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How do social interactions and support systems positively or negatively influence the desired health outcome?

It should be emphasized at the outset that the social determinants of health can be conceptualized as influencing health at multiple levels throughout the life course. Thus, for example, poverty can be conceptualized as an exposure influencing the health of individuals at different levels of organization—within families or within the neighborhoods in which individuals reside. Moreover, these different levels of influence may co-occur and interact with one another to produce health. For example, the detrimental health impact of growing up in a poor family may be potentiated if that family also happens to reside in a disadvantaged community (where other families are poor) rather than in a middle-class community. Furthermore, poverty may differentially and independently affect the health of an individual at different stages of the life course (e.g., in utero, during infancy and childhood, during pregnancy, or during old age).

In short, the influence of social and cultural variables on health involves dimensions of both time (critical stages in the life course and the effects of cumulative exposure) as well as place (multiple levels of exposure). The contexts in which social and cultural variables operate to influence health outcomes are called, generically, the social and cultural environment.

An association between SES and health has been recognized for centuries (Antonovsky, 1967). Socioeconomic differences in health are large, persistent, and widespread across different societies and for a diverse range of health outcomes. In the social sciences, SES has been measured by three different indicators, taken either separately or in combination: educational attainment, income, and occupational status. Although these measures are moderately correlated, each captures distinctive aspects of social position, and each potentially is related to health and health behaviors through distinct mechanisms.

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