A randomised controlled trial conducted in 2018 in two Swiss local disability offces was established to test the feasibility and relevance of some of these recommendations. The idea was to provide SLBs with a nudge to adopt a life-course perspective when assessing benefciaries and deciding whether to give them access to rehabilitation measures. The results, although modest, suggested that a stronger intervention, such as a training program, could be effcient in boosting such a life-course perspective among SLBs (Visintin et al., 2021).

#### Conclusion

This chapter illustrates the relevance of a multilevel approach to social policies, both in analytical and action-oriented terms. It sheds light on the potential gaps and discrepancies between the various levels involved in social policies and on their implications on the ability of social interventions to reduce benefciaries' vulnerability. It underlines the key position of meso-level actors in this respect and the importance of providing them with adequate working conditions. Furthermore, it suggests how social policy analysis can provide insights towards a deeper achievement of social policy goals and the role of a life course perspective in this respect. By providing a convincing account of why social policies are often unable to reach their twofold objective of reducing vulnerability and increasing resilience, the approach developed in this chapter shows how a multilevel and life course analytical perspective on social policies can contribute signifcantly both to the social policy literature—by closing the gaps between most of the existing research works that tend to focus on a single level and to the design and implementation of social policies that are more genuinely oriented towards the human development of their benefciaries. Although many issues require further research, our work within LIVES paves the way towards opening a new agenda for a life course-oriented social policy.

#### References

Anderson, J., & Honneth, A. (2005). Autonomy, vulnerability, recognition, and justice. In J. Christman & J. Anderson (Eds.), *Autonomy and the challenges to liberalism: New essays* (pp. 127–149). Cambridge University Press.

**Open Access** This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/ by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

### Vulnerabilities in Local Contexts

### *Felix Bühlmann, Katy Morris, Nicolas Sommet, and Leen Vandecasteele*

#### Neighbourhoods as Meso-level Contexts of Vulnerability

Over the last few years, the LIVES program has developed a theoretical framework that defnes vulnerability as 'as a process of resource or reserve loss or insuffciency in one or more life domains' (Spini & Widmer, in this volume). When exposed to an individual or social stressor, vulnerable persons do not have the reserves to cope with the stressor and are unable to (rapidly) recover from stress (Cullati et al., 2018). The central concepts in the LIVES approach to vulnerability—exposure to stressors and endowment with resources and reserves—are not purely individual concepts but depend on contextual factors. Usually, these contextual factors are studied at the macro-level; for example, a country's culture, economic situation or welfare policies have been found to shape the dynamics of vulnerability in daily life (e.g., see Cheung & Chan, 2007). While such macro-level contextual factors undoubtedly exert a critical infuence on the risk of

F. Bühlmann (\*) • K. Morris • N. Sommet • L. Vandecasteele

University of Lausanne, Lausanne, Switzerland

e-mail<EMAIL_ADDRESS><EMAIL_ADDRESS><EMAIL_ADDRESS><EMAIL_ADDRESS>
<sup>©</sup> The Author(s) 2023

D. Spini, E. Widmer (eds.), *Withstanding Vulnerability throughout Adult Life*, https://doi.org/10.1007/978-981-19-4567-0\_9

becoming vulnerable, we are all embedded within multiple layers of social relations below the country level. As Elder et al. suggest, individuals are not just national citizens but also residents of particular neighbourhoods and members of particular groups and communities. The local context is an important determinant of social inequality. For instance, living in a neighbourhood with concentrated poverty increases crime and reduces educational attainment, well-being and employment chances. We believe it is important not to neglect these so-called meso-level contexts or local contexts (Ranci, 2009).

According to Spini and Widmer (in this volume), a focus on the mesolevel makes us aware that *'vulnerability is not just individual but also impacts close connections, who amplify, share or suppress the effects of stressors and who bring or share needed resources'.* In this contribution, we show how meso-level integration is necessary for the understanding of vulnerability processes. Specifcally, we argue that the dynamic between resources and stressors is shaped by the local contexts within which individuals are embedded: in personal networks (that provide support or information), in social groups (that purvey collective identities and meaning), or in neighbourhoods (that structure daily routines and shape the experience of social structures). The moderating function of the meso-level seems particularly important to us as it can not only activate or reinforce processes of vulnerabilisation but also weaken, transform, or nullify the effects of stressors (Vacchiano & Spini, 2021).

In the next three sections, we discuss the added value of the integration of the meso-level for the study of vulnerability. We frst show how mesolevel labour market contexts can substantially alter the size of the penalties associated with low levels of educational attainment or a more disadvantaged background for young people seeking employment for the frst time. Second, we examine the role of local networks and neighbourhood deprivation for unemployment duration. Third, we investigate how people residing in zones with higher levels of income inequality perceive others as being more competitive and how such perceptions can affect their health.

#### Local Economic Structures and Vulnerability in the School-to-Work Transition

Moments of transition, from one stage of the life course to another, are moments of heightened exposure to stressors. The transition from school or university to the world of work—where young people leave behind the fxed and familiar certainties of teachers, timetables and classes and seek employment—is one such moment (Schoon & Silbereisen, 2009). For some, the process of fnding stable employment is a relatively swift and trouble-free affair. Others, however, face long periods of unemployment, inactivity or employment in insecure positions. These experiences have immediate consequences in terms of lost income and delayed independence and are also associated with a host of negative outcomes in middle age, including include higher unemployment, lower wages, worse outcomes in terms of mental and physical health and higher risk of premature death.

The multifaceted, enduring and costly nature of these so-called 'scarring effects' is such that there is a clear need to understand who is most vulnerable to 'bad beginnings' in the labour market. Sociological frameworks typically view vulnerability through a micro-macro lens that overlooks meso-level infuences. The 'transition regimes' framework (Smyth et al., 2001), for instance, holds that vulnerability refects the interaction between the micro-level resources and attributes of labour market entrants and macro-level institutional arrangements, which are assumed to be uniform at the country level (Raffe, 2014). This view offers invaluable insight into the sources of lingering cross-national differences in vulnerability among young people. However, there are also indications that it produces a misleading picture of the individual-level drivers of vulnerability and resilience.

Contrary to the implicit assumptions of much research on the schoolto-work transition, uneven processes of economic growth and industrial restructuring have given rise to substantial variation in the number and range of occupational opportunities in any given location. Analysis that refects the reality of this profound meso-level variation has shown that the local employment opportunity structure can substantially moderate—and, indeed, sometimes even nullify—the size of the youth labour market penalties associated with the core micro-level vulnerabilities of low educational attainment and a more disadvantaged family background.

For example, while individual educational attainment is widely recognised to be 'the single most important determinant of occupational success in industrialized societies', our analysis of British Household Panel and German Socio-Economic Panel data showed that the strength of the education-destination gradient varied substantially within the United Kingdom and Germany (Morris, 2021). In strong local economies such as Cambridge and Hamburg, young people obtain employment with relative ease irrespective of their highest level of educational attainment. However, gaps—between the less qualifed and between the most and least qualifed—appear and grow as local economic performance worsens. On average, it takes young people with low qualifcations between one and three months longer to fnd employment of any sort if they are located in a place of low rather than high labour demand, and the job search time gaps between most and least qualifed in weak local economies are substantial (Fig. 9.1).

A similar story emerges when considering the intergenerational transmission of (dis)advantage at labour market entry. Net of educational attainment, young people have an equal probability of fnding employment and securing a good frst job in strong local labour markets within the UK and Germany, irrespective of their social origins. However, those in weak labour markets such as Hull and Gelsenkirchen are 12-15 percentage points less likely to fnd employment within a two-year period, and those who do so obtain frst jobs that are 5-8 ISEI points1 lower in occupational status if their parents are care workers rather than secondary school teachers. Young people who are not bumped out of the labour market are bumped down into frst jobs that likely offer fewer opportunities for progression over the later life course.

These fndings highlight the relevance of the meso-level economic structures within which young people are embedded for understanding who is most at risk of bad beginnings in the labour market. Individual resources are undoubtedly the most important component of both vulnerability and resilience, but meso-level opportunity structures can both amplify and mitigate the risks associated with low educational attainment or a more disadvantaged family background.

1The ISEI is the International Socio-Economic Index of Occupational Status created by Ganzeboom et al. (1992). It ranges from a minimum of 16 (unskilled employee) to a maximum of 90 (judge), with higher values indicating higher occupational status and hence a higher location in social space.

**Fig. 9.1** Predicted median time in months to frst job in the UK and Germany after leaving full-time education and training

#### Neighbourhood Deprivation and Unemployment: The Role of Social Interactions in the Neighbourhood

Several studies have demonstrated that living in a poor neighbourhood increases the risk of and duration of unemployment (Buck, 2001), independent of one's individual labour market and socioeconomic characteristics (Buck, 2001; Miltenburg & Van de Werfhorst, 2017). In the same vein, relocating residents from more- to less-deprived neighbourhoods improved their employment outcomes in the long run (Mendenhall et al., 2006). While research has convincingly demonstrated that neighbourhood disadvantage affects employment, the mechanisms through which this operates have been less explored. Inhabitants of disadvantaged neighbourhoods may face more unemployment for three main reasons: spatial mismatch, neighbourhood discrimination, and social interactions (Galster, 2012; Sampson et al., 2002). Jobs may be less available in deprived neighbourhoods, and transport connections to places with better employment chances may be bad (spatial mismatch). Job seekers from disadvantaged neighbourhoods may face discrimination from employers on the basis of the stigma associated with their neighbourhood (*neighbourhood discrimination*), they may lack connections to people who can provide them with information about job opportunities or other help in the job search process, or they may put less effort into the job search due to neighbourhood peer infuences (*social interaction mechanism*).

Whereas there is a good account of these mechanisms of neighbourhood disadvantage, it is more diffcult to disentangle them in empirical research, and most studies are limited to demonstrating that neighbourhoods matter without explicitly examining the mechanisms infuencing their signifcance. In particular, the social interaction mechanism is simply often assumed to be important without being explicitly measured. Neighbourhood deprivation and neighbours as part of personal networks are rarely examined simultaneously in empirical population-level research (Desmond & An, 2015; Fernandez & Su, 2004). One reason may be that the literature on neighbourhood effects and the literature on network effects have developed largely separately. The neighbourhood effects literature has shown that residential neighbourhoods affect their inhabitants' life chances and choices, but it has rarely included good measures of social networks and interactions (Galster, 2012; Sampson et al., 2002). The social networks literature, by contrast, has examined the properties of social networks and how these affect socioeconomic outcomes, usually without a focus on the geographical location of personal networks (Granovetter, 1995; Portes, 1998). More recent contributions, for instance, from Brändle (2018) or Ganjour et al. (2020), have examined the geographical and structural aspects of personal networks and have shown that these networks are, indeed, often local.

We conducted an integrated study of personal networks and neighbourhoods with population-level data from the UK Household Longitudinal Study, also known as Understanding Society (Vandecasteele & Fasang, 2020). The data include a measure of the proportion of friends who live in the same neighbourhood as well as small-scale information on specifc dimensions of neighbourhood deprivation. Figure 9.2 shows the probability of ending an unemployment spell by neighbourhood employment deprivation as well as the share of friends in the local area. The results showed that neighbourhood employment disadvantage prolonged unemployment, but only for individuals who reported that all of their friends live in the same deprived neighbourhood (darker line). By contrast, the predicted probabilities in Fig. 9.2 show that living in an

**Fig. 9.2** Predicted probabilities of exiting unemployment between 2011 and 2012 by neighbourhood deprivation and proportion of friends in the neighbourhood (Vandecasteele & Fasang, 2020)

advantaged neighbourhood with all of one's friends in the neighbourhood improved the chance to exit unemployment.

