Humans are dependent on other human beings. Group living is perhaps one of the most significant aspects of humanity, and our well-being may be threatened if social relationships are stressful. Experiencing abuse in the family or being bullied are social stressors. Living in a violent neighborhood is another example.

On the other hand, stress can be alleviated via social support—for example, having good friends or a loving family. Warm and nurturing families teach children how to manage stress effectively.

Poverty and social hierarchy

Sapolsky's research on the physiological effects of stress in baboon troops was ground-breaking. The idea that social hierarchies - and our place within a social hierarchy - could affect our health challenged the idea that those at the top of the hierarchies must be the most stressed. At least in baboons, it appeared that those at the bottom were the most stressed - and had the most negative health effects.

Tung et al (2012) carried out research with female macaques that shows that one's place in the hierarchy leads some genes to express themselves. They manipulated the hierarchy by using middle-ranking female macaques and introducing them into a new group one at a time. Newly introduced monkeys almost always adopt a role subordinate to existing group members. The researchers took blood samples to determine the effect of the hierarchy on the genetic expression in the monkeys.

They found that the monkeys at the bottom of the hierarchy had more activity in genes associated with the production of immune-related cells and inflammation. In humans, chronic inflammation and stimulation of the immune system is a risk factor for many different diseases - ranging from heart trouble to Alzheimer's disease.

They also found that low-ranking monkeys had higher rates of glucocorticoids. It is believed that this hormone may play a key role in the gene expression observed in the study. This research goes a long way in explaining why a hierarchy may actually lead to health problems for those lower down in the system.

Looking at the research on hierarchies, that leads us to the question - does poverty in and of itself lead to poorer health? There are two different positions on this argument.

Evans & Kim (2007) argue that poverty exposes people to risk factors that lead to a higher vulnerability to stress and, therefore, poorer health. Their vulnerability theory was tested by evaluating the health of 207 thirteen-year-olds living in poverty in the US. Qualitative data was also gathered regarding their exposure to risk factors such as domestic violence, crime in their neighborhood or lack of quality housing. The researchers found that the greater the number of years spent living in poverty, the greater the number of health issues. Most significantly, children who had lived in poverty for an extended period of time had higher overnight levels of cortisol and showed early signs of poor cardiovascular health.

However, the argument about risk factors cannot account for the fact that in the poorest societies on the planet, we still see the trend that those at the top of the hierarchy have better health than those below. It has been found that among the wealthiest quarter of countries on earth, there is no relation between a country’s wealth and the health of its people – in other words, living in a wealthy country does not guarantee that you will be healthier than people living in a less wealthy country. In fact, people in Greece on average earn half the income of Americans yet have a longer life expectancy. How can this be true?

When looking at the role of social factors in stress, it is impossible to rule out either biological or cognitive factors. Wilkinson (2001) has argued that it is the level of income inequality that is the most predictive of one’s health – rather than simply one’s socio-economic status.

This was demonstrated by a clever study carried out by Operario et al (2004). In their study  participants looked at a diagram of a ladder with 10 rungs and then were asked, “In society, where on this ladder would you rank yourself in terms of how well you’re doing?” The ladder was not labeled in any way to indicate income level – it was completely up to the participant to decide how they defined the rungs of the ladder. The researchers found that one’s subjective assessment of his/her socioeconomic status was a predictor of one’s level of cardiovascular health.  The research assumes that the act of social comparison is a chronic stressor, especially when social mobility is limited.  It may be that upward comparison –  that is, comparing yourself to those who have more in society than you do, may be the root of poor health, and not simply the risk factors in your community.

Social support as a protective factor

Social support is exceptionally important for maintaining good physical and mental health. Remember the study by Cohen on common colds in the section on the biological aspects of health? 

Overall, it appears that positive social support of high quality can enhance resilience to stress. In the Alameda County Study (Breslow and Breslow, 1993) 6,928 participants completed questionnaires regarding their health, social network, and personal characteristics. Follow up interviews and questionnaires took place at intervals for up to 20 years.  The findings indicated that men and women without ties to others were 1.9 to 3 times more likely to die from heart disease, stroke, cancer, or a host of other diseases over the duration of the study compared to individuals with many more social contacts.

 Teacher only box

1.  Make a list of the stressors that you would personally experience if tomorrow you moved to a new country.  How does this list differ from the stressors you would assume that a refugee would experience?

The goal of this question is to help students think more deeply about the refugee experience; it is not simply that people are moving homes or leaving their country to live and work in another country.

2. What could your school community do to help promote better health among refugees in your community?

According to the study, social support is important.  So, although going to a refugee center and volunteering to speak English with a refugee may be seen as good for helping their job opportunities (and it is), the more important aspect may be the friendship and sense of social support that is developed as a result of this commitment to weekly English lessons.