Impacts on solidarity & social cohesion

Social cohesion draws on the principle of solidarity. This domain addresses questions about whether an intervention has the potential to unify people within a society or drive them apart. Unlike impacts on personal relationships – which addresses how an intervention may affect people’s relationships to their family members, friends, and other close contacts – social cohesion looks at society at large.

To assess features of the health intervention relevant to solidarity & social cohesion, consider:

• Are there any ways that a decision to include or exclude a health intervention from coverage could:
  • cause pre-existing divisions, distrust, or conflict to get worse?
  • help foster social cohesion through better understanding, cooperation, and a sense of belonging across different groups of society?

Considerations about the health condition, intervention, and eligibility:

• Are there any attitudes or public perceptions about the health condition that are relevant to solidarity & social cohesion, for better or worse? For example:
  • Some health challenges can bring people together and promote solidarity, such as responding to a national health crisis or a common condition.
  • Alternatively, if the health condition has negative associations or addressing it could worsen existing tensions between groups, are there ways to addressed or minimise potential harms to solidarity & social cohesion through public communications or engagement activities?
• Are there any features of the health intervention that might promote or diminish solidarity & social cohesion? For example:
  • An infectious disease control intervention, like vaccination, may make people feel like they are doing their part to reduce the overall risk to their community and society.
    • Does the intervention make it easier or harder for people to look after their own health in ways that support public health or preserve limited health resources for the population?
  • Alternatively, could a decision to cover health intervention could exacerbate existing social rifts or political divides if it is associated with contentious actors or companies, or if the intervention is the subject of public debate?
• To what extent might social cohesion be an issue if the intervention were only covered for a select, targeted group?
  • In the case of offering interventions only to a targeted population group, there may be a trade-off to consider:
  • On the one hand, a targeted approach may be more cost-effective because it focuses on those who are likely to experience the largest health benefits. Targeting the worst off or most disadvantaged groups may also promote equity.
  • But, groups who are not covered may feel excluded, causing increased tensions between groups with pre-existing conflicts.

Note: This domain will not necessarily be applicable to every intervention. Many interventions are likely to be uncontroversial. Also, there may be limited or different types of evidence for assessing this domain. Public engagement activities may be best for determining how and when intervention may impact social cohesion. Public engagement may also be the best tool to address concerns about negative impacts on solidarity & social cohesion.