Consequently, it is not only residing in a disadvantaged neighbourhood but also having social connections there that prevents individuals from reentering employment. In contrast, neighbourhood location is not associated with unemployment exit if one's friends do not live in the same neighbourhood. Our study is the frst to fnd evidence with populationwide panel data that neighbourhood effects on employment outcomes depend on the location of personal networks. These results thus show support for the importance of the social interaction mechanism of neighbourhood disadvantage. It could be argued that resource-sharing and norm-setting in neighbourhoods exacerbate vulnerabilisation processes in deprived local settings. Hence, at least for employment chances, local connections to other deprived people may add to the cumulative disadvantage experienced by economically vulnerable population groups.

#### The Effects of Local Income Inequality on Psychological Health

Over the last two decades, many countries have seen dramatic increases in income inequality (e.g., see Saez, 2019). Given the scope of this phenomenon, many scholars have wondered whether income inequality acts as a contextual stressor and impairs psychological health (for recent reviews, see Buttrick & Oishi, 2017). However, this body of research has produced mixed results: In particular, the effects of income inequality on psychological health outcomes seem to be largely inconsistent (for a metaanalysis, see Ngamaba et al., 2017).

We believe that one of the reasons for these inconsistencies is that most extant studies have operationalised income inequality at broad levels of aggregation (e.g., national income inequality). However, we know that individuals systematically misestimate the magnitude of macro-level income inequality (e.g., within their countries), whereas they perform much better when estimating the magnitude of meso-level income inequality (e.g., within their ZIP code or municipality; see Johnston, & Newman, 2016: 175-177).

We conducted three series of studies using meso-level income inequality as a predictor, with the aim of resolving some inconsistencies in the literature on income inequality and psychological health. Our theoretical starting point was as follows: In economically unequal (vs. equal) local contexts, the poor and the rich are mechanically further away from one another on the pay scale, which makes standards of income comparison more salient (e.g., the rich are more noticeable in the residential context and become recurrent targets of economic comparison; for empirical evidence, see Payne et al., 2017). As such, meso-level inequality could prompt concerns about one's relative position in the economic hierarchy and induce the perception that everyone around oneself is competitive.

A frst series of studies tested the association of meso-level inequality with perceived competitiveness in the United States (Sommet et al., 2019). We asked 2,500+ U.S. residents to report the level of perceived competitiveness in their area on a scale comprising items such as 'In my town/city, it seems that people are competing with each other'; then, we gathered the Gini coeffcient of the ZIP code where each participant lived.2 The Gini coeffcient was found to be a consistent and robust predictor of perceived competitiveness: The higher the meso-level inequality, the higher the perceived competitiveness.

In a second series of studies, we went one step further and examined the downstream consequences of the inequality-competitiveness link on psychological health (Sommet et al., 2020). Drawing on the LIVES framework (see Spini and Widmer in this volume), we reasoned that the perceived competitiveness induced by income inequality should act as a social stressor and evoke both (i) avoidance-based psychological processes (focused on the risk of falling behind the competition) and (ii) approachbased psychological processes (focused on the possibility of getting ahead of the competition). To test this idea, we conducted a two-year longitudinal study with 1,700+ U.S. residents (median age = 48) recruited through a national volunteer research registry named ResearchMatch (see Harris et al., 2012). The Wave 1 (2016) to Wave 2 (2017) response rate was approximately 75%. We showed that an increase in the Gini coeffcient of the participants' areas was associated with an increase in perceived competitiveness over time. More importantly, we showed that this increase led to opposing effects on psychological health: Meso-level income inequality had both a *negative* indirect effect on psychological health via avoidancebased psychological processes (focused on avoiding failure) and a *positive* indirect effect on psychological health via approach-based psychological processes (focused on attaining achievement).

In a third and fnal series of studies, we sought to examine the conditions under which meso-level income inequality impairs rather than improves psychological health (Sommet et al., 2018). This time, we reasoned that the contextual stressor of perceived competitiveness induced by income inequality should be particularly threatening for individuals with low monetary reserves (i.e., facing fnancial scarcity: having insuffcient monetary resources to cover monthly expenses; Mullainathan & Shafr, 2014). To test this idea, we pooled the responses from the Swiss Household Panel, a nationally representative panel survey that followed approximately 15,000 participants from 1,700+ municipalities over 15 years of assessment. We showed that an increase in meso-level income inequality (i.e.,

2The Gini coeffcient is an indicator describing the income distribution for a given zone and may range from 0 (perfect equality: each household in the ZIP code has an equal share of income) to 1 (perfect inequality: only one household in the ZIP code has all of the income).

**Fig. 9.3** Effects of meso-level income inequality over the life course on psychological health as a function of monetary reserves

the Gini coeffcient of the municipality of residence) over the life course led to an increase in psychological health problems only for people facing fnancial scarcity (approximately 10% of the Swiss population; see Fig. 9.3).

#### Conclusion

Our fndings, whether on the school-to-work transition, unemployment or psychological health, have one common denominator: They show that meso-level structures such as local contexts or neighbourhoods are of crucial importance to understand vulnerability as a dynamic of stressors and resources. It is in the local context that social stress is experienced, but it is also at this meso-level that people have access to resources that allow them to mitigate or nullify the impact of macro-level structures or individual characteristics.

In our study on the school-to-work transition, we showed that mesolevel structural opportunities and resources crucially infuenced how young people are able to handle such stressful biographical transitions these resources can mitigate or in some cases even nullify individual disadvantages, such as low qualifcations. Unemployment is one of the major social stressors of modern societies. In a second study, we showed how the effectiveness of resources connected to personal networks—information about job opportunities or help for the job search—depended substantially on their spatial distribution. In a deprived neighbourhood, those who reported all their friends as also living in the neighbourhood faced prolonged unemployment. Only for those living in a privileged neighbourhood did a high share of the personal network living nearby become a resource allowing them to exit unemployment. High local income inequality increased the perception that everyone around oneself is competitive. This perceived competitiveness can be conceptualised as a social stressor, especially for people living in unequal contexts. Our third case shows that an increase in meso-level income inequality led to an increase in psychological health problems, but only for people facing fnancial scarcity.

In terms of social policy, this fnding means that the local level is particularly suited for interventions to buffer the main macro-sociological risks of vulnerability. It is the level at which people can be empowered to acquire and accumulate resources that protect them from vulnerability in the long term. For instance, policies supporting young people when entering the labour market should be adapted to regional specifcities and reinforced in regions with a weak labour market. Regional and local policies, especially in regard to residential policies, should aim at blending populations across economic fault lines. Such an approach will help mitigate situations of vulnerability and reinforce the buffering effects that local contexts may have on social stressors.

#### References

**Open Access** This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/ by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

### How Family and Other Close Ties Shape Vulnerability Processes

*Clémentine Rossier, Laura Bernardi, Marie Baersywil, Michel Oris, Marlène Sapin, and Eric Widmer*

#### Introduction

This chapter focuses on the effects of *close interpersonal relations* on vulnerability processes. Close relations—family and friends—affect vulnerability processes in three ways (Spini et al. 2017, Bernardi et al. 2019). First, they correspond to differential individual investments in varying life domains. These investments are highly gendered, as women invest more in close relations than men, especially in the family domain. Second, close

University of Geneva, Geneva, Switzerland

#### M. Sapin FORS, University of Lausanne, Lausanne, Switzerland e-mail<EMAIL_ADDRESS>
C. Rossier (\*) • M. Baersywil • M. Oris • E. Widmer

e-mail<EMAIL_ADDRESS><EMAIL_ADDRESS>michel.oris@ unige.ch<EMAIL_ADDRESS>
L. Bernardi University of Lausanne, Lausanne, Switzerland e-mail<EMAIL_ADDRESS>
relations act as meso-level resources, providing emotional or instrumental support (of varying quality) and economic transfers that individuals use to advance towards their life goals. In times of shock, such resources act as buffers. Close relations also shape individuals' life goals, acting as mesolevel normative references. Third, close relations accompany individuals throughout the life course (Spini & Vacchiano 2021) and constitute longterm investments or lasting constrains.

Close relations include both intimate family members and close friends. Together, these relations constitute the *personal networks* of signifcant others; however, *family ties* have specifc properties. Family confgurations of ties, as stressed by anthropologists, are created through fliation and conjugality (Sahlins 2013). Kinship shrinks or expands following diverse demographic events (birth, cohabitation, marriage, departure of children, union disruption, death). Moreover, rights and obligations are institutionalised within family ties, notably through laws, albeit sometimes informally (i.e., cohabiting unions and step relationships). Exchanges within family ties can be non-reciprocal, which is not the case with elective ties. Finally, family ties that do not enter personal networks are not dissolved as easily as friendship ties.

Family ties are thus likely to affect vulnerability processes differently from other close ties. First, the transmission of socioeconomic privileges (pensions, heritage, shared consumption, loans, investments) remains confned within families, especially well-endowed ones (Pitrou, 1992; Coenen-Huther et al., 1994; Künemund et al., 2005). Other close relations only occasionally provide useful information or bypasses. Second, family-transmitted roles and values are incorporated during childhood, thereby triggering stronger emotional reactions later (La Rossa & Reitzes, 2009). Moreover, poor relational style during childhood and trauma powerfully shape individuals' psychosocial skills and their capacity to create ties later. Third, and because of the aforementioned aspects, emotional and instrumental support is still mainly assumed by family members, especially when needs are high, although other close relations can also provide it. This limitation can have negative implications if family ties are of poor quality (Bengston et al., 2002). By contrast, purely elective ties are undone more quickly when confict arises and are thus of better quality. The upside of the durability of family ties is that non-close family ties constitute a reservoir of close relations on which individuals can draw to create new close relations in times of need.

In what follows, we examine these hypothesised differences in how close family and close friends affect vulnerability processes by using three longitudinal datasets collected within LIVES, *Social Stratifcation, Cohesion and Confict in Contemporary Couples*, *The multiple paths of lone parenthood*1, *Vivre/Leben/Vivere*2, and a stream of work leading to the construction of the network module of the *International Social Survey Programme 2017*3. The frst three studies focused on the role played by family and other close relations over time for long-term couples, lone parents, and ageing individuals in their fght to overcome diffcult events or maintain their level of well-being. The fourth stream of work examined the role played by confict and support in personal networks (friends and family) of adults facing life events. In what follows, we examine the results of this last study before proceeding to the three longitudinal studies.

#### Conflict and Support in Personal Networks After Life Events

One of the frst task within LIVES was to explore the active changes in network composition which take place during life transitions or when facing vulnerabilizing events, as a way to secure suffcient relational resources (Sapin, 2014). Some individuals exclude extended family members from their personal networks and refocus on the nuclear family. In contrast, other individuals recompose their networks by including more distant family members (blood, alliance) with whom they have an affnity. Some individuals with fewer or poor quality family links nevertheless receive support from close relations by pluralizing their personal networks with the inclusion of friends and colleagues as well as health professionals, who provide links to resources in other groups (Widmer, Kempf, Sapin, & Galli Carminati, 2013). In general, the more diverse (nuclear family, extended family, friends, colleagues, health professionals) the personal network is, the more effcient the support. For instance, new parents heavily mobilise their personal network during the most demanding and stressful months following the birth of a child, when tremendous psychological and concrete adjustments are needed (Sapin & Widmer, 2016). In addition to the direct positive effect of diverse personal network compositions, such

<sup>1</sup> https://www.lives-nccr.ch/en/page/multiple-paths-lone-parenthood-n3912

<sup>2</sup> https://cigev.unige.ch/vlv/

<sup>3</sup> http://w.issp.org/menu-top/home/

diversity also increases network density, which bolsters the safety net of emotional and instrumental support. However, individuals who add their extended family as members in their personal networks, such as parents and parents-in-law, see a particular elevation of network density. After this frst period, parents return to a more stable role organisation; the mobilisation of family and friends and their collective support tends to diminish. Larger and less dense personal networks (with links to other groups) then prove especially useful by providing more punctual and diverse assistance.

