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.     

Self-rated health and social capital in transitional countries: Multilevel analysis of comparative surveys in Armenia, Azerbaijan, and Georgia

The objective of this study is to analyze the effect of social capital on self-rated health in transitional countries of the South Caucasus region. The study is based on recent, 2009, cross-sectional nationally-representative surveys of 2082 respondents in Armenia, 2014 in Azerbaijan, and 1837 in Georgia with response rate of 78-80%. Two-level random-coefficient ordered logistic regression, modeling individual and community variations in subjective health was estimated to account for the hierarchical structure of the data set which includes individuals nested within communities. The results allow several interesting conclusions to be drawn. First, a proportion of the total variation in self-rated health explained at the community level is 0.23 for Azerbaijan, 0.10 for Georgia, and 0.08 for Armenia. These findings highlight the importance of more decentralized community-based healthcare interventions in the region. Second, human capital covariates remained significant predictors of health status even after controlling for social capital both at individual and community levels. Likewise, social capital variables are significant predictors of health status when used alone and when they are controlled by human capital covariates. These findings suggest that human capital and social capital influence health status independently of each other. Finally, this study sheds light on whether social capital collectively benefits members of a community in transitional countries beyond the individual benefits. In Armenia and Azerbaijan, community level differences in health status are rooted in "compositional" differences between social capital of individuals in the communities rather than at the community "contextual" level. In Georgia, by contrast, the beneficial effect of social capital can be simultaneously observed at the individual "compositional", and community "contextual" levels. These findings suggest that neither "compositional" nor "contextual" models of the social capital effect of health status can apply to all transitional societies universally.     

Healthy communities: the challenge of social capital in the Lisbon Metropolitan Area

The debate about social environment, sustainability and health has been highlighted by the interest in social capital. It has been suggested that social capital varies from place to place and that such variations are relevant for explaining variations in health. This paper explores the association between neighbourhood social capital (making a distinction between linking, bonding and bridging social capital) and self-rated health. The study has involved 4,577 residents in 143 neighbourhoods of the Lisbon Metropolitan Area. Logistic regression was used to measure the relationship between social capital and self-rated health. The results show that social capital was strongly associated with self-rated health, even after an adjustment for individual attributes. It is not possible to divorce health planning from urban planning and from the promotion of social capital. A sense of place, identity and belonging needs to be at the core of all healthy planning interventions.     

A four year (1996–2000) analysis of social capital and health status of Canadians: The difference that love makes

Despite extensive research on the relationship between social capital and health, the specific pathways through which social capital is related to health have not been fully elucidated. Moreover, research has generally been cross-sectional, particularly in Canada, and hence not clearly attentive to the causal relationship between social capital and health. In this study we have examined the importance of multiple forms of individual social capital for the functional health status of adult Canadians, employing the Canadian National Population Health Survey (NPHS). We examine changes in health between 1996 and 2000, using individual level variables from 1996 as predictors. In our final model, the key aspect of social capital affecting changes in health status is being loved by someone. This is predicted by being married, frequency of family contacts, religious service attendance and being born in Canada. Insecurity about food also has a direct effect on changes in health status. The latter is affected by income, daily smoking and age. The results suggest that policies to support family stability and family unification, for example through immigration, and efforts to minimize the disruptions of divorce could contribute to the health of Canadians.     

The importance of gender and conceptualization for understanding the association between collective social capital and health: a multilevel analysis from northern Sweden

