Social health as core to sex education

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I’ve arrived in Malmo and already been invited to a queer BBQ, a drag pub quiz and sunbathed naked by the sea pool - Sweden is treating me well! I also met with academic Dr Julia Bahner from Lund University where our conversation introduced me to a new concept: social health.

Social health is a dimension of overall wellbeing which stems from connection and community.  Promotion of social health requires investment in the skills that enable someone to access and participate in such communities at local, national and international levels. These skills, which include understanding norms of social engagement, emoting ‘appropriately’, shared idiosyncrasies and language etc are often taken for granted but for adults with cognitive disabilities they often need to be learnt. Understanding the rules of social engagement extend far beyond manners and pleasantries, and involves recognising when and how to modify behaviour for different parts of your social ecosystem - from flirting with a possible love interest, and disclosing a secret to a friend to sharing appropriate information with a GP and safely navigating police interactions. As such promoting social health for these individuals involves significant skill building around these fundamental building blocks of social participation. 

A key takeaway from my research with disability-inclusive sex education programmes across Australia and Scandinavia is that sex education is about so much more than just sex. The work includes support around emotional literacy, processing grief and rejection, recognising and communicating boundaries, critical reflection on fixed and changing identities and so on. These skills are not unique to navigating intimacy and are also essential skills for maintaining social health. Foundational social skills such as the capacity to read a situation, identify a need and communicate it comprehensively to others would be as useful in an intimate encounter as it would be to enable someone to get to the hospital, use the supermarket, or generally navigate the more mundane infrastructure of daily life. Therefore, sexual health becomes intrinsically tied up with social health, as the skills to succesfully navigate one field are directly applicable in the other. Without the foundational skills in social health, sexuality education becomes abstract at best, and meaningless at worst. 

The impact of poor social health cannot be overstated. Social health is not just aWHO recently confirmed that social isolation and loneliness are major under-recognised public health crises. One in six people are affected by loneliness with serious health consequences (including cardiovascular disease, depression, dementia, and premature death) and social factors account for over 50% of health outcomes and health inequities globally. Yet social care continues to deprioritise social connection as a need or right. People with cognitive disabilities experience higher rates of loneliness from institutionalized social exclusion as well as fewer opportunities for the casual, unstructured social interactions many of us take for granted. 

Loneliness is not just linked to poor health outcomes, but leads to the erosion of the very skills that mitigate it. Neuroscientist John Cacioppo found that chronic loneliness fundamentally alters how the brain processes social information, with people becoming hypervigilant to social threat, less trusting and less able to accurately read body language - all skills essential to navigating intimacy and maintaining positive social health. This self-perpetuating cycle is exaggerated for adults with cognitive disabilities who are disproportionately more socially excluded, and therefore at a higher risk of both poor social health and the erosion of the skills necessary to combat that. 

Axel Honneth argues that loneliness is not just the absence of company but the absence of recognition. His recognition framework states that full personhood relies on being recognised across three dimensions: as loveable (in intimate relationships) as a rights-bearer (legally/politically) and as a valued contributor to society (socially/culturally). If people are not supported to realise personhood across all dimensions then their genuine personhood gets eroded. Charles Taylor builds on this, arguing that identity requires an interlocutor, someone who sees, hears, responds to and takes you seriously, recognising that without external validation, selfhood is hollow as we are in relation to others. For adults with cognitive disabilities who have spent years in systems designed to manage their behaviour rather than engage with their humanity there is a chronic absence of recognition.  The lived experience of being seen as asexual, as incapable of political thought, as a recipient of care rather than an agent of their own life doesn't just limit their rights but shapes how they understand themselves. In this sense loneliness is not just a chronic lack of recognition but a form of identity deprivation, the condition of living without full personhood. 

Ken Plummer and Diane Richardson consider personhood with citizenship, arguing that citizenship is not just a legal entitlement but requires the social capacity to exercise such rights. Social health becomes not just about wellbeing in a functional sense but about the relational conditions necessary for self-knowledge and self-determination. Without being embedded in relationships and communities where you are genuinely recognised, citizenship remains theoretical and therefore non-existent. Richardson goes on to discuss sexual citizenship as the question of whose claims around rights around intimacy, body and identity are recognised as legitimate. Richardson distinguishes between conduct rights (the right to do i.e. have sex), identity rights (the right to be recognised as something i.e. be sexual) and relational rights  (the right to have relationships recognised as valid). The same argument applies here, that without genuine opportunities for exercising these rights in all areas, sexual citizenship is not realised. 

These theories come together to suggest this 1) Identity is socially constructed as we come to know ourselves through being recognised 2) Social health is the enabling condition which creates the relational infrastructure for recognition to happen (the medium for identity formation) 3) Social health is not a static entity but a goal requiring skills to attain 4) The same skills required for attaining social health are essential for navigating intimacy. 

Ultimately, sex education cannot just be the prevention of sexual harm, but the promotion of sexual wellbeing, a process inseparable from the recognition of full sexual citizenship, which is itself inseparable from personhood more generally. Sex education that attends to social health is therefore not a preliminary step before the real work begins but is the real work of building the conditions in which full recognition and therefore full citizenship becomes possible.

Plain English version 

Sex education is really about teaching life skills — and loneliness is a serious health problem we're ignoring.

The author is researching disability-inclusive sex education in Sweden and Australia, and here's what they've found:

Good sex education for people with cognitive disabilities isn't mainly about sex. It's about teaching foundational social skills — how to read a situation, express your feelings, set boundaries, and communicate what you need. These same skills are useful everywhere: at the doctor's office, in a friendship, at the supermarket, or in a romantic relationship.

This connects to a bigger problem: loneliness is genuinely dangerous. It's linked to heart disease, depression, dementia, and early death. People with cognitive disabilities are especially isolated — they get fewer casual social interactions and are often treated as people to be managed rather than as full human beings.

That isolation creates a vicious cycle. The lonelier you are, the worse your social skills become, which makes you more isolated.

The deeper point is about being seen as a full person. If society treats someone as incapable of having relationships, opinions, or desires, they start to believe it themselves. Real personhood — and real citizenship — requires being genuinely recognised by others.

So the conclusion is: sex education done properly isn't just about preventing harm. It's about building the social foundations that let people fully participate in life — as friends, partners, and citizens.