We also showed that families and personal networks can yield stressful and negative interactions among their members that contribute, in their own way, to poor psychological health, a negative impact which is exacerbated during life crises. We found that it is the overall 'feel and look' of such networks that matters, that is, the interdependent patterns of support and confict, more than the amount of confict (Sapin, 2014). Vulnerable individuals (showing higher levels of psychological distress) are embedded within networks in which family support triggers an overload situation; the individual often holds a central position in the family networks from the perspective of confict (Sapin, Iglesias, & Widmer, 2016). Strains and confict develop due to the increasing pressure exerted by life crises, not only on vulnerable individuals but also on members of their family or personal networks (Sapin, 2014; Widmer, Girardin & Ludwig, 2018). The limited resources circulating in these personal networks increase the competition between their members and do not allow them to fulfl members' daily needs, especially when stressful events or transitions occur (Sapin, 2014; Sapin, Widmer, & Radulescu, 2008). Individuals in such vulnerable situations not only cope less well with stressful events but also perceive events to be more frequently stressful and have a lower level of social support in their personal networks while also not having the economic or cultural resources that might compensate for such challenges. The pressures of their life contexts are high, while their relational and other reserves are low or even, sometimes, absent. Such a situation makes them unable to navigate their life trajectories and to cope with the requirements and goals of each life domain.

To explore some of these patterns across national contexts, we developed a module to collect innovative data on personal networks and social resources for the *International Social Survey Programme* (ISSP) under LIVES leadership and expertise (Sapin, Joye, Wolf, et al. 2020; Joye, Sapin, & Wolf, 2019). Preliminary analyses of these data show that in high-income countries, support and socioeconomic resources that matter for well-being more often come from the family, while in middle- and lowincome countries, the resources have a more mixed origin; confict has everywhere the strongest relation to well-being (Brule, Sapin, Rossier, 2020).

#### The Personal Networks of Conjugal Partners

Previous research has long shown that partners with larger and more overlapping networks, on average, perform better throughout their life together on a variety of outcomes associated with well-being than those with smaller and less overlapping networks (Kearns & Leonard 2004, Widmer, 2004). LIVES conducted the longitudinal *Social Stratifcation, Cohesion and Confict in Contemporary Couples* study (Widmer et al., 2017) to explore the lesser-known infuence of life course factors on couples' personal and family networks. Vesela (2017) showed that distinct types of conjugal networks are developed, from the least to the most supportive, with an unequal presence of friends and family members from both partners. Supportive networks decreased the likelihood of experiencing later low conjugal quality, hence confrming the overall positive impact of network support on couples. However, when a nonnormative event occurred, such as falling into unemployment, couples who were part of supportive networks were more likely than others to develop conjugal dissatisfaction and instability. These fndings suggest a counterintuitive vulnerabilizing effect of supportive networks when couples are confronted with some important nonnormative stressful events. Altogether, the empirical results suggest that a small rather than large reserve of family members and friends and low levels of contact and support may better buffer stress associated with experiencing socially frowned-upon events, whereas supportive networks may in such circumstances create further stress that weakens couples because of their interference (Julien et al., 1994).

The personal and family networks of conjugal partners are impacted not only by nonnormative events but also by expected and positively defned life transitions. Our data underlined the overall stability of interaction models between partners throughout the years (Widmer, Kellerhals, Levy, Gouveia, 2017, Schika, 2015). However, change can be noticed in partners' personal networks. Because partnerships occupy a central position in the social lives of individuals and their self-concepts, they provide a strong impetus for couples to merge their respective personal networks of close family and friends into a larger, shared social network in the early stages of family life (Kalmijn, 2003). Spouses whose households experienced empty nesting and retirement were more likely to report shared networks and shared personal contacts with their partner than those who did not experience such transitions (Cohn-Schwarz, Roth and Widmer, 2021). In other words, both transitions were associated with increasingly shared social interactions and friendship networks between spouses. The results are congruent with a series of mechanisms that account for the continuity of self-identity and well-being in later adulthood across life transitions and role losses. Because partners belong to each other's convoy of signifcant relationships (Antonucci et al., 2013), their network members tend to become closer (their network tends to overlap increasingly) as partners separate from peripheral ties when constraints associated with work and children dissipate. Because the transition to an empty nest and retirement entail disconnections from central face-to-face activities associated with paid work and raising children, more importance is placed on the partnership as a dimension of life continuity. Consequently, the time freed by role losses appears to be spent socializing with the partner and the couple's associates. Such changes in the shared personal networks of partners have benefcial effects for partners and lead to improvements in the spousal relationship (Kearns & Leonard 2004, Cornwell, 2012).

#### Lone Parenthood: Vulnerability and Support

Focusing also on less normative family confgurations, LIVES documented the trajectories of lone parents and their close relations as well as the interplay between this micro relational dimension and the macro dimension of institutional support. Lacking a partner to share economic and parental burdens, lone parents—and lone mothers in particular—are often poorer and more vulnerable in terms of health and income and are, on average, more socially isolated (Bernardi et al. 2018; Struffolino & Bernardi 2017). A few studies have examined the changing personal networks of mothers during the two years following divorce and found that despite women experiencing a signifcant decrease in network size and social support, the primary and most supportive members of their networks—family and friends—remained stable (Duffy 1993). Research that has focused on the agency and coping competencies of lone mothers and the role of support from family and friends has shown that lone mothers are rarely fully isolated (Niepel 1994; Lumino et al., 2016). Bernardi and Mortelmans (2018) investigated the personal network of the most economically vulnerable lone mothers—those who were unemployed or receiving social assistance—as well as the ways in which the web of relations they were embedded in contributed to their well-being (Keim 2018). The fndings showed a large variation in the number and composition of personal contacts and identifed four kinds of networks: networks dominated by the family of origin, networks centred on a couple relationship, extended networks, and very restricted networks. Different types of networks were related to well-being in complex ways. Network composition was both a condition for support but also a consequence of the lone mothers' strains. Diverse larger networks, displaying the woman's own or her partner's family of origin or more heterogeneous and multiplex relations, were associated with higher well-being than other confgurations. However, in most cases, the association was mediated by the lone mother's perception of the relational qualities of the single ties: only the absence of confictual ties and the presence of adequate support fostered well-being (Keim 2018).

The most salient relationships for lone parents, besides that with their children, are the relationships with the children's biological father and that with a new partner. The relationship with the father of the children, when there is a relationship at all, can be legally, emotionally, and socially sustained by child maintenance and custody arrangements, emotional exchanges or the common social ties of the previous couple. A new romantic partnership, if started, may represent a further family transition (towards step and blended families) that brings about a role reconfguration for the lone parent and their children. We examined the relationship between the biological father and the lone mother in its interaction with family policies and legal regulations in Switzerland (Larenza 2019). Overall, the conclusions stressed that lone mothers facing fnancial and custodial neglect from children's fathers do not always make full use of their rights. Some lone parents integrate their ex-partners' fnancial hardship into the negotiations on maintenance payments or do not react to violations of maintenance agreements already established to avoid repercussions to the fatherchildren relationship. The relationship between repartnering and lone parents' health has also been a matter of empirical investigation. A new union formation could foster wellbeing because couples will possibly share and pool at least some resources, such as income and social ties (conjugal resource model: Williams, Sassler, & Nicholson, 2008), and, particularly for lone mothers, potentially partially share parental care responsibilities. In contrast, repartnering could also challenge wellbeing because it represents a change in the relational status quo, thereby potentially creating stress even if temporary (crisis model: Amato, 2010). Repartnering may be particularly stressful if it deteriorates the relationship with the children's biological father (Berger, Cancian, & Meyer, 2012). Drawing on the resources and crisis models and on the comparative dataset of the Harmonized Histories, Recksiedler and Bernardi (2019) examined the relationship between lone mothers' repartnering and health in three welfare contexts in Europe, according to type of family policy: the dual-earner (family policy supporting gender equity and women's work), marketoriented (domestic and parental work outsourced to the economic market), and general family policy model and support for lone parents (less gender progressive family policy). They uncovered six distinct repartnering trajectories that varied regarding the timing, type, and stability of higher-order unions for different cohorts of lone mothers. The policy support context is related both to the shape of the repartnering trajectories and to the association of such trajectories with mental health. Unstable repartnering was more frequent in market-oriented contexts, while contexts with more comprehensive family support fostered more stable repartnering. Possibly, the lack of public family support induces lone mothers to quicker transition into a new union. Since a more dynamic union trajectory is also more common in market-oriented societies than elsewhere, mothers experiencing unstable repartnering reported enjoying better health if living in these policy contexts rather than in general or dualearner contexts. Altogether, the fndings suggest that even if higher fnancial needs and less generous welfare may translate into more unstable repartnering histories, they seem to have positive spillover effects on mothers' health.

#### Progress and Inequalities in the Evolution of Friendship in Old Age

Finally, we examined the role of friendship as a resource in ageing to tackle vulnerabilities, which various studies show has important effects, for instance, in its impact on older adults' wellbeing (Ihle et al. 2018). In this context, we were more particularly interested in the structural factors of friendships (Baeriswyl & Oris, 2022), a dimension that is still underdocumented in the older-age friendship literature. Because of the individualised characteristics (elective and fexible ties) of friendships, researchers have tended to forget that friends are not distributed evenly across socioeconomic groups, nor are the resources required for the maintenance of these ties (Stevens & Van Tilburg, 2010; Suanet et al., 2013).

From a macro sociocultural perspective, we confrmed that the prevalence of friendship, a type of tie that theoretically meets the ever-increasing need for the expression of individuality that is a feature of our modern societies, has increased among individuals 65 years and older in Switzerland from the late 1970s until the end of the frst decade of the new millennium (1979-2011) (see also Baeriswyl, 2017). Moreover, our analyses showed that a close friendship increase is part of a broader lifestyle change after retirement (the trend towards active ageing), with increasing social ties and engagements outside the family, in which close friendship can arise and be maintained.

However, at the individual level, it appears that close friendship is not equally distributed among the older population. In particular, having a close friend remained, in 2011, less likely among less educated people. In addition, because over these three decades the number of older adults with limited educational resources fell from a clear majority to a minority, the latter became even more marginalised compared with the rest of the population, who have taken advantage of the considerable progress that has occurred since the mid-20th century in access to education and in health conditions. Moreover, better-educated older adults have generally benefted from the increase in a more socially active lifestyle outside the household after retirement. This observation stresses the accumulation of advantages in which friendship resources are involved. However, our comparison across recent historical time of the structural determinants of friendship also showed a growing differentiation between men and women, with increases that benefted women more, which is not in line with the idea of an accumulation of dis/advantages. Older women are usually seen as more vulnerable because they tend to have fewer resources in terms of health or income and are at greater risk of residential isolation (which has been confrmed through our own data; see Baeriswyl, 2018; Oris et al., 2017). Nonetheless, they have a greater chance to beneft from this important socioemotional resource of friendship. This fnding is in line with results in other Western countries (Arber et al., 2003; Chambers, 2018) stressing older women's advantages in terms of social relationships and some rewards of investing in this life domain.

