Development of an instrument for community-level health related social capital among Japanese older people: The JAGES Project

Background

We developed and validated an instrument to measure community-level social capital based on data derived from older community dwellers in Japan.

Income inequality, social capital and self-rated health and dental status in older Japanese

The erosion of social capital in more unequal societies is one mechanism for the association between income inequality and health. However, there are relatively few multi-level studies on the relation between income inequality, social capital and health outcomes. Existing studies have not used different types of health outcomes, such as dental status, a life-course measure of dental disease reflecting physical function in older adults, and self-rated health, which reflects current health status. The objective of this study was to assess whether individual and community social capital attenuated the associations between income inequality and two disparate health outcomes, self-rated health and dental status in Japan. Self-administered questionnaires were mailed to subjects in an ongoing Japanese prospective cohort study, the Aichi Gerontological Evaluation Study Project in 2003. Responses in Aichi, Japan, obtained from 5715 subjects and 3451 were included in the final analysis. The Gini coefficient was used as a measure of income inequality. Trust and volunteering were used as cognitive and structural individual-level social capital measures. Rates of subjects reporting mistrust and non-volunteering in each local district were used as cognitive and structural community-level social capital variables respectively. The covariates were sex, age, marital status, education, individual- and community-level equivalent income and smoking status. Dichotomized responses of self-rated health and number of remaining teeth were used as outcomes in multi-level logistic regression models. Income inequality was significantly associated with poor dental status and marginally significantly associated with poor self-rated health. Community-level structural social capital attenuated the covariate-adjusted odds ratio of income inequality for self-rated health by 16% whereas the association between income inequality and dental status was not substantially changed by any social capital variables. Social capital partially accounted for the association between income inequality and self-rated health but did not affect the strong association of income inequality and dental status.     

Places and health: a qualitative study to explore how older women living alone perceive the social and physical dimensions of their neighbourhoods

There is growing interest in the impact that neighbourhood environment might have on the health of older people. Although the number of older Australian women, particularly those living alone, is projected to increase in coming decades, their experiences of neighbourhood have not been exclusively examined. The aims of this paper are: (1) to explore, from the perspective of these women, the social and physical dimensions of neighbourhoods and (2) to investigate variation in these accounts according to whether women lived in areas of higher or lower socioeconomic status. Twenty women aged between 75 and 93 years, residing in metropolitan Adelaide, South Australia (SA), participated in a series of two in-depth interviews. Women's perceptions of their neighbourhood, and accounts of every-day activities in the community were analysed to determine how both social and physical aspects of neighbourhood might relate to health and wellbeing. Findings suggest that a reciprocal and trusting relationship with neighbours underpinned older women's sense of satisfaction with, and feeling of security within, the neighbourhood. Other factors such as living in close proximity to services and existing social networks were also seen as important. Women's stories demonstrated that they were able to draw on both existing social networks and neighbours to sustain their independence and social connection within the community. Women living in more disadvantaged areas were more conscious of social disconnection in their neighbourhoods, and to the way that traffic noise and pollution detracted from their neighbourhood environment. These findings indicate that, for older women living alone, trusting and reciprocal relationships with neighbours are likely to form an important part of their broader social support network and should be recognised in relation to the process of maintaining the health of older women living in the community.     

The relationship between social capital and self-rated health in a Japanese population: a multilevel analysis

Objective  

The aim of this study was to use a multilevel analysis to examine whether cognitive and structural dimensions of regional social capital were associated with individual health outcomes after adjusting for compositional factors.     

Social capital: a guide to its measurement

The primary aims of this paper are to review the concept of social capital and related constructs and to provide a brief guide to their operationalization and measurement. We focus on four existing constructs: collective efficacy, psychological sense of community, neighborhood cohesion and community competence. Each of these constructs taps into slightly different, yet overlapping, aspects of social capital. The existence of several instruments to measure each of these constructs calls for further study into their use as measures of social capital. Despite differences in the approach to measurement, there is general agreement that community characteristics, such as social capital, should be distinguished from individual characteristics and measured at the community level.     

