Powell Blake W, Ostertag Stephen F, Chen Xiaojin
School of Liberal Arts, Tulane University, New Orleans, LA, 70118, United States.
Department of Sociology, Tulane University, New Orleans, LA, 70118, United States.
SSM Popul Health. 2022 Mar 4;17:101057. doi: 10.1016/j.ssmph.2022.101057. eCollection 2022 Mar.
Most health care approaches to understanding social ills are rooted in strain or ecological models. Strain models assume that the impact of poor physical health operates through the individual, that it is the individual suffering from poor health who engages in social ills as a means of adapting, and that the impact of poor health is rather direct and immediate. Meanwhile, ecological approaches of health acknowledge how poor health may impact others and the collective, but poorly account for the case in which this is not so, leaving unexplained the many instances of people who are in poor health but remain actively engaged with their communities and preserve relationships that nurture trust, shared norms, and cooperation. To rectify this problem, we introduce the concept of "compulsive immobility": the situation in which those in poor health are compelled to stay indoors and refrain from community socialization. We argue that compulsive immobility mediates the relationship between poor physical health and collective efficacy, suggesting that illness, specifically to a point of physical immobility (e.g., bedridden), enables poor health to detract from collective efficacy. This allows scholars to both acknowledge how poor health may impact the individual and community, while specifying the mechanism through which it operates. To support our claim, we draw on GSS data to examine the relationship among poor health, health-related immobility, and collective efficacy. Our results provide empirical support for our argument, revealing that general health conditions influenced the level of generalized trust directly and indirectly through compulsive immobility. We conclude with suggestions on how compulsive immobility might impact neighborhood crime and propose ways through which subsequent research may refine and further test compulsive immobility as a mediator between poor health and collective efficacy.
大多数理解社会弊病的医疗保健方法都植根于压力或生态模型。压力模型假设身体健康不佳的影响是通过个体起作用的，即正是健康状况不佳的个体参与社会弊病作为一种适应手段，而且健康不佳的影响相当直接和即时。与此同时，健康的生态方法承认健康不佳可能如何影响他人和集体，但对并非如此的情况解释不足，从而无法解释许多健康状况不佳但仍积极参与社区活动并维持培养信任、共享规范和合作的关系的人的情况。为了纠正这个问题，我们引入了“强迫性不动”的概念：即健康状况不佳的人被迫呆在室内并避免社区社交的情况。我们认为，强迫性不动介导了身体健康不佳与集体效能之间的关系，这表明疾病，特别是到身体无法行动的程度（例如卧床不起），会使健康不佳降低集体效能。这使学者们既能认识到健康不佳可能如何影响个人和社区，又能具体说明其运作的机制。为了支持我们的观点，我们利用综合社会调查（GSS）数据来研究健康不佳、与健康相关的不动和集体效能之间的关系。我们的结果为我们的论点提供了实证支持，表明总体健康状况通过强迫性不动直接和间接地影响了普遍信任的水平。我们最后提出了关于强迫性不动可能如何影响邻里犯罪的建议，并提出了后续研究可以完善和进一步检验强迫性不动作为健康不佳与集体效能之间的中介的方法。