These results highlight the various aspects of close friendship inequalities, whatever indicator we use to measure friendship, for example, the visiting of friends or acquaintances (Baeriswyl, 2017; Baeriswyl & Oris, 2021). Moreover, we can contrast these results with those for family participation (visiting of family members): while both participation types are signifcantly linked to the satisfaction with life of individuals 65 years and older in Switzerland, family participation does not appear to be stratifed in terms of gender or socioeconomic status. On the one hand, these results confrm the importance of involvement in close ties—kin and non-kin for subjective well-being in older age, but on the other hand, they stress the particularly unequal dimension of friendship: As outlined above, socially better-off individuals are more prone to have elective friendships.

Overall, the various results obtained within LIVES stress the tension between progress and inequalities in friendship evolution in old age. While an increasing number of older adults can beneft from friendship, its availability is not equally distributed (by socioeconomic status and gender), notably in contrast with other close ties that are family ties. In this context, and in parallel with a more general evolution towards a post-retirement lifestyle that is more participative and open to the outside world, friendship integrates a trend involving increasing distance between wealthy and healthy older adults and those who have not benefted from the progress of recent decades and, on the contrary, have accumulated penalties across their life courses. However, our results underline the complexity of the inequalities linked to this relational resource regarding the dis/advantages accumulation hypothesis, in which socioeconomic inequalities are not combined with gender inequalities since women are more likely to develop elective friendships than men. This complexity highlights the importance of examining the issue of intersectionality in more depth in future work.

#### Conclusion

In this chapter, we discussed the distinct role of two types of close relations on vulnerability processes: family ties versus friends. The research discussed in this chapter has shown that the ambivalent and sometimes negative (i.e., resource depletion) aspects of family relationships emerge, in particular, in situations in which other key resources (including friendship ties) are missing, typically with the occurrence of stressful life events. Conversely, negative family events are more quickly overcome when suffcient resources (including friends) are available. Interestingly, some negative life events, such as job loss, are better dealt with through sparser personal networks. By contrast, normative life events act as densifers or enlargers of both elective and family networks.

LIVES 'vulnerability life course' framework enabled us to uncover some of the conditions in which family relations become negative/remain positive during the life course process, and some of the situations in which friendship relations contribute to well-being and help overcome life's hurdles. On the whole, the results obtained show that poor quality family relations and friendships defcits tend to refect and amplify socioeconomic and structural inequalities, although there are exceptions. Further research could focus on the numerous functions still assumed by close families ties today -despite the de-institutionalizing of conjugality, the diversity of family trajectories, and the greater mobility and digitalization of society-, on the key role played by friendships in promoting supportive family links, and on the ways public policies could help individuals create resilient family and personal ties.

#### References

**Open Access** This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/ by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

### The Many Faces of Social Connectedness and Their Impact on Well-being

*Adar Hoffman, Anahita Mehrpour, and Christian Staerklé*

Over the last decade, different theoretical frameworks have been developed to account for the impact of social connectedness on individual outcomes such as subjective well-being and mental health (Santini et al., 2015), particularly approaches based on social identity theory (Haslam et al., 2018), social networks (Smith & Christakis, 2008), and social capital (Ehsan et al., 2019; Helliwell & Putnam, 2004). In this chapter, we review research that describes how such social connectedness approaches are rooted in psychological (Holt-Lunstad et al., 2010; Rook, 2015), social-psychological (Haslam et al., 2009; Jetten et al., 2017) and sociological (Putnam, 2000; Szreter & Woolcock, 2004) traditions. We review conclusive evidence regarding the links between social relations and wellbeing and discuss how these links intertwine in the contextual dynamics of vulnerability. Our contribution is thus concerned with the multilevel perspective advocated in the life course model of vulnerability that

169

A. Hoffman (\*) • A. Mehrpour • C. Staerklé

University of Lausanne, Lausanne, Switzerland

e-mail<EMAIL_ADDRESS><EMAIL_ADDRESS><EMAIL_ADDRESS>
<sup>©</sup> The Author(s) 2023

D. Spini, E. Widmer (eds.), *Withstanding Vulnerability throughout Adult Life*, https://doi.org/10.1007/978-981-19-4567-0\_11

suggests analysing the dynamics of vulnerability across three levels of analysis: the person, the group and the collective (Spini et al., 2017). Further developing this multilevel view of vulnerability, we examine interactions between group-based resources and individual stress and well-being as a function of different forms of social connectedness.

In the frst part, we summarise the key arguments of this multilevel approach in terms of the processes that relate the collective-relational (i.e., networks, identifcation with social groups) to the individual-psychological (i.e., well-being, mental health). Across disciplinary frameworks, there is a consensus that social connectedness is generally seen as a protective resource and is thus associated with positive individual outcomes such as resilience, prevention of physical and mental health issues and improved subjective well-being and life satisfaction (for a review, see Holt-Lunstad et al., 2010). Under some circumstances, however, these positive effects weaken or disappear (DeMarco & Newheiser, 2019; Villalonga-Olives & Kawachi, 2017). In the second part, therefore, we discuss how these approaches view the boundary conditions of these processes in relation to the dynamics of stress and resources as the basic components of vulnerability processes (Spini & Widmer, 2022). We review research that explains contextual variation in the relation between connectedness and well-being as a function of social conditions such as negative and stigmatised social identities (Begeny & Huo, 2017), weak social relations (Cheng et al., 2018), and structural inequality (Bakouri & Staerklé, 2015). In the last section, we offer an integrative approach that brings together the different disciplinary approaches to social connectedness as a novel contribution to the multilevel perspective of life course vulnerability (Spini et al., 2017).

#### Health and Well-being: From Social Networks to Social Identities

Social connectedness refers to "*the degree to which a person experiences belongingness, attachment, relatedness, togetherness or entrenchment in one's social relationships. It refers to subjective feelings and attitudes towards oneself in relation to the social context, rather than to specifc relationships"* (Santini et al., 2015, p. 54). By this defnition, social connectedness is a meso-level concept that inhabits the intersection between the social context at the macro level and the self at the micro level. In the following section, we examine how different multilevel approaches conceptualise the link between social connectedness and individual well-being.

#### *The Social Network and Social Capital Approach*

All individuals are part of multiple social networks throughout their life course. These networks may include inherited connections, such as in family networks, or chosen connections with individuals from different backgrounds. These networks have direct and indirect effects on members' attitudes, beliefs, and behaviours (Vacchiano & Spini, 2021). Social networks are a way of thinking about social life through a lens that focuses on the relationships among the entities that comprise the system (Scott, 2017). As social networks represent relationships (ties) among people (nodes) in groups, they are quintessential grounds for the empirical study of social relationships. Social Network Analysis (SNA) enables the systematic study of network structures and their impact on various outcomes (Clifton & Webster, 2017; Rosenquist et al., 2011) through processes such as 'social contagion' of psychological and emotional states (Smith & Christakis, 2008). Societies and communities in which people are well connected have been shown to possess greater levels of prosperity, health, and subjective well-being (Helliwell & Putnam, 2004; Putnam, 2000). Consequently, overall, people beneft from their involvement in these webs of relationships.

Two aspects of social networks account for their impact on individual well-being. On the one hand, social networks are viewed as *structures* consisting of ties or edges between actors and entities (Clifton & Webster, 2017). For example, *homophily* is a relational-level indicator of the quantity of ties with similar network members (McPherson et al., 2001). In a study with adolescents, Baggio et al. (2017) assessed homophily patterns related to mental health. Homophily patterns showed that participants with low mental health had fewer connections, but also were more likely to have ties with similar participants having poorer mental health. *Density*, the proportion of ties that actually exist relative to the number that could potentially exist, suggests that dense social networks are associated with positive outcomes for individuals, such as better integration and cohesion (Walker, 2015). Last, *centrality* measures how well connected a person is to the rest of the network (Girardin & Widmer, 2015) and has been shown to act as a stress buffer because it is associated with increased access to resources (Berkman et al., 2000). Nonetheless, although being well connected is generally benefcial, this is not always the case. In the context of transition to university, for example, Mojzisch et al. (2021) showed that occupying a central position in the network was associated with greater stress for students weakly and moderately identifed with other students. These fndings imply that being well connected in a group, in the absence of a shared social identity, leads to unpleasant obligations and social pressure. However, centrality effects on stress are inconclusive, as centrality may, at the same time, lead to greater access to resources.

On the other hand, social networks are viewed as *resources* in terms of the *social capital* that the connections bring about (Widmer et al., 2018). The pioneers of social capital research, Coleman (1994) and Bourdieu (1986) conceptualised social capital as a resource available to individuals resulting from group belonging and other social relationships. From this resource perspective, maintaining enduring networks of relations enables access or mobilisation of resources through the ties that can generate a return for the actor (Lin, 2002). Subsequently, Putnam's (2000) work conceptualised social capital as social networks defned by associated norms of reciprocity and trustworthiness. In a multilevel approach, networks are meso-level structures that link *agency* and *structure*, understood as a space between micro and macro levels of analysis from which both constraints and opportunities arise (Vacchiano & Spini, 2021). This mesolevel conceptualisation enables to link the value of social networks with individual health and well-being outcomes.

Investigating network composition and the structural position of individual members leads to a distinction between the resulting *bonding* and *bridging* social capital. These terms refer to the idea of horizontal versus vertical network ties, respectively. In this sense, bonding social capital refers to horizontal relationships, such as family, relatives, friends or colleagues, whereas bridging social capital describes vertical ties, such as in work hierarchies or between citizens and civil servants (Ferlander, 2007). Throughout the life course, bonding and bridging social capital play different roles and have both advantages and disadvantages for individuals (Girardin & Widmer, 2015). Bonding capital facilitates coordination, which is an advantage in life transitions and stages such as old age but can also represent an obstacle to autonomy, which is highly valued by the elderly (Cornwell, 2011). Bridging capital is advantageous since it provides opportunities to mediate and control the fow of resources in networks such as in the family context but is highly demanding of the individual in the bridging position (Widmer, 2016).

This distinction between bonding and bridging social capital has been used in various strands of health research concerned with structural health disparities, community health, and personal health behaviours. These concepts are useful for analysing how the structural positions of individuals shape their general health conditions, behaviours, and the fow of health-related information and resources (Ferlander, 2007). Moreover, bonding and bridging capital have different functional values. While bonding social capital promotes functional and emotional support and is thus vital for *'getting by'*, bridging social capital facilitates access to resources and informational support and is thus vital for *'getting ahead'* (Briggs, 1998).

However, not all social relationships have the same supportive effects from a health point of view. Bonding social capital refers to relations between individuals who see themselves in terms of their 'shared social identity'. Bridging social capital, in turn, develops between individuals who "know that they are not alike in some sociodemographic (or social identity) sense" (Szreter & Woolcock, 2004, p. 655) and is based on lesspermanent (e.g., professional) relationships that are highly context specifc. It should be noted, however, that this terminology of a *shared social identity* is used here interchangeably with *shared sociodemographic characteristics*, thereby failing to consider conceptual differences in terms of an *objective* versus *subjective* understanding of social identity. Viewing a shared identity in terms of a shared sociodemographic characteristic refers to an objectively defned category membership that is a culturally provided and fxed part of the social structure. A subjective view of social identity, in contrast, is not confned to this classifcation (Emler, 2005). Rather, it refers to a subjective and contextual defnition of selfhood based on a feeling of temporary belongingness within any social category that is relevant in a given situation or period of life (see next section). This objective versus subjective understanding of shared identity therefore serves as a meeting point between social capital and social identity approaches to social connectedness and individual health outcomes.