Social capital in its place: using social theory to understand social capital and inequalities in health

Social capital has been controversially linked to public health benefits, particularly as an explanation for the relationship between economic inequalities and health. This paper focuses on social capital in this context, particularly a recent emphasis on social capital in neighbourhoods and growing use of Bourdieu's social theory in empirical investigations. A review of some of this work is used to suggest the need for a more coherent theoretical approach to using Bourdieu and to introduce an ethnographic study of social connections in New Zealand. Forty-six residents of, a rural town, a deprived city suburb, or an affluent suburb, volunteered to be interviewed about their social connections. Their talk was transcribed and analysed in terms of everyday practice. The results of this study suggest that social connections are not necessarily located in neighbourhoods, and that social capital will be better understood in a broader social context which includes competition for resources between deprived and non-deprived groups, and the practices of all citizens across neighbourhoods. When considering social capital, an exclusive focus on deprived neighbourhoods as sites for research and intervention is not helpful.     

Bonding versus bridging social capital and their associations with self rated health: a multilevel analysis of 40 US communities

STUDY OBJECTIVE: Few studies have distinguished between the effects of different forms of social capital on health. This study distinguished between the health effects of summary measures tapping into the constructs of community bonding and community bridging social capital. DESIGN: A multilevel logistic regression analysis of community bonding and community bridging social capital in relation to individual self rated fair/poor health. SETTING: 40 US communities. PARTICIPANTS: Within community samples of adults (n = 24 835), surveyed by telephone in 2000-2001. MAIN RESULTS: Adjusting for community sociodemographic and socioeconomic composition and community level income and age, the odds ratio of reporting fair or poor health was lower for each 1-standard deviation (SD) higher community bonding social capital (OR = 0.86; 95% = 0.80 to 0.92) and each 1-SD higher community bridging social capital (OR = 0.95; 95% CI = 0.88 to 1.02). The addition of indicators for individual level bonding and bridging social capital and social trust slightly attenuated the associations for community bonding social capital (OR = 0.90, 95% CI = 0.84 to 0.97) and community bridging social capital (OR = 0.96, 95% CI = 0.89 to 1.03). Individual level high formal bonding social capital, trust in members of one's race/ethnicity, and generalised social trust were each significantly and inversely related to fair/poor health. Furthermore, significant cross level interactions of community social capital with individual race/ethnicity were seen, including weaker inverse associations between community bonding social capital and fair/poor health among black persons compared with white persons. CONCLUSIONS: These results suggest modest protective effects of community bonding and community bridging social capital on health. Interventions and policies that leverage community bonding and bridging social capital might serve as means of population health improvement.     

Does low workplace social capital have detrimental effect on workers' health?

While the majority of studies of social capital and health have focused on conceptualizing social capital at the geographic level, evidence remains sparse on workplace social capital. We examined the association between workplace social capital and health status among Japanese private sector employees in a cross-sectional study. By employing a two-stage stratified random sampling procedure, 1147 employees were identified from 46 companies in Okayama in 2007. Workplace social capital was measured based on two components; trust and reciprocity. Company-level social capital was based on aggregating employee responses and calculating the proportion of workers reporting mistrust and lack of reciprocity. Multilevel logistic regression analysis was conducted using Markov Chain Monte Carlo methods to explore whether individual- and company-level mistrust and lack of reciprocity were associated with poor self-rated health. Odds ratios (ORs) and 95% credible intervals (CIs) for poor health were obtained for each variable. Workers reporting individual-level mistrust and lack of reciprocity had approximately double the odds of poor health even after controlling for sex, age, occupation, educational attainment, smoking, alcohol use, physical activity, body mass index, and chronic diseases. While we found some suggestion of a contextual association between company-level mistrust and poor health, no association was found between company-level lack of reciprocity and health. Despite the thorough examination of cross-level interaction terms between company-level social capital and individual characteristics, no clear patterns were observed. Individual perceptions of mistrust and lack of reciprocity at work have adverse effects on self-rated health among Japanese workers. Although the present study possibly suggests the contextual effect of workplace mistrust on workers' health, the contextual effect of workplace lack of reciprocity was not supported.     

