At the heart of the sustainable development goals is the need to improve population health by 2030. Although a number of strategies are underway in achieving this, an appropriate response to the South African health challenge is assumed to be by addressing the social determinants of health which lie outside of the health system while also strengthening the system itself.

Throughout the developed countries, evidence of the role of individual’s perception of their neighbourhoods are emerging. More importantly, the social cohesion construct which in various operationalizations encompasses trust, social support, tolerance and quality and quantity of social connections is becoming one of the neighbourhood attributes that are increasingly being recognised as relevant internationally.  However, evidence of the health benefit of positive perception of neighbours in an African sample is almost lacking. As a result, we attempted to understand if social cohesion can contribute to improvements in population health in South Africa. We asked participants to rate their neighbourhoods on a scale based on how people in their neighbourhood could be trusted, share similar values, willing to help each other.

Since it is known that racial inequalities pose negative effects on population health through unequal access to health care services, we also examine how race interact with social cohesion to affect the health of adults in South Africa. We suspected that social cohesion could serve as a buffer among black Africans adults such that they could improve their health by residing in highly cohesive neighbourhoods characterised by trust, sense of belonging and shared values.

Staying Healthy Together

Our study highlights the benefit of social cohesion in increasing individual’s perception of their health status. We found that adults who were residing in the highest tertile of social cohesion were more likely to report moderate or good health compared to those in the lowest tertile. There are several reasons why this might hold. Higher social cohesion could contribute to the social control of health-related behaviours and the elimination of inequalities in access to health care services. It may also contribute to the management of neighbourhood physical hazards, and psychosocial processes all of which may generate a protective effect for health and reduce venerability to health-compromising conditions. High levels of neighbourhood social cohesion based on friendships, visiting and borrowing and exchange of favours with neighbours may also facilitate access to networks and services that may help improve population health. It may also foster healthy lifestyle behaviours such as safe public spaces for activity, clean and safe housing, and availability of nutritional foods all which may generate a protective effect for health and reduce venerability to health-compromising conditions. It could also improve the local services and resources that are available, and increase a personal sense of control, which in turn, can alleviate depressive symptoms.

Since, high social cohesion reflects communities that are supportive of overall well-being characterised by trust, lower crime rates, more civic participation, and better access to health care among others, social cohesion within a neighbourhood may also provide more support between neighbours, reduce the number of stressors that residents perceive to exist within the neighbourhood, and buffer or mitigate the stressors which do occur.

Although we had suspected that social cohesion could reduce the health disadvantage of being in a racial group, we could not find any evidence that this relationship differed by race.

Next Steps

Our study demonstrated that adults who perceived their neighbours to be less trustworthy, or willing to help or with different values are less likely to report being in good health. This finding calls for a collaborative engagement among the people of South Africa, government and the relevant stakeholders to reduce and eliminate all forms of barriers to social cohesion in the country. This is especially important if considerable progress is to be made in improving population health by 2030. More importantly, since our study affirms the role that individual perception of where they live have on their health status, it is noteworthy to seek clarifications on levels of trust, shared values, and willingness to help before relocating to a neighbourhood.

Given that our study has only examined the role of social cohesion in improving individual’s assessment of their health status, more scholarship is needed to understand whether the protective benefits of social cohesion extend to other health indicators such as body mass index, health behaviours, and others within the context of Africa particularly in South Africa.

NOTE – This study which is an excerpt from a master’s research on the relationship between social cohesion and health status of adults in South Africa at the University of the Witwatersrand, South Africa. The manuscript was co-authored with Prof Clifford Odimegwu (University of the Witwatersrand, South Africa) and Dr. Nicole DeWet (University of the Witwatersrand, South Africa). Published manuscript available here.