Empirically, little research has investigated the links between objective and subjective understandings of social connectedness. In a study with college sports club teams, network centrality and density were positively associated with team identifcation, used as a proxy for well-being (Graupensperger et al., 2020). In that study, network centrality functioned as an objective relational measure that predicted team identifcation, which is a subjective measure. Another study showed that social networks and religiosity predicted life satisfaction through increased religious identity (Lim & Putnam, 2010). In that study, again, an objective measure—i.e., congregational connections—explained a subjective measure, i.e., religious identity, measured as the subjective importance of religion for the sense of self. These studies shed light on the network-identity linkage and target the interrelationships among different conceptualisations of social connectedness and the mechanisms that link them with well-being.

#### *The Social Identity Approach*

In considering how social networks impact individual health and wellbeing, it is necessary to consider how social group and category memberships are subjectively integrated into the self, that is, one's *identifcation* with social groups. This particular view of the intersection of the social and the individual is based on the social identity approach to health and wellbeing (for reviews, see Haslam et al., 2018), derived from *Social Identity Theory* (SIT; Tajfel & Turner, 1979) and *Self-Categorization Theory* (SCT; Turner et al., 1994).

According to this *social cure* perspective (Haslam et al., 2009; Jetten et al., 2017), the sense of self that individuals derive from their different group and category memberships (see SIT; Tajfel & Turner, 1979) has the potential to promote health and well-being. Empirical evidence over the past decade has demonstrated the key role of social identifcation as a psychological resource to cope with a wide array of planned and unplanned life stressors and transitions (for a meta-analysis, see Steffens et al., 2017). Social identifcation is the emotional valuation of the relationship between the self and the group (Postmes et al., 2013), and identifcation is a central driving force in the capacity of social groups to determine important health and well-being outcomes (Haslam, Jetten, Cruwys, Dingle, Haslam et al., 2018).

*Social cure pathways* describe the various mechanisms that make social identities a valuable resource for individual well-being, thereby highlighting the protective role of social identifcation (Jetten et al., 2017). Most prominently, the impact of social identity on well-being is mediated by self-esteem, social support, need satisfaction, sense of control, and selfeffcacy (Haslam et al., 2018). In two studies among friendship and army groups, for example, the effects of group identifcation and social contact on mental health were compared. Group identifcation had stronger implications for mental health than contact, indicating that mere contact does not necessarily lead to better mental health (Sani et al., 2012). Therefore, what matters for health is less the frequency of contacts than the degree of one's identifcation with subjectively important groups, which suggests that group identifcation is central to the process that leads from social connections to well-being. Another study found that social identity counters depression by facilitating social *support*, providing *meaning* in life, and enabling a sense of *belongingness* (Cruwys et al., 2014). Overall, social connectedness from the social cure perspective is a strong and consistent predictor of mental and physical health in large population surveys (Saeri et al., 2018) and moderately effective in fostering health and well-being in community interventions (Steffens et al., 2019).

#### Contextual Dynamics of Vulnerability

Notwithstanding the general emphasis of the social cure approach regarding the protective mechanisms that link group identifcation with wellbeing, these positive effects weaken or disappear under specifc circumstances. Social identifcation with a devalued or undermined group, or situations in which social capital does not lead to positive outcomes, represent such conditions. In such meso-level contexts, social connectedness does not act as a resource for individual well-being, which resonates with the conception of vulnerability as a *'process of resource loss or insuffciency in one or more life domains'* elaborated in the LIVES framework (Spini et al., 2017; Spini & Widmer, this volume). In this view, it is not the lack of resources *per se* that leads to negative well-being consequences. Instead, it is that the resource cannot be optimally mobilised or taken advantage of *within a given context*. In this section, we describe how both the social identity and social capital approaches undergo contextual variations in the protective function of social connectedness. In so doing, we analyse the boundary conditions of social connectedness and well-being and conclude with the necessity of a *dynamic* approach that integrates the contextual interplay between objective and subjective conditions in determining individual outcomes.

In the social identity approach, the capacity of social identifcation to function as a resource for well-being is constrained by a group-level factor formulated in the social cure paradigm as the *group circumstances hypothesis*. According to this hypothesis, the status and circumstances of the group with which people identify directly impacts well-being. An enhanced or compromised group thus entails, respectively, positive or negative consequences for individuals (Jetten et al., 2017). Identifcation with low status, stigmatised and discriminated groups may thus exert a negative impact on individual health and well-being (Begeny & Huo, 2017; Schmitt et al., 2014; see also Haslam et al., 2018). Lacking group self-esteem may also interfere with the benefcial implications of identifying with groups (DeMarco & Newheiser, 2019).

In the context of the transition from high school to university, for example, students from low-status backgrounds beneft less from identifying with the (high-status) student group because their new identities are less compatible with their backgrounds (Iyer et al., 2009). From a life course perspective, transitions in the life course imply changes in social identities, which are more likely to be gradual than abrupt. First, such identities require psychological adaptations that take time to develop. Second, some social identities may drive resistance to the new posttransition identities (Emler, 2005). More generally, perceiving barriers to successful life transitions harms individuals' self-esteem, but this negative effect can be buffered by social identities that connect the self to signifcant others, termed 'bonding identities' (Bakouri & Staerklé, 2015). Finally, life course transitions often represent simultaneously lost and gained social identities, which are inherently challenging at different stages and transitions of the life course (Spini & Jopp, 2014).

The 'social cure' effect of positive social identities may thus be transformed into a 'social curse' effect for negative social identities (Muldoon et al., 2019). Notwithstanding such burdening effects of negative social identities, they may still be mobilised, under the right circumstances, to drive positive well-being effects. This empowering process has been demonstrated in the context of a group of individuals suffering from acquired brain injury who have been shown to beneft from a common feeling of belonging to this stigmatised group (Muldoon et al., 2019). In a similar vein, a Swiss study showed that perceiving a mental health problem as central to one's identity had positive effects for recovery, but only if patients had felt stigmatised due to that mental health problem (Klaas, 2018). In contrast, a study on migrant detainees revealed that while existing social identities supported them in coping with the distressing situation, these same identities were also experienced as a burden and cause for rejection (Kellezi et al., 2019). These examples point to a complex dynamic in which the negative impact of group circumstances on well-being operates alongside other compensation mechanisms aimed at restoring a sense of positive identity as a function of the social context (Jetten et al., 2017).

One such compensation strategy is strengthening identifcation with a stigmatised group that then functions as a buffer against the negative implications of group devaluation (see Rejection-Identifcation-Model; Branscombe et al., 1999; Schmitt & Branscombe, 2002). However, identifcation with low-status or stigmatised groups does not occur in a void, as research has shown that identifcation with low-status groups is dependent on the perceived permeability of group boundaries (Ellemers et al., 1988). Indeed, when individuals perceive that it could be possible for them to move into another, usually higher-status group (i.e., perceived permeability of group boundaries), they may distance themselves from the low-status group and instead engage in individual upward mobility. The perceived properties of the social structure could therefore drive interactive effects between group circumstances and social identifcation and exert a complex impact on individual well-being.

Research in the social capital approach also provides evidence for the impact of group circumstances on the protective function of social connectedness. Limited bridging social capital, for example, can have negative implications for individual well-being (Szreter & Woolcock, 2004). Another study found differential effects of social capital on well-being as a function of ethnicity and race. The analysis of the impact of bonding and bridging social capital across 40 U.S. communities showed that social capital was associated with lower odds of self-reported poor health. This positive association between community bonding social capital and health, however, was signifcantly weaker among Black participants and among those who self-assigned to the 'other' ethnic category, compared with white participants (Kim et al., 2006). In a study among residents of an impoverished and racially segregated neighbourhood, bonding social capital was indeed positively associated with mental distress and did not mediate the relationship between economic and environmental stressors on well-being (Mitchell & LaGory, 2002). These fndings further show that in severely disadvantaged contexts, social capital may lead to less rather than more favourable health outcomes.

Other factors that may impair the positive effects of bonding capital concern excessive demands for support by other group members, restrictions on freedom due to excessive informal control, exclusion of outgroup members, and harmful effects of norm conformity in general (Portes, 1998). A meta-analysis found such negative associations between bonding capital and health in 44 studies (Villalonga-Olives & Kawachi, 2017). Overall, these studies suggest that bonding social capital, in particular, should be viewed as a 'double-edged' phenomenon that, depending on the context, can have both positive and negative outcomes for individuals.

This short overview of contextual variations of the protective function of social connectedness calls for an integrative approach that focuses on dependencies between group and individual-level effects as well as on the interactions between these levels. As such, our perspective contributes to the general LIVES approach to vulnerability by providing a more detailed understanding of the multilevel nature of vulnerability and by answering the call for an interdisciplinary approach to vulnerability (Spini & Widmer, this issue; Spini et al., 2017). A dynamic approach that views social connectedness as operating at different levels and on different dimensions of objectivity and subjectivity may thus represent the common ground of social identity and social network approaches to individual health and well-being. In the fnal section, we outline such an approach, which should be able to account for multiple context-dependent processes linking social connectedness and individual well-being.

#### A Multilevel Approach to Vulnerability and Social Connectedness

Social connectedness is inherently a meso-level phenomenon that calls for interdisciplinary perspectives to gain a comprehensive understanding of the mechanisms involved in predicting individual health and well-being outcomes. Findings from the social identity approach, social networks and social capital research traditions largely converge on the overall positive impact of social connectedness on individual well-being outcomes. However, these approaches also highlight contextual dynamics of vulnerability that suggest that in some contexts, individuals cannot mobilise social connectedness as a resource for well-being.

Considering these complexities, we conclude by offering a blueprint for an approach to the multilevel nature of vulnerability that aims to integrate these different conceptualisations of the relationship between social connectedness and individual well-being. We identify three organising principles of such a multilevel perspective, defned by its capacity to account for (a) subjective and objective conceptualisations of social connectedness, (b) the within- and between-group nature of social dynamics underlying agency and well-being trajectories, and (c) different types (additive, mediation, interaction, or moderation) of causal relationships between connectedness and well-being.

The frst organising principle refers to *objective* versus *subjective* conceptualisations of social connectedness. As we have shown in this chapter, this distinction characterises the conceptualisation and measurement of a shared identity from a social capital and social identity perspective. Regarding the impact of social connectedness on individual well-being, the objective and subjective can operate in tandem (Sani et al., 2012), indirectly (Lim & Putnam, 2010), in interaction (Mojzisch et al., 2021), or as compensation (Schmitt & Branscombe, 2002). Under conditions where objective circumstances are detrimental to the protective function of social connectedness (e.g., in stigmatised and marginalised groups), subjective strategies can compensate and protect well-being. The protective impact of social connectedness is therefore simultaneously contingent on the *objective* features as described in the social network and social capital approach (with measurements such as density, homophily and centrality) and on the *subjective* understandings and perceptions of group membership as described in the social identity approach (with measurements of identifcation, salience, and differentiation).

The distinction between objective and subjective understandings of connectedness is tied to the problem of overlapping or confusing terminology employed by different approaches. The terms 'social identity' and 'shared identity' are extensively used in the social network and social capital traditions, but often refer to mere membership in a category or to shared sociodemographic characteristics. The social identity approach, in contrast, uses the same concepts, but puts forward the subjective sense of self that is derived from (sometimes temporary) belonging to a group and the resulting categorisation in terms of 'us' vs. 'them'. Precise terminology is important because, from the social capital and social network perspectives, the protective factor is actual engagement and involvement in the social group. From the social identity perspective, in contrast, people experience health-related benefts of a given group membership only to the extent that they identify with that group (Haslam et al., 2018).

