Social capital and self-rated health in Argentina

The potential link between social capital and health suggests important pathways by which health may be improved. We examine this relationship using a unique data set from Argentina. This national survey allows us to determine whether the relationships between social capital and health that have been found in the US and Europe also apply to countries in South America (Argentina is the second-largest country in South America with a population of approximately 40 million). We estimate a causal effect of individual-level social capital on health using a measure of informal social interactions as our measure of social capital. Using information about access to public transportation as instrumental variables, we find that both men and women with higher levels of social capital report better health.     

Social capital as a determinant of self-rated health and psychological well-being

Objective  

To examine whether specific dimensions of social capital are related to self-rated health and psychological well-being.     

Social trust and self-rated health in US communities: a multilevel analysis

This study assessed the contextual and individual effects of social trust on health. Methods consisted of a multilevel regression analysis of self-rated poor health among 21,456 individuals nested within 40 US communities included in the 2000 Social Capital Community Benchmark Survey. Controlling for demographic covariates, a strong income and education gradient was observed for self-rated health. Higher levels of cominunity social trust were associated with a lover probability of reporting poor health. Individual demographic and socioeconomic preditors did not explain the association of community social trust with self-rated health. Controlling for individual trust perception, however, rendered the main effect of community social trust statistically insignificant, but a complex interaction effect was observed, such that the health-promoting effect of community social trust was significantly greater for high-trust individuals. For low-trust individuals, the effect of community social trust on self-rated health was the opposite. Using the latest data available on community social trust, we conclude that the role of community social trust in explaining average population health achievements and health inequalities is complex and is contingent on individual perceptions of social trust. Future multilevel investigations of social capital and population health should routinely consider the cross-level nature of community or neighborbood effects.     

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.     

Social capital, income inequality, and self-rated health in 45 countries

There has been growing interest in the relationship between the social environment and health. Among the concepts that have emerged over the past decade to examine this relationship are socio-economic inequality and social capital. Using data from the World Values Survey and the World Bank, we tested the hypothesis that self-rated health is affected by social capital and income inequality cross-nationally. The merit of our approach was that we used multilevel methods in a larger and more diverse sample of countries than used previously. Our results indicated that, for a large number of diverse countries, commonly used measures of social capital and income inequality had strong compositional effects on self-rated health, but inconsistent contextual effects, depending on the countries included. Cross-level interactions suggested that contextual measures can moderate the effect of compositional measures on self-rated health. Sensitivity tests indicated that effects varied in different subsets of countries. Future research should examine country-specific characteristics, such as differences in cultural values or norms, which may influence the relationships between social capital, income inequality, and health.     

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,gender and self-rated health. Evidence from the Moscow Health Survey 2004

The state of public health in Russia is undoubtedly poor compared with other European countries. The health crisis that has characterised the transition period has been attributed to a number of factors, with an increasing interest being focused on the impact of social capital – or the lack of it. However, there have been relatively few studies of the relation between social capital and health in Russia, and especially in Moscow. The aim of this study is to examine the relationship between social capital and self-rated health in Greater Moscow. The study draws on data from the Moscow Health Survey 2004, where 1190 Muscovites were interviewed. Our results indicate that among women, there is no relationship between any form of social capital and self-rated health. However, an association was detected between social capital outside the family and men's self-rated health. Men who rarely or never visit friends and acquaintances are significantly more likely to report less than good health than those who visit more often. Likewise, men who are not members of any voluntary associations have significantly higher odds of reporting poorer health than those who are, while social capital in the family does not seem to be of importance at all. We suggest that these findings might be due to the different gender roles in Russia, and the different socializing patterns and values embedded in them. In addition, different forms of social capital provide access to different forms of resources, influence, and support. They also imply different obligations. These differences are highly relevant for health outcomes, both in Moscow and elsewhere.     

Contextual social capital as a risk factor for poor self-rated health: a multilevel analysis

In this study, we critically examine whether contextual social capital (CSC) is associated with self-rated health, with an emphasis on the problem of confounding. We also examine different components of CSC and their association with self-rated health. Finally, we look at differences in susceptibility between different socio-demographic groups. We use the cross-sectional base line study of the Stockholm Public Health Cohort, conducted in 2002. A postal questionnaire was answered by 31,182 randomly selected citizens, 18-84 years old, in Stockholm County. We used four measures of social capital: horizontal (civic trust and participation), vertical (political trust and participation), cognitive (civic and political trust) and structural (civic and political participation). CSC was measured at parish level from aggregated individual data, and multilevel regression procedures were employed. We show a twofold greater risk of poor self-rated health in areas with very low CSC compared with areas with very high CSC. Adjustments for individual socio-demographic factors, contextual economic factors and individual social capital lowered the excess risk. Simultaneous adjustment for all three forms of confounding further weakened the association and rendered it insignificant. Cognitive and structural social capital show relatively similar associations with self-rated health, while horizontal CSC seems to be more strongly related to self-rated health than vertical CSC. In conclusion, whether there is none or a moderate association between CSC and self-rated health, depends on the extent to which individual social capital is seen as a mediator or confounder. The association with self-rated health is similar independent of the measure of CSC used. It is also similar in different socio-demographic groups.     