Growing research on social capital and health has fuelled the debate on whether there is a place effect on health. A central question is whether health inequality between places is due to differences in the composition of people living in these places (compositional effect) or differences in the local social and physical environments (contextual effects). Despite extensive use of multilevel approaches that allows controlling for whether the effects of collective social capital are confounded by access to social capital at the individual level, the picture remains unclear. Recent studies indicate that contextual effects on health may vary for different population subgroups and measuring "average" contextual effects on health for a whole population might therefore be inappropriate. In this study from northern Sweden, we investigated the associations between collective social capital and self-rated health for men and women separately, to understand if health effects of collective social capital are gendered. Two measures of collective social capital were used: one conventional measure (aggregated measures of trust, participation and voting) and one specific place-related (neighbourhood) measure. The results show a positive association between collective social capital and self-rated health for women but not for men. Regardless of the measure used, women who live in very high social capital neighbourhoods are more likely to rate their health as good-fair, compared to women who live in very low social capital neighbourhoods. The health effects of collective social capital might thus be gendered in favour for women. However, a more equal involvement of men and women in the domestic sphere would potentially benefit men in this matter. When controlling for socioeconomic, sociodemographic and social capital attributes at the individual level, the relationship between women's health and collective social capital remained statistically significant when using the neighbourhood-related measure but not when using the conventional measure. Our results support the view that a neighbourhood-related measure provides a clearer picture of the health effects of collective social capital, at least for women.     

El impacto diferencial del capital social sobre la salud mental de la población autóctona y los inmigrantes residentes en Cataluña

ObjectivesThis study attempts to create a bridge between the literature on immigration and on social capital and health. The objectives were two-fold: firstly, to provide new empirical evidence on the association between social capital and health, using data from Catalonia for the first time and, secondly, to explore the possible existence of a differential impact of social capital on health between native-born residents and immigrants. We also distinguished between individual and community-level social capital.MethodsWe used the 2006 Catalan Health Survey (ESCA 2006). To assess the relationship between social capital and mental health, we used multilevel models, estimated separately for native-born and immigrant residents.ResultsThe results revealed a positive link between social capital and good mental health in Catalonia. However, this effect was stronger for individual than for community-level social capital. The results did not support the hypothesis of a differential impact between immigrants and native-born Catalans, but did indicate differences with respect to Spaniards born outside Catalonia. Geographic heterogeneity in the effect of individual social capital on mental health in both immigrants and native-born residents was also detected.ConclusionsWe believe that enhancing social capital could potentially be an effective policy tool to achieve objectives related to health status improvement.     

Social determinants of tuberculosis case rates in the United States

BACKGROUND: Social capital has been related to a number of important public health variables such as overall mortality, health status, and sexually transmitted infections (including AIDS case rates). However, the relationship of social capital to tuberculosis has received little attention. Because social capital may be related to the constructs of poverty and income inequality, any exploration of the correlation between social capital and tuberculosis should include examination of the interrelationships with poverty and income inequality as well. OBJECTIVE: This study examined the state-level relationship between social capital, poverty, income inequality, and tuberculosis case rates. METHODS: The design was state-level, correlational analysis (including bivariate linear correlational analysis, and multivariate linear stepwise regression analysis). Main outcome measures were 1999 state-level case rates of tuberculosis. RESULTS: In bivariate analyses, poverty, income inequality, and social capital were all significantly correlated with tuberculosis case rates. In stepwise multiple regression analyses predicting tuberculosis case rates from this set of three predictor variables, social capital and income inequality entered the regression equation (with social capital being the strongest predictor variable). CONCLUSIONS: These results suggest that social capital is highly predictive of tuberculosis at the state level. The results indicate the need for further research into this potentially causal relationship, including the examination of structural interventions designed to increase social capital.     

Social capital and health. A study of adult twins in the U.S

BACKGROUND: A growing number of studies have suggested a link between social capital and health. However, the association may reflect confounding by factors, such as personality or early childhood environment, that are unmeasured prior common causes of both social capital and health outcomes. The purpose of this study was to investigate the impact of social capital on physical and mental health among adult twins in the U.S. METHODS: A cross-sectional national survey of twins within the National Survey of Midlife Development in the U.S. (MIDUS), 1995--1996 was analyzed in 2007. The study population included 944 twin pairs (37.2% monozygotic [MZ] and 62.8% dizygotic [DZ]). Data were obtained on individual-level social capital variables (social trust, sense of belonging, volunteer activity, and community participation); health outcomes (perceived physical and mental health, depressive symptoms and major depression); and individual covariates (age, gender, race, education, working status, and marital status). A fixed-effects model was used to examine health status among twin pairs who were discordant on levels of social capital. RESULTS: In the individual data analysis, social trust, sense of belonging, and community participation were each significantly associated with health outcomes. In the fixed-effects model, physical health remained significantly positively associated with social trust among MZ and DZ twins. However, major depression was not associated with social capital. CONCLUSIONS: The present study is the first to find the independent positive effect of social trust on self-rated physical health using fixed-effects models of twin data. The results suggest that the association between social capital and physical health status is not explained by unobserved confounds, such as personality or early childhood environment.     