The second organising principle concerns the within- and betweengroup nature of social dynamics underlying well-being. While the social network approach is traditionally concerned with the structure and composition of a single ingroup, the functional aspects of differentiation between ingroups and outgroups form a central tenet in the social identity approach. Although network research considers the multilevel and multigroup nature of networks (Lazega & Jourda, 2016; Vacchiano & Spini, 2021), the basic motivation to construe a positive social identity on the basis of comparative intergroup differentiation remains the hallmark of the social identity approach. This emphasis on subjective and perceptual processes is most evident in the extensive research on the effects of the perceived properties of social structures, particularly in terms of perceived permeability from low- to high-status groups. Such perceptions determine whether individuals engage in individual (social mobility) or collective (social change and social creativity) strategies to improve their identity (Tajfel, 1978) and thus to cope with vulnerability.

These considerations lead us to suggest that these two strategies are likely to be contingent upon bonding and bridging capital, described above. Indeed, bridging social capital describes connections that link ('bridge') people *between* communities, groups, or organisations and thus helps them to 'get ahead'. Bridging social capital therefore implies a degree of perceived (vertical) intergroup permeability and is likely to facilitate individual social mobility strategies. In contrast, bonding social capital describes connections *within* a group characterised by high levels of similarity between group members and strong ingroup identifcation.

From this view, future research is needed to determine to what extent bonding and bridging social capital could bolster different identity strategies that can be used to compensate for negative social identities derived from low group status or group devaluation. Consequently, well-being can be improved via more positive social identities. If social identifcation with the ingroup is high, a lack of bridging capital may promote collective strategies that mobilise bonding capital, for example, in social movements and collective action. Lacking bonding capital (i.e., lacking social identifcation) can be compensated for with bridging capital and lead to individual upward mobility strategies.

The third organising principle of our multilevel approach to vulnerability requires the specifcation of *different types of causal relationships* between connectedness and well-being. Existing attempts to integrate social identity and social networks in determining well-being outcomes have hypothesised additive, interactive or mediating relationships of these approaches. Additive effects imply that social networks and social identity operate independently, exerting either equivalent or different impacts. Such an additive impact has been shown in friendship and army groups, where identifcation was a better predictor of well-being than network contact (Sani et al., 2012). A mediating effect, in contrast, implies that a given social connectedness measure impacts well-being indirectly via another construct, for example, when network centrality and density in sports teams are positively modelled with well-being through team identifcation (Graupensperger et al., 2020). Finally, interactive effects imply that the impact of one social connectedness conceptualisation is contingent upon the level of another intervening factor. Such a moderating effect has been described in a 'closed' network of university students, in which network centrality and social identifcation interact in affecting stress, suggesting that being central in the group is only benefcial when accompanied by a psychological sense of belonging (Mojzisch et al., 2021).

#### Conclusion

In this chapter, we have outlined possible avenues of an interdisciplinary integration between social network, social capital and social identity approaches to individual health and well-being from a life course perspective. Our overview has identifed many commonalities but also important conceptual differences among these approaches. Combining the different social connectedness conceptualisations requires a careful analysis of the relational and psychological processes operating at each level of analysis, especially at the intersections of the collective and the individual levels, as well as regarding the objective and subjective conceptualisations of social connectedness. The various approaches converge on the idea that any process relating connectedness and well-being must necessarily be analysed as a function of the social context in which it operates, for example, in terms of (perceived) social structure, group status or competition between groups.

Overall, however, our analysis points towards the important explanatory potential of a multilevel and interdisciplinary approach that integrates social networks, social capital and social identity with a life course perspective. This approach should not only be able to account for the multiple context-dependent processes linking social connectedness and individual well-being but also to identify the structural conditions and the social psychological processes through which social capital leads to improved well-being. It is our hope that our multilevel perspective on vulnerability, notably showing the potential of an interdisciplinary and integrated mesolevel perspective, proves useful for future life course research.

#### References

Baggio, S., Luisier, V., & Vladescu, C. (2017). Relationships Between Social Networks and Mental Health: An Exponential Random Graph Model Approach among Romanian Adolescents. *Swiss Journal of Psychology, 76*(1), 5–11. https://doi.org/10.1024/1421-0185/a000186

**Open Access** This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/ by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

### Vulnerability around Health Issues: Trajectories, Experiences and Meanings

*Claudine Burton-Jeangros and Vanessa Fargnoli*

In this chapter, we discuss how vulnerability takes on contrasting and ambivalent meanings when approached at different levels. More specifcally, we are interested in how institutional approaches do not necessarily align with the perceptions and experiences of those who are defned as vulnerable. Over the last decades, scientifc knowledge, and technical and medical measures have supported the development of the prevention and management of vulnerability. However, despite social and public health interventions, vulnerability reduction remains unequal across social groups. Starting from this mismatch, we focus our attention on how individuals in vulnerable circumstances develop their own strategies and meanings in the context of adversity, along but also against collective defnitions of and responses to vulnerability.

In the introduction, Spini and Widmer contrast two main perspectives on vulnerability. The frst focuses on individuals having diffculties coping with adversity due to their low resources and their subsequent need for support

C. Burton-Jeangros (\*) • V. Fargnoli

Institute of Sociological Research and LIVES Center, University of Geneva, Geneva, Switzerland

e-mail<EMAIL_ADDRESS><EMAIL_ADDRESS>
<sup>©</sup> The Author(s) 2023

D. Spini, E. Widmer (eds.), *Withstanding Vulnerability throughout Adult Life*, https://doi.org/10.1007/978-981-19-4567-0\_12

from social institutions through different categories of welfare. The second perspective starts from individuals' interpretations of their own circumstances at different stages of their life course, thereby connecting vulnerability with their own defnitions of social citizenship and in relation to integration in society. This distinction suggests that '"vulnerability" means different things to different people' (Brown 2011, p. 313). Indeed, we propose that these meanings vary depending on people' s relationship with vulnerability: as a condition that they ought to protect others as part of their professional role (as health professionals or social workers) or as a personal condition refecting one' s own life trajectory and aspirations. In this chapter, we tackle these contrasting meanings to better understand the complexity of the social processes taking place around vulnerability. We consider that institutional or professional views, on the one hand, and lay or ordinary meanings, on the other hand, are not fully independent. Rather, they are interrelated and mutually infuential, notably through social norms.

This discussion will focus on health issues. From a medical and public health perspective, vulnerability tends to be defned through biological conditions, individual characteristics or behaviours (Armstrong, 2014). In this approach, contexts, interactions and life course effects are most often absent. However, the life course perspective invites us to consider how interpretations of vulnerability change over time at the individual level over successive life stages and at the societal level as a result of medical and social transformations (Delor & Huber, 2000; Wadsworth, 1997). These changes are not likely to occur synchronously across levels, thereby contributing to generating divergent views on what vulnerability actually means. In addition, focusing on how meanings and experiences develop over time sheds light on the intersection of agency and structural processes and emphasises the importance of contexts, social norms and interactions in people' s understandings of vulnerability.

Based on research conducted on health trajectories in the context of the LIVES research program, the frst section shows the importance of paying attention to various understandings of vulnerability and emphasising its situated character related to actors' positions. The second section illustrates the argument in greater depth by using elements from a qualitative study on the experience of HIV-infected women's trajectories (Fargnoli, 2021) to highlight contradictions between their own understandings of vulnerability and its medical framing. In conclusion, we stress the importance to policymaking of defning vulnerability based on people' s needs and their own assessments.

#### Vulnerability around Health Trajectories

We approached vulnerability through the lens of health inequalities. Along with developments in life course epidemiology, we aimed to contribute to the understanding of why health inequalities remain persistent in highincome countries, despite an overall improvement in population health (Cullati et al., 2018a). Analysing health trajectories implies approaching health as a dynamic feature that, beyond biological ageing, is shaped by a number of exposures, including genetic and biological make-up, family and work conditions, and societal and environmental factors (Burton-Jeangros et al., 2015). Moving beyond associations between individual risk factors and specifc diseases, epidemiology has endorsed a life course perspective to account for the long-term infuence of lifelong factors on the evolution of health (Burton-Jeangros, 2020). Adopting a cumulative (dis)advantage framework (Dannefer, 2003), empirical analyses of longitudinal data were employed to assess the role of individual socioeconomic resources and institutional resources in how health evolves across social categories. In addition to the infuence of childhood and adulthood socioeconomic circumstances over health trajectories later in life (Cullati, 2014, 2015; Cullati et al., 2014a, 2014b), the impact of welfare regimes in moderating health inequalities was also assessed (Sieber et al., 2019; Sieber et al., 2020). Such quantitative analyses inform us about general trends and describe how social determinants shape contrasting health trajectories. They provide important insights into the accumulation of vulnerability as a result of 'dynamics of stressors and resources across the life course' (Spini et al. 2017, p. 5). These processes matter not only for individuals' social life but also for their health. Current developments in epigenetics allow to analyse biomarkers and socioeconomic data jointly and thus to better understand the intersection of biological and social processes in shaping health trajectories (Landecker & Panofsky, 2013).

However, these analyses also present shortcomings. For one, they tend to adopt a top-down view of vulnerability based on defnitions formulated by scientists and policymakers of what individuals should do to avoid being in a vulnerable condition. Furthermore, the medical perspective refects modern individualism, emphasising the importance of individuals' characteristics and behaviours for health (Armstrong, 2014). In both welfare and public health actions, activation policies have become the preferred strategies to address vulnerability. Next to recommendations to promote social justice, vulnerable people are continuously encouraged to modify their 'inappropriate' behaviours to improve their social and health circumstances. The idea of risk, so common concerning health issues, has promoted this emphasis on individuals' agency: 'Being at risk therefore established the perfect machinery for placing the population in a constant state of readiness and awareness in regard their health' (Armstrong 2014, p. 167). Public health measures advocated in the context of the COVID-19 pandemic have reiterated this focus on individual responsibility regarding risk.

Against this institutional perspective, a number of fndings suggest that meanings of vulnerability can vary along contextual and temporal circumstances. People interpret their life circumstances and their capacity to act upon them in light of their own life course, experiences, hardships, and aspirations. In support of this, research dedicated to well-being has shown that additional resources do not systematically improve individuals' quality of life, as revealed in analyses of the quality of life of successive cohorts of women born between 1916 and 1945 in Switzerland (Burton-Jeangros & Zimmermann-Sloutskis, 2016). Those born more recently reported higher resources but lower quality of life than those born earlier. This discrepancy could result from the contrasting levels of adversity experienced by successive cohorts; women born earlier having encountered more hardships. It could also refect changing sociocultural expectations among more privileged populations with regard to health and life conditions, hence reducing their perceived quality of life.

In the Parchemins study on undocumented migrants' health and wellbeing (Jackson et al., 2019), the quality of life of newly regularised migrants was found to be approximately as high as the quality of life reported by local residents. However, the resources available to both categories are widely unequal (as measured, for example, by average income, ranging between 23,000 CHF/year for undocumented migrants and 83,000 CHF/year for regular local residents). In this context, the motivations underlying undocumented economic migration are likely to shape expectations and aspirations that are clearly distinct from those of people who have resided in Switzerland without having encountered the hardship experienced by migrants who remain undocumented for a long time. The latter are willing to accept their diffculties in regard to their capacity to support their families who remained in the country of origin (Burton-Jeangros et al., 2021).

