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Supported by CIS-HDGEC, Carnegie Mellon University, Pittsburgh. NSF Center of Excellence, SBR-9521914. Living in groups, dying alone: A population health perspective on resilience. James Tansey SDRI, UBC. Overview. Introduction and justification Central messages in population health

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living in groups dying alone a population health perspective on resilience

Supported by CIS-HDGEC, Carnegie Mellon University, Pittsburgh.

NSF Center of Excellence, SBR-9521914

Living in groups, dying alone: A population health perspective on resilience

James Tansey


  • Introduction and justification
  • Central messages in population health
  • Social networks and health
  • Study design
  • Initial results
  • Conclusions
climate change and health external factors
Climate change and health:External factors
  • Mosquito born diseases
  • Increased heat waves
  • Extreme events
  • Urban air quality
  • Range and seasonality of infectious diseases
  • Biotoxins from marine environmental change
  • Changes in food supply affecting nutrition
  • Economic decline affecting health indirectly (Watson et al, 2001: 259)
adaptation options
Adaptation options

Source: Watson et al, 2001: 261.

social dimensions of health
Social dimensions of health?

‘There is little published evidence that changes in population health status actually have occurred in response to observed trends in climate over recent decades. A recurring difficulty in identifying such impacts is that the causation of most human health disorders is multifactorial, and the “background” socioeconomic, demographic, and environmental context changes significantly over time’ (Watson et al, 2001: 259)

environmental and social risk
Environmental and social risk

Risks and hazards as external ‘natural’ events with human health impacts

Exposure and vulnerability to risk determined by social and institutional conditions

Social risk and resilience: population health perspective on human health and well being

inequality and mortality
Inequality and mortality

Ross et al, 2000 in Evans

class and health
Class and health

Similar trend seen in Whitehall study

Longitudinal study showed raised mortality and morbidity by job grade

Included controls for smoking etc.

Source: Marmot et al, 1998

social networks and mortality
Social networks and mortality

Social network measures:

Marriage, contact with friends and family, church membership and formal/ informal memberships

9 year prospective study

Berkman and Syme in

House et al 1988.

central message of population health literature
Central message of population health literature
  • Social factors are at least as important as external factors in determining health and well-being
  • Not simply health transition effects
  • Inequality, mastery, demand, control, sense of agency all significant
  • Impacts on hypertension, stress reactivity, immune system integrity, mental health.
relevance to climate change
Relevance to climate change
  • Increase resilience to uncertain climate change and variability impacts by addressing known social factors:- reduce stress and resulting strain especially in childhood- inequality may be a proxy for social isolation and vulnerability, esp. in US- social networks as insurance in crises
lifecourse health model


Income/inequality, social exclusion and capital, status


Parental stress, mental health, nutrition

Working conditions, control, employment security, socially mediated health behaviours

Social support and survival rates


Social support and biological embedding

Kin based social support, psychological state

Individual Lifecourse




Lifecourse health model
invention of social capital
Invention of ‘social capital’
  • Capital as kind of power: money makes things happen
  • Human capital: value in people
  • Social capital: value in social groups
  • Coleman’s three key arguments
    • Social relations as insurance
    • Social relations as common language
    • Social relations create predictability
  • Is Social Capital like other forms of capital?
  • ‘the aggregate of actual or potential resources which are linked to possession of a durable network of more or less institutionalized relationships of mutual acquaintance or recognition’ (Bourdieu 1985: 248)
  • ‘features of social life – networks, norms and trust – that enable participants to act together more effectively to pursue shared objectives’ (Putnam, 1995: 664–65).
social networks and health
Social networks and health
  • Problems with social capital: too much baggage, confuses means with ends, narrow measures, only sees benefits.
  • Emphasis on social networks instead
  • Ecological studies in US show strong links with health: 1% rise in inequality = 21.7% rise in SMR
  • Individual level studies show no effect in Canada
  • Multi-level and multi-strategic approaches essential
social networks and resource dependent forest communities
Social networks and resource dependent forest communities
  • Highly dependent on health of natural systems
  • Exposed to acute crises and structural change over two decades
  • Methods: nation survey with oversample (6500/1500), detailed contextual data (health, census, economic, educational), intensive analysis of clusters
  • Follow-up survey underway
key variables at sawmill scale
Key variables at sawmill scale
  • Dependent: Self-rated health
  • Individual independent: Contact with family, neighbours, economic security, income, education, membership of service, recreational, religious, helping, youth clubs, trust, ethnicity
  • Aggregate independent: census variables
charity and church
Charity and church

Attend church, religious services

disruption index



Powell River

Port Alberni





Aggregate deviation








Disruption index
  • When the going gets tough, the poor get going
  • Need to understand whether and how resource communities different
  • Significant differences between communities
  • National level analysis showed weak but significant relationship between social capital and health
  • Need to drill down through qualitative analysis
  • Social networks strongly related to traditional demographic variables
  • Educational factors very significant
  • Multi-level model of health underway
  • Second survey underway
  • Multistrategic methods required