Mediation Role of Social Relationships in the Association Between Socioeconomic Position and Health/0ral Health

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IntroductionSocial inequalities in health are universally recognised as a major public health problem (WHO, 2008). Explanations for health inequalities include material, behavioural and psychosocial pathways. Whilst material and behavioural pathways have been studied extensively, few studies have explored the contribution of social relationships to social gradients in health. The term 'social relationships' is an umbrella term including concepts of social networks and social support. The importance of social relationships for health and well-being is well established (Holt-Lunstad et al., 2010; Berkman and Krishna 2014), and there is evidence that access to social networks and social support is influenced by socioeconomic position (House et al., 1988; Taylor and Seeman, 1999). Individuals who face socioeconomic disadvantage throughout life have been found to become less socially active after retirement to face limiting illnesses earlier than their more affluent peers (Blane et al., 2007). Given the evidence that social engagement and social connectedness are important determinants of health, it would be imperative to understand whether social relationships also contribute to social inequalities in health and healthy ageing - an area that remains less well understood. The limited number of existing studies that examine the mediating role of social relationships on health inequalities have mainly looked at mortality and cardiovascular disease, however results have been contradictory (Marmot et al, 1998; von dem Knesebeck, 2005; Stringhini et al., 2012; Wang et al., 2015; McCrory et al., 2016; Aartsen et al, 2017; Gorman and Sivaganesan, 2017). Aims/ObjectivesThe proposed research aims to examine the mediating role of social relationships on the association between socioeconomic position and health. The following objectives will be addressed:1. To assess the social gradients in health outcomes 2. To assess whether social relationships are linked to socioeconomic inequalities in health3. To assess how much of the socioeconomic gradient in health is explained by structural and functional social relationshipsHypothesisIt is hypothesised that social relationships mediate the association between socioeconomic position and health. Methodology: I propose to use data from the UK English Longitudinal Study of Ageing (ELSA), to examine the dynamics of social relationships and their influence on health inequalities across older age. The following health outcomes will be considered: self-rated health, self-rated oral health and difficulties, physical function and cognitive function. ELSA is a rich dataset containing measures on socioeconomic position (education, income, wealth) and social relationships (social networks/cohesion, social support, loneliness). The hypothesised pathways will be tested using regression models and structural equation modelling.The findings of proposed project could inform policy interventions aimed at reducing social inequalities in health through promotion of active participation and social cohesion.