工作场所社会资本与健康关系的探索性研究

目的评价工作场所社会资本量表的信度和效度,分析工作场所社会资本与健康的关系。方法采用整群抽样的方法,对上海市10个单位的员工进行问卷调查。应用克隆巴赫系数(Cronbach’sα)、Guttman分半系数和验证性因子分析评价工作场所社会资本的信度和效度;采用多元线性回归分析工作场所社会资本与健康的关系。结果工作场所社会资本量表的Cronbach’sα系数为0.94,Guttman分半系数为0.92,表明量表具有较好的内部一致性;验证性因子分析结果显示:KMO值为0.91,共提取1个公因子,累计方差贡献率为70.5%,表明量表具有较好的结构效度。在控制其他可能影响健康的因素后,工作场所社会资本与自报健康得分呈负相关(B=-0.112,P<0.01)和身心健康呈正相关(B=1.771,P<0.01)。结论工作场所社会资本量表具有较好的信度和效度,且工作场所社会资本是自评健康和心理健康的重要影响因素。     

Religious social capital: its measurement and utility in the study of the social determinants of health

As a social determinant of health, religiosity remains not well understood, despite the prevalence of religious activity and prominence of religious institutions in most societies. This paper introduces a working measure of Religious Social Capital and presents preliminary associations with neighborhood social capital and urban stressors. Religious social capital is defined as the social resources available to individuals and groups through their social connections with a religious community. Domains covered include group membership, social integration, values/norms, bonding/bridging trust as well as social support. Cross-sectional data come from a convenience sample of 104 community dwelling adults residing in a single urban neighborhood in a large US city, who also provided information on neighborhood social capital, and experiences of urban stressors. Results suggest that religious social capital is a valid construct that can be reliably measured. All indicators of religious social capital were higher among those who frequently attended religious services, with the exception of bridging trust (trust of people from different religious groups). A weak, inverse, association was also observed between religious and neighborhood social capital levels. Levels of religious social capital were correlated with higher levels of reported urban stressors, while neighborhood social capital was correlated with lower urban stressor levels. A significant percent of the sample was unaffiliated with a religious tradition and these individuals were more likely to be male, young and more highly educated. Social capital is a promising construct to help elucidate the influence of religion on population health.     

Salir Adelante: Social capital and resilience during the Covid-19 pandemic in Argentina

The Covid-19 pandemic has stimulated new appraisals of how social cohesion, including neighborhood-level social capital, fosters resilience in the face of crisis. Several studies suggest better health outcomes in neighborhoods with higher level of social capital, in general and during the pandemic. Building on a growing body of research which suggests that those who live in close-knit neighborhoods have fared better during the pandemic, this article analyzes how social capital influences individual and collective perceptions and attitudes about the experiences of the Covid-19 pandemic in Tucumán, Argentina. To assess this question, we used a mixed-methods approach, combining focus groups, semi-structured interviews, and an online survey (n = 701 respondents) conducted in September 2021. We find widespread experiences of resilience in response to the Covid-19 pandemic, in spite of difficult socioeconomic conditions and perceived poor government performance. Results from logistic regression analysis indicate that perceptions of high neighborhood social capital are associated with more positive outcomes in many dimensions, including personal resilience, ability to cope with uncertainty, perceptions of community solidarity, and reported compliance with public health measures. We further argue that conceptualizations of social cohesion need to be adjusted to local or national-level cultural norms to accurately capture the experience of countries of the Global South.     

The relative influence of neighbourhood incivilities,cognitive social capital,club membership and individual characteristics on positive mental health

Previous research indicates that residents׳ perceptions of their neighbourhoods can have an adverse influence on their health and wellbeing over and above the influence of structural disadvantage. Contrary to most prior research, this study employed an indicator of positive wellbeing and assessed the impact of individual characteristics, perceived social and environmental incivilities, indicators of cognitive and structural social capital, and perceived safety. Analyses of data from a large regional UK representative study (n=8237; 69.64% response rate) found the most influential determinants of wellbeing were physical health problems, age, SES and cognitive social capital. Smaller, significant effects were also found for environmental and social incivilities, and for perceived safety. The effect of cognitive social capital was moderated by age, with a stronger effect found among those aged 65 years and over than among younger participants. Findings indicate that the promotion of positive mental health within communities may be facilitated by efforts to foster a greater sense of belonging among residents, and that older adults may benefit most from such efforts.     