Social capital and mental health: a comparative analysis of four low income countries

Women and the poor are disproportionately affected by common mental disorders (CMD), and women in low income countries are particularly at risk. Social capital may explain some of the geographical variation in CMD, but the association between social capital and CMD in low income countries has rarely been studied. This paper aims to explore the relationship between individual and ecological measures of social capital and maternal CMD in four low income countries. Cross-sectional data from the Young Lives (YL) study with information across 234 communities in Peru, Ethiopia, Vietnam and Andhra Pradesh (India) were used. The mental health of mothers of one-year-old children (n=6909), and the individual cognitive and structural social capital of all respondents was assessed. Ecological social capital was calculated by aggregating individual responses to the community level. Multi-level modelling was used to explore the association between individual and ecological (community level) social capital and maternal CMD in each of the four countries, adjusting for a wide range of individual and community level confounders. The analysis shows that individual cognitive social capital is associated with reduced odds of CMD across all four countries. The results for structural social capital are more mixed and culturally specific, with some aspects associated with increased odds of CMD. This suggests that structural social capital has context-specific effects and cognitive social capital more universal effects on maternal CMD.     

The flip-side of social capital: the distinctive influences of trust and mistrust on health in rural China

Despite increasing evidence that social capital is positively associated with health, the pathways that link social capital to health are not definitive and invite further investigation. This paper uses household survey data from 22 villages in China in 2002 to test the relationship between social capital and the self-reported health status of the rural population. Focusing on the cognitive dimension of social capital, this paper complements current social capital research by introducing an overlooked distinction between trust and mistrust. Trust and mistrust are measured at the individual and aggregate levels, and the distinct ways in which they affect general and mental health are explored. We adopt an ordered logistic regression using survey procedures in SAS version 9.1 to account for the stratified and clustered data structure. The results suggest that: (1) individual-level trust and mistrust are both associated with self-reported health in rural China--trust is positively associated with both general health and mental health, while mistrust is more powerfully associated with worse mental health; and (2) the effects of individual-level trust and mistrust are dependent on village context--village-level trust substitutes for individual-level trust, while individual-level mistrust interacts positively with village-level mistrust to affect health. However, an unexpected protective health effect of mistrust is found in certain types of villages, and this unique result has yet to be examined. Overall, this study suggests the conceptual difference between trust and mistrust and the differential mechanisms by which trust and mistrust affect health in rural China. It also suggests that effective policies should aim at enhancing trust collectively or reducing mistrust at the personal level to improve health status in rural areas of China.     

Social capital and health of older Europeans: causal pathways and health inequalities

This study uses a time-based approach to examine the causal relationship (Granger-like) between health and social capital for older people in Europe. We use panel data from waves 1 and 2 of SHARE (the Survey of Health, Ageing, and Retirement in Europe) for the analysis. Additional wave 3 data on retrospective life histories (SHARELIFE) are used to model the initial conditions in the model. For each of the first 2 waves, a dummy variable for involvement in social activities (voluntary associations, church, social clubs, etc.) is used as a proxy for social capital as involvement in Putnamesque associations; and seven health dichotomous variables are retained, covering a wide range of physical and mental health measures. A bivariate recursive Probit model is used to simultaneously investigate (i) the influence of baseline social capital on current health - controlling for baseline health and other current covariates, and (ii) the impact of baseline health on current participation in social activities - controlling for baseline social capital and other current covariates. As expected, we account for a reversed causal effect: individual social capital has a causal beneficial impact on health and vice-versa. However, the effect of health on social capital appears to be significantly higher than the social capital effect on health. These results indicate that the sub-population reaching 50 years old in good health has a higher propensity to take part in social activities and to benefit from it. Conversely, the other part of the population in poor health at 50, may see their health worsening faster because of the missing beneficial effect of social capital. Social capital may therefore be a potential vector of health inequalities for the older population.     