A multilevel analysis of social capital and self-rated health: Evidence from China

We investigate relationship between social capital and self-rated health (SRH) in urban and rural China. Using a nationally representative data collected in 2005, we performed multilevel analyses. The social capital indicators include bonding trust, bridging trust, social participation and Chinese Communist Party membership. Results showed that only trust was beneficial for SRH in China. Bonding trust mainly promoted SRH at individual level and bridging trust mainly at county level. Moreover, the individual-level bridging trust was only positively associated with SRH of urban residents, which mirrored the urban–rural dual structure in China. We also found a cross-level interaction effect of bonding trust in urban area. In a county with high level of bonding trust, high-bonding-trust individuals obtained more health benefit than others; in a county with low level of bonding trust, the situation was the opposite.     

Social capital and health: a meta-analysis

The relationship between social capital and health has received extensive attention in fields such as public health, medicine, epidemiology, gerontology and other health-related disciplines. In contrast, the economics literature on this subject is relatively small. To address this research gap, we investigate the cross-disciplinary empirical literature using meta-analysis. We analyze 12,778 estimates from 470 studies. Our analysis finds that social capital is significantly related to a variety of positive health outcomes. However, the effect sizes are consistently very small. This finding is robust across different types of social capital (e.g., cognitive, structural, bonding, bridging, linking), and for many different measures of health outcomes (e.g., mortality, disease/illnesses, depression). The small effects that we estimate cast doubt on recent initiatives to promote health through social capital such as those by the WHO, the OECD, and US Healthy People 2020.     

Social capital and self-rated health in Colombia: the good, the bad and the ugly

Although there is increasing evidence supporting the associations between social capital and health, less is known of potential effects in Latin American countries. Our objective was to examine associations of different components of social capital with self-rated health in Colombia. The study had a cross-sectional design, using data of a survey applied to a nationally representative sample of 3025 respondents, conducted in 2004-2005. Stratified random sampling was performed, based on town size, urban/rural origin, age, and sex. Examined indicators of social capital were interpersonal trust, reciprocity, associational membership, non-electoral political participation, civic activities and volunteering. Principal components analysis including different indicators of social capital distinguished three components: structural-formal (associational membership and non-electoral political participation), structural-informal (civic activities and volunteering) and cognitive (interpersonal trust and reciprocity). Multilevel analyses showed no significant variations of self-rated health at the regional level. After adjusting for sociodemographic covariates, interpersonal trust was statistically significantly associated with lower odds of poor/fair health, as well as the cognitive social capital component. Members of farmers/agricultural or gender-related groups had higher odds of poor/fair health, respectively. Excluding these groups, however, associational membership was associated with lower odds of poor/fair health. Likewise, in Colombians with educational attainment higher than high school, reciprocity was associated with lower odds of fair/poor health. Nevertheless, among rural respondents non-electoral political participation was associated with worse health. In conclusion, cognitive social capital and associational membership were related to better health, and could represent important notions for health promotion. Human rights violations related to political violence and gender based discrimination may explain adverse associations with health.     

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.     

Association between contextual factors and self-rated health: a systematic review of multilevel studies

The influence of residential characteristics on self-rated health has received little research attention, especially in Brazil. This study summarizes the available evidence on the association between contextual factors and self-rated health, using a systematic review of articles published from January 1995 to August 2005. We searched for the terms neighbourhood or neighborhood, ecological, contextual, environment, and community, combined with self-rated health, self-reported health, and multilevel or hierarchical in digital bases. Most of the 18 reviewed studies analyzed socioeconomic indicators, while some investigated psychosocial variables and a few included physical environmental indicators. Spatial units of reference varied from census tracts to States. Differences among scales of contextual analysis and several indicators, with different categories, were identified. The associations corroborate the hypothesis that neighborhood context influences self-rated health, beyond the effect of individual factors. Physical and psychosocial neighborhood characteristics are important contextual factors in the determination of self-rated health. Worse socioeconomic neighborhood conditions have a negative effect on health, thereby increasing the odds of worse self-rated health.     