Social capital and self-rated health: results from the US 2006 social capital survey of one community

Using data from the 2006 Social Capital Community Survey in Duluth, Minnesota, and Superior, Wisconsin, USA, we investigate associations between individual social capital measures (attitudes on trust, formal group involvement, informal socializing, organized group interaction, social support and volunteer activity) and self-rated health after controlling for individual and economic characteristics. In particular, we address issues of social capital as an endogenous determinant of self-reported health using instrumental variables probit estimation. After accounting for the endogeneity of these various measures of individual social capital, we find that individual social capital is a significant predictor of self-rated health.     

Contextual effect of different components of social capital on health in a suburban city of the greater Tokyo area: A multilevel analysis

Social capital (SC) can be broken down into a number of aspects and dimensions, but few studies have differentiated between the effects of different components of SC on health. This study examined the relationship between contextual SC and health (self-rated health, and co-occurrence of lifestyle risk factors such as smoking, drinking, overweight/underweight and physical inactivity) among the general population in a Japanese suburban area. The specific research question was to explore which components of contextual SC had what effects on health. In 2009, we randomly selected 4123 residents, aged 20 years and over, from 72 districts in the city of Kashiwa, Chiba prefecture (a typical suburban city of Tokyo) to participate in a cross-sectional survey using mailed questionnaires. We used four indicators of SC: cognitive/horizontal (trust in neighbors), cognitive/vertical (institutional trust in the national social security system), structural/horizontal (participation in groups with egalitarian relationships) and structural/vertical (participation in groups with hierarchical relationships). District-level SC was calculated by aggregating the individual responses of each SC indicator within each district. The response rate was 42.1% (1716 questionnaires), 43.7% of the respondents were male, and the mean age was 54.8 ± 16.4 (ranging from 20 to 97). A multilevel analysis showed that higher district-level institutional mistrust was associated with self-rated poor health, but higher district-level mistrust in neighbors was inversely associated with it, after adjusting for individual-level covariates. There was no contextual effect of any SC components on co-occurrence of risk factors. Our findings showed that institutional trust has a beneficial effect on self-rated health, but trust among neighbors might negatively affect the health of the residents in a Japanese suburban city. These unique findings could suggest the advantage of breaking down SC to examine more specific relationships between SC and health, and the importance of accumulating the evidence in specific cohorts to develop customized health promotion strategies.     

Social capital and suicide: an ecological study in Tokyo,Japan

Objective

The aim of this study is to clarify the association between area-based social capital and suicide rate among municipalities of Tokyo.

Methods

The study areas were 20 administrative municipalities of Tokyo. Social capital (i.e., organizational membership, social trust, fairness, helpfulness, and confidence in organizations) was measured based on data from a previous survey (response rate 28 %). Gender-specific age-adjusted suicide rates averaged over 5 years, sociodemographic, and other area characteristics were obtained from relevant national statistics. Multiple linear regression analysis of suicide rates was applied on each social capital variable, adjusting for the other area characteristics.

Results

There was no significant crude Pearson’s correlation between any social capital variable and suicide rate. Multiple regression analyses revealed a significant negative association between social trust and suicide rate for men (p = 0.04).

Conclusions

While based on only limited evidence from a cross-sectional ecological study, area-based social trust may be associated with decreased suicide rates for men in Tokyo.     

Individual-level analysis of social capital and health: a comparison of Arab and Jewish Israelis

