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,political trust and self-reported psychological health: A population-based study

This study investigates the association between political trust (an aspect of institutional trust) in the Riksdag (the national parliament in Sweden) and self-reported psychological health, taking generalized (horizontal) trust in other people into account. The 2004 public health survey in Skåne in Southern Sweden is a cross-sectional postal questionnaire study that was answered by 27,757 respondents aged 18–80 yielding a 59% response rate. A logistic regression model was used to investigate the associations between political trust and self-reported psychological health adjusting for possible confounders (age, country of origin, education, economic stress and generalized trust in other people i.e. horizontal trust). We found that 13.0% of the men and 18.9% of the women reported poor psychological health. A total of 17.3% and 11.6% of the male and female respondents, respectively, reported that they had no trust at all in the national parliament, and another 38.2% and 36.2%, respectively, reported that their political trust was not particularly high. Respondents in younger age groups, born abroad, with high education, high levels of economic stress, low horizontal trust and low political trust had significantly higher levels of self-reported poor psychological health. There was a significant association between low political trust and low horizontal trust. After adjustments for age, country of origin, education and economic stress, the inclusion of horizontal trust reduced the odds ratios of self-reported poor psychological health in the “no political trust at all” category compared to the “very high political trust” category from 1.6 to 1.4 among men and from 1.7 to 1.4 among women. It is concluded that low political trust in the Riksdag seems to be significantly and positively associated with poor mental health.     

A life-cycle approach to the analysis of the relationship between social capital and health in Britain

I examine to what extent social capital can promote individual well-being in the form of good physical and mental health. Our analysis is based on multiple waves of data from the National Child Development Survey and the British Cohort Study, two large cohort studies following the lives of children who were born in Britain in one particular week in 1958 and 1970. I use waves that are comparable across the surveys in childhood and adulthood to explore the association between aspects of social capital and several measures of health when adopting a life-cycle approach. The findings suggest that individuals with high levels of social capital generally fare better than individuals with lower levels of social capital and that such associations are robust to the inclusion of controls such as physical and mental health in childhood and circumstances of the family of origin.     

Perceptions of social capital and the built environment and mental health

There has been much speculation about a possible association between the social and built environment and health, but the empirical evidence is still elusive. The social and built environments are best seen as contextual concepts but they are usually estimated as an aggregation of individual compositional measures, such as perceptions on trust or the desirability to live in an area. If these aggregated compositional measures were valid measures, one would expect that they would evince correlations at higher levels of data collection (e.g., neighbourhood). The aims of this paper are: (1) to investigate the factor structure of a self-administered questionnaire measuring individual perceptions of trust, social participation, social cohesion, social control, and the built environment; (2) to investigate variation in these factors at higher than the individual level (households and postcodes) in order to assess if these constructs reflect some contextual effect; and (3) to study the association between mental health, as measured by the General Health Questionnaire-12 (GHQ-12), and these derived factors. A cross-sectional household survey was undertaken during May-August 2001 in a district of South Wales with a population of 140,000. We found that factor analysis grouped our questions in factors similar to the theoretical ones we had previously envisaged. We also found that approximately one-third of the variance for neighbourhood quality and 10% for social control was explained at postcode (neighbourhood) level after adjusting for individual variables, thus suggesting that some of our compositional measures capture contextual characteristics of the built and social environment. After adjusting for individual variables, trust and social cohesion, two key social capital components were the only factors to show statistically significant associations with GHQ-12 scores. However, these factors also showed little variation at postcode levels, suggesting a stronger individual determination. We conclude that our results provide some evidence in support of an association between mental health (GHQ-12 scores) and perceptions of social capital, but less support for the contextual nature of social capital.     

Social capital, anticipated ethnic discrimination and self-reported psychological health: a population-based study

This study investigates the association between anticipated ethnic discrimination and self-reported psychological health, taking generalized trust in other people into consideration. The 2004 Public Health Survey in Skåne, Sweden, is a cross-sectional postal questionnaire study including a total of 27,757 respondents aged 18–80 with a 59% response rate. Multivariate analyses of anticipated discrimination and self-reported psychological health were performed using logistic regressions in order to investigate the importance of possible confounders (age, country of origin, education and horizontal trust). Poor psychological health was reported by 13.0% of men and 18.9% of women, and 44.8% and 44.7%, respectively, reported that 50% or more of employers would discriminate according to race, colour of skin, religion, or cultural background. Respondents in younger age groups, born abroad, with high education, low trust and high levels of self-reported anticipated discrimination, had significantly higher levels of poor self-reported psychological health. There was a significant association between anticipated discrimination and low horizontal trust. After multiple adjustments for age, country of origin and education, the addition of trust in the model reduced the odds ratio of poor self-reported psychological health in the “most employers” category from 1.8 (1.4–2.1) to 1.5 (1.3–1.9) among men and from 2.2 (1.8–2.6) to 1.8 (1.5–2.2) among women. Generalized trust in other people may be a confounder of the association between anticipated discrimination and poor psychological health. Anticipated discrimination may have effects on the mental health of not only the affected minorities, but also on the mental health of the general population.     

