Commentary: Understanding it all—health, meta-theories, and mortality trends

摘要

Investigations into the determinants of health within and between countries contribute to a generally slow, but incremental process. Leaping forward to the big picture of how it all fits together represents an attractive alternative to merely continuing with this laborious spadework. Bunker and colleagues advance the idea of bounded freedom as being the key to health and well-being, a viewpoint which shares some characteristics with others who consider embeddeness within strong social networks as being the important determinant of population health. The positive benefits of strong social ties seem self evident, but "the plausible role of biological pathways leading from social disconnection to disease" that Bunker and colleagues evoke has not been satisfactorily elucidated. Indeed, degree of social support may be influenced by health rather than the reverse. The supposedly protective influence of social support has been shown among the majority populations of the United States, United Kingdom, and Scandinavia, but in groups that have different connotations for such networks social ties can appear detrimental, rather than beneficial, to health.