Discrepancies exist in existing research regarding the association between social capital and self-rated health, most of which has been undertaken in the developed world. The aim of this study is first to assess the levels of the various variables describing individual social capital in Jews and Arab residing in Israel, and second to assess the association between individual social capital and self-rated health in these two population groups. The data were obtained from an Israeli health interview survey (knowledge, attitudes and practices (KAP)) conducted during 2004-2005, which is based on 3,365 interviews with adult Jews and 985 adult Arabs. Social capital measures included social trust, neighborhood safety, perceived helpfulness, trust in local and national authorities and social support. Data were also obtained on self-rated health and socioeconomic and demographic variables. Multivariate logistic regression revealed that Jews reported higher levels of social trust, perceived helpfulness, trust in authorities, and social support compared to Arabs, after adjusting for demographic and socioeconomic variables. Social contacts, however, were reported more frequently in the Arab population. Neighborhood safety was similar in the two population groups. Among Jews, those reporting higher levels of individual social capital reported better self-rated health after adjusting for demographic and socioeconomic variables. Among Arabs, only those reporting higher levels of social support reported better self-rated health. In Israel, individual levels of social capital seem to be lower in the Arab minority than in the Jewish majority. Individual social capital was associated with better self-rated health mainly in the Jewish population and less so in the Arab population. Social capital factors may be associated with health to a higher extent in affluent populations with relatively high social capital and less so in low social capital and more traditional communities. More research is needed to verify these differences.     

The contextual effects of social capital on health: a cross-national instrumental variable analysis

Past research on the associations between area-level/contextual social capital and health has produced conflicting evidence. However, interpreting this rapidly growing literature is difficult because estimates using conventional regression are prone to major sources of bias including residual confounding and reverse causation. Instrumental variable (IV) analysis can reduce such bias. Using data on up to 167,344 adults in 64 nations in the European and World Values Surveys and applying IV and ordinary least squares (OLS) regression, we estimated the contextual effects of country-level social trust on individual self-rated health. We further explored whether these associations varied by gender and individual levels of trust. Using OLS regression, we found higher average country-level trust to be associated with better self-rated health in both women and men. Instrumental variable analysis yielded qualitatively similar results, although the estimates were more than double in size in both sexes when country population density and corruption were used as instruments. The estimated health effects of raising the percentage of a country's population that trusts others by 10 percentage points were at least as large as the estimated health effects of an individual developing trust in others. These findings were robust to alternative model specifications and instruments. Conventional regression and to a lesser extent IV analysis suggested that these associations are more salient in women and in women reporting social trust. In a large cross-national study, our findings, including those using instrumental variables, support the presence of beneficial effects of higher country-level trust on self-rated health. Previous findings for contextual social capital using traditional regression may have underestimated the true associations. Given the close linkages between self-rated health and all-cause mortality, the public health gains from raising social capital within and across countries may be large.     

社会资本与农村合作医疗的发展

社会资本是存在于社会结构中的社会规范和社会关系等，具有社会和资本双重特性，对经济增长和社会发展具有明显的外在作用。合作医疗是一种社区筹资，它通过对疾病负担的分摊，保障农村、尤其是农村贫困地区居民的基本卫生服务需求，减缓农民“因病致贫、因病返贫”的发生。社会资本在合作医疗基金的筹集、补偿、卫生服务提供和利用以及合作医疗的监督管理中，具有极为重要且广泛的作用。激活和充分利用社会资本，是合作医疗持续发展的关键之一。     

Social capital and social inequality in adolescents' health in 601 Flemish communities: a multilevel analysis

Although it is widely acknowledged that community social capital plays an important role in young people’s health, there is limited evidence on the effect of community social capital on the social gradient in child and adolescent health. Using data from the 2005–2006 Flemish (Belgium) Health Behavior among School-aged Children survey (601 communities, n = 10,915), this study investigated whether community social capital is an independent determinant of adolescents’ perceived health and well-being after taking account of individual compositional characteristics (e.g. the gender composition within a certain community). Multilevel statistical procedures were used to estimate neighborhood effects while controlling for individual level effects. Results show that individual level factors (such as family affluence and individual social capital) are positively related to perceived health and well-being and that community level social capital predicted health better than individual social capital. A significant complex interaction effect was found, such that the social gradient in perceived health and well-being (i.e. the slope of family affluence on health) was flattened in communities with a high level of community social capital. Furthermore it seems that socioeconomic status differences in perceived health and well-being substantially narrow in communities where a certain (average) level of community social capital is present. This should mean that individuals living in communities with a low level of community social capital especially benefit from an increase in community social capital. The paper substantiates the need to connect individual health to their meso socioeconomic context and this being intrinsically within a multilevel framework.