Is social capital a protective factor against obesity and diabetes? Findings from an exploratory study

PURPOSE: The aim of this exploratory study is to examine the relationship between social capital and the important public health variables of obesity and diabetes in the adult population in the United States. METHODS: State-level correlational analyses were conducted. Predictor variables included social capital (Putnam's measure), income inequality, and poverty. Outcome variables were state-level rates of obesity and diabetes as reported by the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. RESULTS: Social capital and poverty had significant bivariate relationships with obesity and diabetes; multivariate linear regression showed social capital to be the strongest predictor of both outcome variables (explaining 10% of the variance in obesity and 44% of the variance in diabetes). Social capital was related inversely to both variables, indicating a protective effect. Sensitivity analyses showed that an alternate measure of income inequality had a bivariate relationship with diabetes, but was not as strong a predictor as social capital in multivariate analyses. CONCLUSIONS: These exploratory study results suggest that greater levels of social capital are protective against obesity and diabetes. This initial finding warrants subsequent empirical investigations designed to identify strategies that can be used to foster the creation of social capital in areas of the United States with an especially high prevalence of obesity and diabetes. In addition, these investigations should operate at multiple levels, examining individual, social-network, and community-level measures of social capital.     

健康相关社会资本对中老年社区居民抑郁症状的影响

目的 研究中老年社区居民群体健康相关社会资本对抑郁症状的影响,为提升其心理健康水平提供依据。方法 采用多阶段分层整群抽样的方法,抽取成都市中老年居民1432人进行问卷调查。抑郁症状采用流调中心抑郁水平评定量表（CES-D）,健康相关社会资本由自编社会资本量表测量。应用多因素logistic回归分析中老年居民社会资本对其抑郁症状的影响。结果 中老年社区居民抑郁症状发生率为25.4%。不同性别、婚姻状况、文化程度、工作状况、健康状况的中老年人社会资本不同（P<0.05）;在控制人口学特征、健康危险因素等变量的情况下,家庭关系较好的中老年人产生抑郁症状的可能性较低（OR=0.555, 95%CI: 0.429~0.720）、社区信任与归属感得分较高的老年人产生抑郁症状的可能性较低（OR=0.726, 95%CI: 0.553~0.952）。结论 家庭关系、社会归属与信任感是影响社区中老年居民心理健康的主要社会资本因素,应对影响居民抑郁症状的因素采取有针对性的措施进行干预。     

Individual social capital, neighbourhood deprivation, and self-rated health in England

Individual social capital is increasingly considered to be an important determinant of an individual's health. This study examines the extent to which individual social capital is associated with self-rated health and the extent to which individual social capital mediates t.he relationship between neighbourhood deprivation and self-rated health in an English sample. Individual social capital was conceptualized and operationalized in both the social cohesion- and network resource tradition, using measures of generalized trust, social participation and social network resources. Network resources were measured with the position generator. Multilevel analyses were applied to wave 2 and 3 of the Taking Part Surveys of England, which consist of face-to-face interviews among the adult population in England (N(i) = 25,366 respondents, N(j) = 12,388 neighbourhoods). The results indicate that generalized trust, participation with friends and relatives and having network members from the salariat class are positively associated with self-rated health. Having network members from the working class is, however, negatively related to self-rated health. Moreover, these social capital elements are partly mediating the negative relationship between neighbourhood deprivation and self-rated health.     

How much does social capital add to individual health? A survey study of Russians

Some Russians are healthier than others. To what extent does their health vary with involvement or exclusion from social capital networks? The first section reviews alternative theories: human capital as the primary determinant; social capital, whether generic, situation-specific or simply a new label for old measures of social integration; or a composite theory--both human and social capital are major determinants of health. The evidence to test hypotheses consists of individual-level data about self-assessed physical and emotional health from the special-purpose social capital questionnaire used in the 1998 New Russia Barometer survey, a nationwide representative sample of the adult Russian population. Multiple regression analysis shows that on their own human capital and social capital each account for a notable amount of variance in health. When both forms of capital are combined in a composite model, each retains major influence, demonstrating that social capital does make an independent contribution to health. Significant social capital influences include involvement or exclusion from formal and informal networks; friends to rely on when ill; control over one's own life; and trust. Significant human capital influences besides age include subjective social status, gender and income. Regression-based estimates of impact show that social capital increases physical and emotional health more than human capital; together they can easily raise an individual's self-reported health from just below average on a five-point scale to approaching good health.     