These fndings indicate that the defnition of vulnerability is normative, based upon values and goals that are not systematically shared across societies, across groups and over time. This assertion is further evidenced by the fact that preventive activities tend to increase health inequalities rather than diminish them. For example, it has been observed that the higher uptake of preventive measures (such as not smoking, eating healthy food, and taking exercise) in higher socioeconomic groups tends to reinforce the gradient in health rather than to diminish it (Stephens, 2010). In other words, more privileged people, who are closer to those holding dominant positions in society, share similar worldviews and aspirations that contrast with those of less privileged people. Research on health care renunciation or social aid non-take-up has also emphasised such a clash of expectations and values across social groups. We observed this in the context of the frst COVID-19 lockdown in Switzerland in spring 2020. Undocumented or newly regularised migrants engaged in only a limited use of institutional support, despite an important deterioration of their economic circumstances. Such limited use was motivated by their fear of being deported but also by their internalisation of the norm of autonomy and thus of not asking for any outside support, as well as by the shame associated with demanding help (Burton-Jeangros et al., 2020).

Health issues are particularly relevant in discussing contrasting views of vulnerability, since they typically encompass different framings of what it means to be healthy or sick. Medical and public health tend to approach individuals as autonomous, self-responsible agents who try to maximise their health (Petersen & Lupton, 1996; Armstrong, 2014). This framing has, however, been criticised for its overly limited consideration of individuals' socioeconomic resources and living conditions. Furthermore, the life course perspective invites us to consider not only contextual circumstances but also people' s own interpretations of what matters to them in terms of health (Burton-Jeangros, 2020). Self-rated health, a commonly used item in population surveys, acknowledges the importance of individuals' own evaluations, especially since many health conditions do not end up in contact with health professionals. Indeed, it appears that this indicator presents important overlaps with more 'objective' indicators of health across cultural contexts (Cullati et al., 2018b). In addition, qualitative anthropological and sociological research has provided useful insights into emic views of health and vulnerability and their contradictions with the perspectives of other social categories, notably those of individuals in professional roles. We consider that these studies, stemming from a different research tradition and usually using ethnographic approaches, are important to provide a more in-depth knowledge of vulnerability. Notably, they analyse how vulnerability changes over individual life stages, in tight connection with signifcant others, while considering individual strategies as well as the external constraints and social norms to which they are exposed.

In summary, longitudinal surveys are useful to show patterns in population health distribution and account for the dynamics of stressful experiences and resources available to individuals. However, they offer only a limited understanding of the mechanisms connecting social and biological conditions. The classical distinction among the medical defnition of disease, the person's own experience of illness, and the policies framing sickness (Bjørn Hofmann, 2016) illustrates the variability and complexity of meanings attached to health-related vulnerability. In the next section, we elaborate on those contrasting understandings, with elements drawn from qualitative research concerning women living with HIV in Switzerland (Fargnoli, 2021). Health inequality research has shown how important resources are in facing stressors and remaining in good health (Burton-Jeangros et al., 2015). However, we want to emphasise here how vulnerability is also shaped by experiences and interactions and by the interpretation of vulnerable situations as elaborated by the people living them and by others around them (cf. Bonvin et al., in this volume).

#### Vulnerability Experiences of Women Living with HIV

In the early 1980s, HIV/AIDS emerged as a risk that threatened large segments of the population at a global scale. The frst decade following its emergence focused on health education to reduce risk behaviours and thus limit the spread of the virus. In the mid-1990s, antiretroviral therapies (ART) normalised the epidemic by keeping infected people alive, thus reducing their biological vulnerability. A decade later, the acknowledgement that HIV-infected people under regular medical treatment were not presenting risks to their regular partner reduced collective vulnerability even further. Medically, the risk of HIV infection has thus been 'domesticated' (Rosenblum et al., 2012), moving from an unacceptable to an acceptable risk with the 'normalisation' of AIDS (Setbon, 2000). Over the last 20 years, the image of an HIV-infected person as capable of leading a 'normal' life has gained traction. While the biomedical approach did not succeed in curing people living with HIV, it does keep them alive in an intermediate status between health and illness—and thus, in a condition of vulnerability. Next to the medical and institutional framings, which emphasise the reduction of individual and collective risk, the narratives of women living with HIV who do not belong to targeted groups1 have revealed how they experienced vulnerability over time.

#### *'Treated Body': HIV under Control*

In the Swiss context, the liberal health model protects individuals (confdential HIV status, access to social insurance in case of incapacity to work) and ensures care for everyone (treatment and medical follow-up reimbursed by mandatory health insurance). At the same time, this system makes individuals responsible for their own health: a 'good' HIV-infected patient or citizen is expected to take antiretroviral therapies, available in Switzerland since 1996. He or she takes care of himself/herself by adopting 'responsible' behaviours to avoid worsening his or her state of health and further disseminating the disease, since infecting others is sanctioned by law.

From the medical point of view, the 'treated body' (Pierret, 2006) represents an HIV infection 'under control'. Thanks to the effciency of ART, the viral load becomes 'undetectable', which means that HIV has been reduced to such a small quantity that standard blood tests cannot detect it. 'Made undetectable through treatment' (interviewed doctor in 2015) has become a medical standard in Switzerland and elsewhere (WHO, 2016).

Medically, 'normalising HIV/AIDS' has meant that in high-income countries, the virus has been transformed into a 'manageable public health problem' (Rosenbrock et al., 2000). The promise behind ART is the guarantee for people living with HIV to survive and lead a life like everyone else (Squire, 2010). Overall, for the HIV specialists interviewed, 'being undetectable' implies that 1) the treatments are taken and effective; 2) there is no risk of HIV transmission, and the virus does not develop resistance to the treatments; and 3) serodiscordant couples2 can have a child naturally. According to their views, based on the latest evidence, vulnerability is thus minimised thanks to medical treatments.

Next to this medical framing, the promise to be able to live a 'normal life' appeared ambivalent for the study participants. The notion of

<sup>1</sup>Thirty in-depth interviews with women living with HIV, who do not belong to targeted groups as defned by the Federal Offce of Public Health (FOPH), were collected between 2013 and 2016, and ten HIV/AIDS specialists were interviewed.

<sup>2</sup>One partner is HIV-positive and the other one is HIV-negative.

'undetectable viral load' remained vague and ambiguous for several of them. Their treated body still represented a 'weak, sick and intoxicated' body, and the perception of it as a 'dangerous body' for others remained.

#### *'Dangerous Body': HIV as a Social Threat*

For the interviewed women, 'being undetectable' did not necessarily mean being healthy but rather no longer representing a risk of HIV transmission, which they translated into no longer being 'dangerous' or 'monstrous'. Therefore, their views on vulnerability were foremost expressed in terms of a social condition that affects others—i.e., a body that had been previously dangerous had become safe for others—rather than as a physiological state. However, for some interviewees, the perception of 'contagiousness' persisted.

'It means that I can' t transmit "it" to someone. I am no longer contagious. Even that would scare me. What does that mean? That I am less dangerous than someone who is HIV-positive and who wouldn' t know it?' (Fanny).3

Although they were declared to have an undetectable HIV viral load and were living without symptoms, they remained perceived as potentially dangerous to others and to society.

'Not many people today would drink from my cup, lick my spoon, when we know very well nobody can get AIDS like that! The fears are just as deep as they were back then. People get along intellectually, but fear is just as deep.' (Adèle).

The infectious nature of HIV remained strongly embedded in social norms and was perceived by interviewees as a powerful driver of their rejection by others.

The impact of HIV on the interviewees' feminine identity was evinced by their perception of their body as 'dirty', a view that nurtured negative feelings towards their intimacy. Being HIV-infected underpinned the idea that, somehow, they had failed to meet female social obligations and roles as 'good' mothers and wives and had transgressed the sociosexual norm of virtue typically assigned to women (Héritier, 2013; Théry, 1999).

<sup>3</sup>Quotes are associated with a pseudonym to respect participants' anonymity.

Therefore, HIV-infected women' s perceptions and experiences appeared to be strongly infuenced by the social and gender construction of HIV/ AIDS as a 'moral disease'.

Some emphasised that their noninfectious status as a result of their treated body did not convince everyone; their body was still associated with representations of 'death transmission'. Indeed, two-thirds of the interviewees had been tested HIV-positive before the introduction of effective ART, at a time when this diagnosis was synonymous with death. Their infection and diagnosis thus took place in a context of medical powerlessness that particularly marked them then and continues to fuel their fears even today. Hence, for most of the interviewees, their current minimal risk of HIV transmission remained an unacceptable risk:

'I am still reluctant to have unprotected sex even if I have a steady partner. I' m never 100% ok. To say that we can have sex without a condom, there is always a little doubt about not infecting a third person.' (Tina).

Moreover, if these HIV-infected people were not themselves convinced of their low risk, nor were the health professionals they had worked with or contacted. Indeed, some participants claimed having experienced discrimination in those interactions. These elements indicate that living with HIV means living with the indelible imprint of the history of a threatening epidemic whose social representations have not been deeply altered by the development of medical solutions.

#### *'Sick and intoxicated body': HIV as Personal Vulnerability*

Descriptions of the 'infected body', 'dangerous body', 'sick body', 'vulnerable body', 'vegetable body', and 'intoxicated body' were present in the women' s narratives to express their body's fght against the virus and the medical treatments. They were concerned with the treatment's longterm side effects, viral resistance, interactions of ART with other treatments and comorbidities.

ART, by destroying HIV, also affects treated individuals' bodies. Most of the interviewees felt their bodies 'threatened' at some point. Some even mentioned having their bodies 'eaten up' by the treatments or 'being intoxicated'. In the long term, the treated body becomes a painful, sick and worn-out body, which has both psychological and social consequences. 'Being in pain all the time' limited these women's autonomy and social interactions. In addition, the irreversible nature of HIV infection, the continuing uncertainty about the course of the disease and long-term treatment weighed on their life course:

'You may be sick, but at the moment you are not sick. You don' t know how long you will not be sick and when you may or may not get sick.' (Valentine).

Discrepancies between participants' expectations and interpretations and those of their physicians also appeared in the explanations of the symptoms experienced. The interviewees considered the treatments exhausting, whereas the doctors never blamed the treatments. Participants complained about not being considered or taken seriously by specialists, who interpreted their complaints in light of the risks of treatment interruption.

According to the interviewees, in the absence of evidence—since their suffering, pain and exhaustion remained invisible—doctors would typically attribute their symptoms to something else, such as advanced age or psychological factors. Thus, the medical vision of an undetectable viremia (the presence of HIV in the blood) ensuring 'normal' experiences with HIV did not resonate with their lived experiences.

'What is the basis for saying that you' re "healthy"? Medical tests or how do I feel?' (Béatrice).

For doctors, undetectable viremia defned a form of normality and the absence of vulnerability. For the participants, however, normality was defned by the way in which the disease affected their daily lives. Through their interruption of treatments, pauses, refusal or reduction in dosages and use of alternative therapies, they expressed a need to exercise some control over the virus and to be an actor in their own health. By (re)appropriating medical standards, they claimed a certain expertise, agency and autonomy.

#### Conclusions

This case study of women living with HIV showed that vulnerability needs to be situated within the life course and social context of the persons concerned. First, if the vulnerability of people living with HIV is controlled from a medical point of view, they live 'a normal life' only under certain conditions: life-long treatment and fear of social rejection. Despite the effectiveness of current treatments, concerns about their toxicity and the development of the disease are still raised. Furthermore, people living with HIV do not have the status of legitimate patients: By making them 'undetectable', treatments take away their legitimacy as 'sick patients'. They are neither fully 'sick' yet, nor fully 'healthy' since they are still HIV-positive and under treatment. Second, their HIV-related vulnerability persists in its social and relational dimensions. Indeed, based on their past experiences, these women's fears of discrimination from potential sexual partners, health professionals, and relatives remained high. Whereas medically HIV has been considered a chronic disease since the end of the 1990s in highincome countries, the treatments have not, to date, achieved 'social normalization' (Poglia Mileti et al., 2014). Furthermore, the transmissibility of the disease is highlighted in the law. This perception of risk makes HIV/AIDS not only a biological but also a social condition.