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.     

The role of social capital in reducing non-specific psychological distress: the importance of controlling for omitted variable bias

This paper examines the relationship between area-level social capital and non-specific psychological distress. It demonstrates that not controlling for non-time-varying omitted variables can seriously bias research findings. We use data from three cross-sections of the US National Health Interview Survey (1999, 2000, and 2001): 37,172 observations nested within 58 Metropolitan Statistical Areas. We also add data from the Area Resource File and County Business Patterns. We use a validated measure of social capital, the Petris Social Capital Index (PSCI), which measures structural social capital. We estimate a two-level multilevel linear model with a random intercept. Non-specific psychological distress is measured using a valid and reliable indicator, the K6. Individual-level variables include sex, age, race/ethnicity, marital status, education, family income, smoking status, exercise status, and number of visits to a health professional. Area-level covariates include the PSCI, the unemployment rate, psychiatrists per 1000 population, non-psychiatric physicians per 1000 population, and area-level indicators to account for non-time-varying area-level omitted variable bias. Time dummies are also included. We find that lagged area-level social capital is negatively related to non-specific psychological distress among individuals whose family income is less than the median. These associations are much larger when we control for non-time-varying area-level omitted variables.     

The impact of changes in different aspects of social capital and material conditions on self-rated health over time: A longitudinal cohort study

Individual aspects of social capital have been shown to have significant associations with health outcomes. However, research has seldom tested different elements of social capital simultaneously, whilst also adjusting for other well-known health determinants over time. This longitudinal individual-level study investigates how temporal changes in social capital, together with changes in material conditions and other health determinants affect associations with self-rated health over a six year period. We use data from the British Household Panel Survey, a randomly selected cohort which is considered representative of the United Kingdom's population, with the same individuals (N = 9303) providing responses to identical questions in 1999 and 2005. Four measures of social capital were used: interpersonal trust, social participation, civic participation and informal social networks. Material conditions were measured by total income (both individual and weighted household income), net of taxation. Other health determinants included age, gender, smoking, marital status and social class. After the baseline sample was stratified by health status, associations were examined between changes in health status and changes in all other considered variables. Simultaneous adjustment revealed that inability to trust demonstrated a significant association with deteriorating self-rated health, whereas increased levels of social participation were significantly associated with improved health status over time. Low levels of household and individual income also demonstrated significant associations with deteriorating self-rated health. In conclusion, it seems that interpersonal trust and social participation, considered valid indicators of social capital, appear to be independent predictors of self-rated health, even after adjusting for other well-known health determinants. Understandably, how trust and social participation influence health outcomes may help resolve the debate surrounding the role of social capital within the field of public health.     

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.     

社区高血压患者社会资本与心理健康的关系

目的评价社会资本量表的信度和效度,分析社区高血压患者社会资本与心理健康的关系。方法采用多阶段整群随机抽样的方法,对上海市某区高血压患者经知情同意进行问卷调查。其中社会资本量表是在相关理论和研究基础上,通过多次专家咨询,对量表的条目进行设计和修改而成,应用Cronbach’s α系数、评分者信度及探索性因子分析对其信度和效度进行评价;世界卫生组织5项心理健康量表用于测评患者心理健康状况。采用多因素非条件logistic回归分析高血压患者社会资本与心理健康状况的关系。结果社会资本量表的Cronbach’s α系数为0．628,量表各维度Cronbach’s α系数为0．507～0．793。评分者信度P值为0．001-0．715。各维度得分与量表总得分相关系数为0．500～0．928。因子分析的KMO值为0．706,提取了3个公因子,共解释了60．99％的方差变异。在控制其他可能的影响因素后,社区高血压患者信任参与程度和心理健康状况呈正相关（OR=1．740,P〈O．01）。结论社会资本量表有较好的信度、效度,社会资本是社区高血压患者心理健康的重要影响因素,尤其是提高患者社区活动参与意识和社区信任感对改善高血压患者心理健康有着积极的促进作用。     