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.     

Social capital, socio-economic status and psychological distress among Australian adults

High levels of social capital may be associated with positive mental health in adults. However, quantifying the various dimensions of social capital has presented a challenge due in part to the diverse definitions and measures used. Data from a representative, population-wide survey of Australian adults aged 16 years and older were used to investigate the links between dimensions of social capital and mental health morbidity. Social capital comprised three constructs and was measured at the individual level: feelings of trust and safety, community participation and neighbourhood connections and reciprocity. Mental health was measured by the 10-item Kessler (K10) instrument and assessed symptoms of psychological distress (i.e., depression and anxiety) over the previous month. Community participation showed a weak, and neighbourhood connections and reciprocity a moderate association with distress. Having higher levels of trust and feeling safe were consistently associated with low levels of psychological distress, after adjusting for socio-demographic characteristics and health conditions. The results clearly demonstrate that having trust in people, feeling safe in the community and having social reciprocity are associated with lower risk of mental health distress. The implications for conceptualising and measuring the individual and collective (contextual) dimensions of social capital are discussed. The findings also suggest the importance of examining the interrelationships between socio-economic status, social capital and mental health for community-dwelling adults.     

Children's health-related quality of life,neighbourhood socio-economic deprivation and social capital. A contextual analysis

Neighbourhood objective socio-economic indicators and community-reported subjective measures of social capital were examined in relation to children's health-related quality of life in the Netherlands. Three different data-sources were used: (1) objective neighbourhood socio-economic indicators, (2) subjective neighbourhood data on social capital, and (3) individual data of a family cohort study, including questions on children's health-related quality of life, and family socio-economic status. Multilevel analyses were conducted using both neighbourhood level and individual level data. Neighbourhood socio-economic status and social capital were associated. Measures of socio-economic deprivation and social capital were both non-specifically associated with children's general health and satisfaction, independent of possible individual-level confounders. However, children's mental health and behaviour were specifically associated with one aspect of social capital, the degree of informal social control in the neighbourhood.     

Does gender modify associations between self rated health and the social and economic characteristics of local environments?

OBJECTIVES: To examine whether area level socioeconomic disadvantage and social capital have different relations with women's and men's self rated health. METHODS: The study used data from 15 112 respondents to the 1998 Tasmanian (Australia) healthy communities study (60% response rate) nested within 41 statistical local areas. Gender stratified analyses were conducted of the associations between the index of relative socioeconomic disadvantage (IRSD) and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, political participation, social trust, trust in institutions) and individual level self rated health using multilevel logistic regression analysis before (age only) and after adjustment for individual level confounders (marital status, indigenous status, income, education, occupation, smoking). The study also tested for interactions between gender and area level variables. RESULTS: IRSD was associated with poor self rated health for women (age adjusted p<0.001) and men (age adjusted p<0.001), however, the estimates attenuated when adjusted for individual level variables. Political participation and neighbourhood safety were protective for women's self rated health but not for men's. Interactions between gender and political participation (p = 0.010) and neighbourhood safety (p = 0.023) were significant. CONCLUSIONS: These finding suggest that women may benefit more than men from higher levels of area social capital.     

微观社会资本与农转非中老年人自评健康关系探究

目的 探讨微观社会资本与自评健康之间的关系,为促进失地农转非中老年人的健康水平提供参考.方法 采取多阶段分层随机抽样的方法,抽取符合条件的居民共2669人进行面对面问卷调查.自评健康采用主观评分的方式,微观社会资本从家庭和个人两个层面测量,通过单因素和Logistic二元回归模型分析微观社会资本对自评健康的影响.结果 ...