Supportive ties: a political economy perspective.

The growing body of evidence linking social support and health has important implications for health promotion, disease prevention and treatment. But serious unsolved problems remain in the areas of research, practice and policy. Key among these are the ethical issues which arise when the reality of the importance of social support is translated simplistically into a policy emphasis stressing individual and interpersonal responsibility for health and justifying major cutbacks in health and social programs. This article examines the interdependencies between supportive ties on the individual and community levels and the larger social and political environments within which social networks operate. The effectiveness of families and other micro level support systems is seen as heavily dependent upon the adequacy of programs and policies on the local state and national levels which provide help with income maintenance, housing, transportation and other basic necessities. The cutting back of these more basic programs and services will be seen to disrupt the delicate web of natural relationships. Professionals concerned with the application of social support and health findings need to look beyond the individual and interpersonal levels toward policy and institutional level interventions. They thus may make an important contribution in advocating on behalf of those policies and programs which are critical to the effective functioning of natural helping networks, and which are at the same time faced with cutbacks. By helping alert colleagues, policy makers and the public both to the promise of the social support and health findings, and to the interdependence of support on local, state and national levels, health educators and others in the health professions may help to facilitate the effective application of these findings in policy and practice.