendships and other social affiliations can counteract these negative affects by providing positive feedback, increasing confidence and feelings of adequacy and self-worth.96

An Example of Social Cohesion

One example of a connected community effort is the redevelopment of Sunnydale, the largest public housing community in San Francisco.

Sunnydale has been defined by poor housing and extreme poverty and violence.

Baseline data, including social and physical needs, was collected on all Sunnydale residents prior to starting redevelopment, which will include replacement of all existing housing with the addition of new units as well as a fitness center, educational facilities, arts program, health clinic, farmers market, and acres of green space.

Additional data on the residents will be collected over time to determine the social and physical impacts of the project, which also aims to find jobs for Sunnydale residents in growing job sectors.97

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References for this section »

86. Chaudry A, Wimer C. Poverty is not just an indicator: The relationship between income, poverty, and child well-being. Acad Pediatr. 2016;16(3):S23-S29.

87. Gilchrist A, Kyprianou P. Social networks, poverty and ethnicity | JRF. https://www.jrf.org.uk/report/social-networks-poverty-and-ethnicity. Published 2011. Accessed June 15, 2020.

88. The Robert Wood Johnson Foundation (RWJF). Exploring the Concept of Positive Health: Identifying Strengths to Prevent Illness, Improve Well-Being. https://www.rwjf.org/en/library/research/2017/08/exploring-the-concept-of-positive-health.html. Published 2017. Accessed June 15, 2020.

89. Mulvaney-Day NE, Alegría M, Sribney W. Social cohesion, social support, and health among Latinos in the United States. Soc Sci Med. 2007;64(2):477-495. doi:10.1016/j.socscimed.2006.08.030

90. Schiefer D, van der Noll J. The Essentials of Social Cohesion: A Literature Review. Soc Indic Res. 2017;132(2):579-603. doi:10.1007/s11205-016-1314-5

91. Gardels N. Behind the breakdown of political consensus. https://www.washingtonpost.com/news/theworldpost/wp/2018/09/21/social-cohesion/. Published September 21, 2018. Accessed June 15, 2020.

92. Larsen C. The Rise and Fall of Social Cohesion: The Construction and De-Construction … – Christian Albrekt Larsen – Google Books. Oxford University Press; 2013.

93. Social Cohesion | Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/social-cohesion. Accessed June 15, 2020.

94. Uslaner E. Segregation and Mistrust: Diversity, Isolation, and Social Cohesion. doi:10.2139/ssrn.1523709

95. Stolle D, Soroka S, Johnston R. When does diversity erode trust? Neighborhood diversity, interpersonal trust and the mediating effect of social interactions. Polit Stud. 2008;56(1):57-75. doi:10.1111/j.1467-9248.2007.00717.x

96. Wilkinson RG. Income inequality, social cohesion, and health: Clarifying the theory – A reply to muntaner and lynch. Int J Heal Serv. 1999;29(3):525-543. doi:10.2190/3QXP-4N6T-N0QG-ECXP

97. Cassidy A. Community Development and Health: Organizations promoting jobs, housing, and better conditions in low-income neighborhoods also focus on health. Heal Aff RWJF Heal Policy Br. 2011. https://www.rwjf.org/en/library/research/2011/11/community-development-and-health.html. Accessed June 15, 2020.

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