The medical point of view has emphasised how treatments have transformed HIV into a manageable public health issue thanks to compliant individuals endorsing the offcial defnition of vulnerability. However, such normalisation of HIV is questioned by the experience of those who are infected. Indeed, women living with HIV reported encountering numerous obstacles in their emotional, sexual, professional and social relationships. Overall, their accounts showed how vulnerability, as defned by institutional approaches, does not match the 'subjective' or lived experience and understanding of those described as vulnerable. Along with others, we consider it important to address the complexity of these contrasting views: 'In emphasising the relational, contextual, and process aspects of the risk itself, we avoid the pitfall of considering vulnerability to be a stable, essential characteristic of individuals' (Delor & Hubert, 2000, p. 1564). The life course perspective contributes to this effort by emphasising not only the temporal dimension—crucial in the context of the HIV epidemic—but also the role of life-long development, interactions and agency in the meanings attached to vulnerability.

The case of women living with HIV described above notably helps us understand how situated defnitions of vulnerability are shaped by the exposures, resources and trajectories of those who formulate them. The medical defnition of vulnerability, based on biomedical and epidemiological evidence, adopts a top-down perspective along specialists' professional trajectories and positions, which do not match the perspective of the persons concerned. Their interactions, affected by divergent understandings, are thus potentially confictual. In addition, people living with HIV remain exposed to social norms, which still defne them as potentially dangerous. Consequently, they experience stigmatisation in different settings and interactions. Offering those who experience vulnerability the opportunity to characterise their experience in their own terms helps to uncover their agency regarding vulnerability amidst those multiple outside infuences.

Thus, analysing the articulation of vulnerability across multiple levels confrms that it is not merely an individual experience. Rather, the understanding and experience of vulnerability are built along relations developed with others and institutions over time, through which people either consolidate or question their identity and their vulnerable position as assigned to them from outside. The diffculty and potentially damaging impact of defning 'vulnerable' groups or individuals have been made visible again in the context of COVID-19 pandemic measures. Offcial categories can deny people' s agency, since some elderly people have contested being labelled particularly vulnerable to the infection. Institutional responses can also potentially trigger discrimination, as observed across age groups in the COVID-19 context.

Considering the coexistence of multiple, socially anchored defnitions of vulnerability also has implications for policymaking. Understanding people' s views, especially when these clash with the dominant defnitions or with social norms, can defnitely help to elaborate policies that are more likely to reach their goals since they are more in line with people' s needs. We therefore concur with the view that addressing vulnerability requires considering its implications in terms of social integration and citizenship. Findings from a number of studies reported here have suggested that the social sciences can contribute to a better understanding of the complexity of vulnerability processes in society. They can do so by comparing views and experiences across social groups and by paying attention to multiple levels, including institutions and social norms, as being either supportive of or detrimental to those who face different forms of adversity.

#### References

Armstrong, D. (2014). Actors, patients and agency: A recent history. *Sociology of Health & Illness, 36*(2), 163–174. https://doi.org/10.1111/1467-9566.12100 Burton-Jeangros, C. (2020). Life course approaches in Global Health. In R. Haring, I. Kickbusch, D. Ganten, & M. Moeti (Eds.), *Handbook of Global*  *Health* (pp. 1–28). Springer International Publishing. https://doi.org/10.100 7/978-3-030-05325-3\_42-1

Boisgontier, M. P., Courvoisier, D., Burton-Jeangros, C., & Cullati, S. (2020). Do welfare regimes moderate cumulative dis/advantages over the life course? Cross-National Evidence from longitudinal SHARE data. *The Journals of Gerontology: Series B, 75*(6), 1312–1325. https://doi.org/10.1093/geronb/ gbaa036

**Open Access** This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/ by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

### Synthesis: Vulnerability in Context

#### *Dario Spini and Mattia Vacchiano*

#### Introduction: On the Articulation of Levels

Scholars in social sciences and life course research have always taken a great interest in understanding life trajectories at the articulations among levels of analysis (Bronfenbrenner, 1994). Since their genesis, the social sciences have turned their attention to how social reality is stratifed into macrostructures, such as social norms, economic opportunity structures or welfare regimes, on the one hand, and microprocesses such as individuals' actions, behaviours or agency, on the other hand (Alexander, 1987; Hitlin & Elder, 2007). How these levels of analysis interact has already been widely discussed in many disciplines, such as anthropology, social psychology, economics, and sociology, albeit through different perspectives on the specifcs of this articulation (Boudon, 2006; Coleman, 1988; Doise, 1986; Turner, 2012). What emerges from this debate is a common need to examine the articulation between macro- and microsocial

D. Spini (\*)

University of Lausanne, Lausanne, Switzerland e-mail<EMAIL_ADDRESS>
M. Vacchiano Department of Sociology, University of Geneva, Geneva, Switzerland e-mail<EMAIL_ADDRESS>
D. Spini, E. Widmer (eds.), *Withstanding Vulnerability throughout Adult Life*, https://doi.org/10.1007/978-981-19-4567-0\_13

processes to understand their specifcities and mutual infuences. This approach means moving beyond the idea that individuals and societal structures can be studied as independent and instead adopting a multilevel perspective to address many complex analytical problems (Klein & Kozlowski, 2000; Spini et al., 2016).

Adopting such multilevel logic is also crucial in a feld such as the life course. In particular, it is key to the study of vulnerability processes, their emergence across transitions and turning points, their persistence and the potential overcoming of them (Spini et al., 2017). Vulnerability is a multilevel problem for numerous reasons: not only are macrosocial structures a source of inequality as such, but every biography is nested within multiple intermediate levels in which human lives take place. The lives of individuals, after all, depend on the neighbourhoods that people inhabit, on the network of institutions and organizations in which they are immersed, and, thus, on their social capital and sense of community. In short, a plurality of meso-level contexts mediate the 'macro' with individual resources, whether genetic, biological, or cognitive (Bernardi et al., 2019).

While these intermediate dimensions are often little discussed in life course research, this section explores different directions through which it can approach this articulation among levels. A set of complementary multilevel perspectives emerges for studying vulnerabilities through examining the infuence of geographic, organizational, or relational contexts on the stressors and resources of individuals. Together, these studies show how vulnerabilities are the result of the complex interactions among levels of social realities and their junctions in neighbourhoods, networks, organizations, institutions and communities.

#### Understanding Vulnerability: Three Ways 'Contexts' Matter

Individual strategies, skills, and resources play a role in the life course as well as the set of constraints and opportunities that are provided by social structures (Settersten & Gannon, 2005). Micro and macro coexist in many ways and explain a plurality of life course phenomena, including, of course, vulnerability. Often, as we stressed in the introduction to this book, vulnerabilities arise due to the lack of resources and reserves needed to cope with the many stressors that can intervene during segments of the life course. However, while structural and individual effects both exert a decisive impact on these processes (see Bernardi et al., 2019), many of them play out primarily in the articulations among these levels in different intermediate dimensions. This characteristic means giving importance to a meso level in which micro and macro are simultaneously rooted and from which processes of vulnerability socially and cognitively emerge (Spini et al., 2017).

A focus on the meso level means giving importance to the multiple contexts in which individual lives unfold. It means looking at the key lifecourse principles—agency, linked lives, timing, time and space across social environments that are more proximate than macrosocial structures (Elder, 1979, 1995). Vulnerability, after all, is amplifed, shared, and overcome within neighbourhoods, communities, families, networks, institutions and organizations where individuals live and work. Consideration of these different contexts places the meso level at the centre of the study of vulnerabilities, thereby bridging the micro-macro gap.

How to address this articulation is certainly a matter of approaches and perspectives, three of which emerge most clearly from the studies that have been conducted as part of the LIVES research program. First, one way to examine this articulation is to study the geographic context in which human lives take place, i.e., the local economic and social contexts. Second, the focus may be on the intermediary role played by organizations and institutions, their norms and practical functioning, and their infuence on vulnerabilities. Finally, a relational approach focused on social relationships can capture the infuence of networks, as intermediate structures, as sources of both stressors and resources. (Sapin, Widmer, & Iglesias, 2016; Vacchiano & Spini, 2021).

In the study of geographic context, local social and economic contexts assume a major role (Ranci, 2010). Geographic areas (e.g., neighbourhoods or regions) can act as amplifers, moderators, or even nullifers of macrosocial dynamics and provide explanatory mechanisms for individual vulnerabilities. While individual resources play a primary role in explaining vulnerability and resilience, meso-level contexts of this kind implicate the opportunity structures that people can access through the territory they inhabit. Many studies have endorsed this perspective and have convincingly demonstrated that living in a poor neighbourhood, for example, increases the risks related to individual resources or reserves, such as low educational attainment or a more disadvantaged family background. Moreover, we know that relocating residents from more- to less-deprived neighbourhoods improves their competitiveness in the labour market (Mendenhall et al., 2006). In short, studying the local context helps to understand macrodynamics, e.g., social policies, norms, macroeconomic indicators, and their infuence on individuals through the study of their immediate social environment (Galster, 2012; Sampson et al., 2002).

As a second lens, organizations and institutions offer another privileged context for studying the articulations among levels of analysis (Klein & Kozlowski, 2000). Human lives unfold in workplaces, educational settings, administrative or health care institutions. The study of vulnerabilities can thus beneft from understanding the weight of institutional norms and obligations, status, practices or values that depend primarily on the organizations and institutions to which individuals belong (e.g., see Vacchiano, Lazega & Spini, 2022). It is important to understand how macrosocial aspects related to norms, social policies or economic structures are fundamentally negotiated within and among the organizations and institutions in which individuals are involved in different areas of their lives: such as education, work or health. At this juncture, it is possible to propose a further point of view on how macro and micro levels meet in the processes of vulnerability (Spini et al., 2017).

Finally, the relational approach conceptualizes networks of relationships as intermediate structures that bridge the micro-macro gap (Alwin et al., 2018; Vacchiano & Spini, 2021). Networks that provide constraints or opportunities, resources or sanctions, stressors or support for people's lives (Antonucci & Akiyama, 1995; Bidart et al., 2020; Cullati et al., 2018; Settersten, 2018). On the one hand, this approach captures how a plurality of macrosocial forces, such as those related to social stratifcation, are reproduced within the more proximate social environment of social relationships (Bourdieu, 1986). For example, the study of family ties allows us to capture social inequalities shaped by origin, gender and social class. Positive and negative effects of networks have been attributed precisely to the ability of these close ties to transmit socioeconomic privileges, as well as strategies of social positioning and material support (Portes, 1998; Widmer, 2006). On the other hand, research is also interested in networks as sources of emotional support and bonding social capital (Rostila, 2011), particularly their importance to the emergence of a sense of connectedness, relatedness, belongingness or attachment at the cognitive level, as explanatory factors of mental health and well-being (Berkman et al. 2000, see also Hofmann, Merphour, & Staerklé, this book). Both the instrumental and cognitive implications of networks offer a look at the articulation of the macro, meso, and micro levels.

#### Vulnerability in Context

Different chapters addressing these multiple facets of the meso level are presented in this section.

In Chap. 8, Bonvin et al. offered insights into how vulnerability processes depend on the implementation of social policies at the meso-level. More precisely, they considered the role played by those intermediary agents in translating and applying the normative regulations of social policies, whom the authors call 'street-level bureaucrats'. This approach led to a refection on the normative functioning of many organizations, such as hospitals, welfare agencies, social services, NGOs, and the (often inadequate) working conditions of those representatives who come into contact with potential recipients of social policies.