Linking social capital and self-rated health: a multilevel analysis of 11,175 men and women in Sweden

This multilevel study included 11,175 participants interviewed 2000-2002 in Sweden. The association between neighbourhood linking social capital (voting in national elections) and self-rated health was analysed. Individuals living in neighbourhoods with the lowest levels of linking social capital exhibited a significantly higher risk of poor health than individuals living in neighbourhoods with the highest levels of linking social capital, after adjustment for individual characteristics, including individual voting. The neighbourhood variance indicated significant differences in self-rated health between neighbourhoods. Both individuals and neighbourhoods need to be targeted in order to enhance people's health in neighbourhoods with low linking social capital.     

Social capital,income inequality and self-rated health in Chita peninsula,Japan: a multilevel analysis of older people in 25 communities

The effect of social capital on one's health has drawn researchers' attention. In East-Asian countries, however, such an effect has been less studied than in Western countries. Mindful of this background, this study aimed to investigate the linkage between social capital and health at the level of a small area in Japan, and also to examine whether social capital mediates the relation between income inequality and health.     

Social capital, geography and health: a small-area analysis for England

There has recently been much debate about the influence of social capital on health outcomes. In particular it has been suggested that levels of social capital vary from place to place and that such variations may account for previously unexplained between-place variations in health outcomes. As yet few studies exist of the influence of small-area variations in social capital on health outcomes. One reason for this is the difficulty of obtaining indicators for small areas such as electoral wards in England, and we describe a method used to derive what we term 'synthetic estimates' of aspects of social capital by linking coefficients produced from multi-level analyses of national survey datasets to census data. We produce estimates for electoral wards in England and apply these in multi-level models of our response variable, the probability of survival of individuals surveyed in the Health and Lifestyle Survey of England. We report various combinations of models incorporating individual attributes, health-related behaviours, area measures of deprivation, and area measures of social capital. Our overall conclusion is that we find little support, at this spatial scale, for the proposition that area measures of social capital exert a beneficial effect on health outcomes.     

Social capital and health promotion: a review

Interest in social capital and health has emerged at an exciting time. In public health, there is a renewed interest in mechanisms that link social inequalities and health. In epidemiology, there has been a critical interrogation of methods and a call for a more explicit use of theory. In health promotion over the last 20-30 years, social health interventions have been somewhat marginalised in an era dominated by interest in traditional cardiovascular disease risk factors. Now that social hypotheses are being reborn in health, there is a risk that the sophistication that has developed in social health promotion and the literatures that have informed it could be overlooked. In this paper, we present a brief history of social capital and how it has come into recent prominence through the debate linking income inequality and health. We present the background to this, the earlier literatures on social environmental influences on health and the possible processes thought to underlie this relationship. Social capital has relational, material and political aspects. We suggest that, although the relational properties of social capital are important (eg, trust, networks), the political aspects of social capital are perhaps under recognised. The paper also reviews how complex social processes at the community level have come to be operationalised by social theorists and intervention agents in other fields. We suggest that social capital research so far has inadequately captured the underlying constructs, in particular the qualitative difference between the macro/context level and the micro/individual level. While being cautious about the science, we conclude that social capital's power as rhetoric and as a metaphor may be of value. We conclude by suggesting that the coalescence of interests in context-level influences on health now invites a revitalisation of theories and interventions inspired by diverse fields, such as geography and ecological community psychology.     

Social capital, SES and health: an individual-level analysis

Stimulated by the finding (Kawachi et al., 1997) that social capital in communities may mediate the relationship between income inequality and health status, this article describes relationships between individual-level elements of social capital--trust, commitment and identity in the social-psychological dimension; participation in clubs and associations and civic participation in the action dimension--and self-rated health status, before and after controlling for human capital (socioeconomic status measured by income and education), using survey data collected in Saskatchewan, Canada (n = 534, 40% response rate). Income (P = 0.001) and education (P < 0.001) were related to health in the expected directions. Both income (P = 0.002) and education (P = 0.004) were related to health among the elderly; education (P = 0.035) to health among the middle-aged; and neither among the youthful respondents. Frequency of socialization with work-mates (P = 0.019) and attendance at religious services (P = 0.034) had the strongest (and positive) relationships with health of the social engagement questions, even after controlling for human capital, and participation in clubs and associations was positively related to health among the elderly (P = 0.009). But for commitment to one's own personal happiness (P = 0.039), trust, commitment and identification of various kinds were not significantly related to health. Civic participation was also unrelated to health. The main conclusion is that little evidence was found for compositional effects of social capital on health. Secondary findings are that the relationship between SES and health was the same for men and women and strongest among the elderly; that socialization with colleagues from work is relevant and that attendance at religious services and participation in clubs are related to health for the elderly.