Quality and quantity: the role of social interactions in self-reported individual health

The public health literature on the detrimental effects of social isolation has shown that the quantity of social connections is positively correlated with individual health. Drawing on pooled cross-sectional data, we test this hypothesis on a representative sample of the Italian population. Our findings show that, in addition to the quantity of interactions, it is their quality--as measured by subjective satisfaction derived from relationships with friends--that works as the best predictor of self-reported health. The frequency of meetings with friends is significantly and positively correlated with good health in all regressions. However, when we add our measure of the quality of relationships to the probit equations, the statistical significance of "quantitative" measures is scaled down. Satisfaction with relationships with friends exhibits a positive and highly significant coefficient. Results of the multivariate probit analysis point out the potential role of unobservable variables suggesting the existence of endogeneity problems which require further investigation. We point out the existence of health disparities based on socio-economic status. There is a higher probability that poorer and less educated individuals report poor health conditions. The risk is even higher for unemployed and retired workers. This paper contributes to the literature in two substantive dimensions. This is the first empirical study of the relationship between social interactions and health in Italy. Second, we add to previous empirical studies by taking into account not only the frequency of various kinds of meetings but also indicators of their "quality", as measured by agents' subjective satisfaction with their social participation. The reliability of the analysis also benefits from the uniqueness and comprehensiveness of our dataset, which tries to overcome a structural deficiency in Italian data by merging information on agents' behaviours and perceptions with data on household income.     

The mechanisms that associate community social capital with post-disaster mental health: A multilevel model

Many scholars have advocated that the time has come to provide empirical evidence of the mechanisms that associate community social capital with individual disaster mental health. For this purpose we conducted a study (n = 232) one year after a flood (2008) in Morpeth, a rural town in northern England. We selected posttraumatic stress as an indicator of disaster mental health. Our multilevel model shows that high community social capital is indirectly salutary for individual posttraumatic stress. In particular, in communities (defined as postcode areas) with high structural social capital, the results suggest that individuals confide in the social context (high cognitive social capital) to address disaster-related demands (high collective efficacy), and employ less individual psychosocial resources (i.e. coping strategies and social support). This “conservation of individual psychosocial resources” in a salutary social context decreases the association between the appraisal of the disaster and posttraumatic stress. As a result of this mechanism, individuals suffer less from posttraumatic stress in communities with high social capital. These findings provide new insights how intervention policies aimed at strengthening both objective and subjective dimensions of social capital may reduce post-disaster mental health.     

社会资本与护士心理健康、职业倦怠、离职意愿及其影响因素间作用模式

目的 探讨社会资本与护士心理健康、职业倦怠、离职意愿及其影响因素间的影响机制.方法 通过随机整群抽样,采用护士离职意愿量表、社会资本测量问卷、护士职业倦怠量表和中文健康问卷对723名护士进行调查,并应用路径分析方法对因素间作用机制进行探索.结果 护士职位可对社会资本产生影响(路径系数为0.124);社会资本与职业倦怠均对护士的心理问题产生较大影响力(路径系数分别为一0.231,0.203);而护士心理问题与职业倦怠又对离职意愿产生影响(路径系数分别为0.088,0.151);模型拟合较好,CMIN/DF为1.645,GFI 0.984,AGFI 0.966,IFI 0.941,CFI 0.937,RMSEA 0.037.结论 社会资本可以为优化护理管理工作提供新的视角,开发护士社会资本可有效缓解其心理问题;而心理问题和职业倦怠的改善最终又降低护士的离职意愿.

Abstract：

Objective To explore the interaction model of social capital, mental health,occupational burnout, turnover intention and the related influence factors on nurses. Methods By random cluster sampling, investigated 723 nurses with Nurses' Turnover Intention Inventory, the Maslach Burnout Inventory, Social Capital Questionnaire and Chinese Health Questionnaire, then explored the interaction model by path analysis. Results Nurses' position can influence their social capital(the path coefficient was 0. 124), social capital and occupational turnout can influence nurses' mental health(the path coefficient were -0. 231,0. 151), the mental health and occupational turnout both can influence nurses' turnover intention directly(the path coefficient were 0. 088,0. 151 ), the model is acceptable(CMIN/DF 1. 645, GFI 0. 984, AGFI 0. 966, IFI 0. 941, CFI 0. 937, RMSEA 0. 037).Conclusion Social capital can provide a new perspective for nurses' management, developing the social capital resources can relieve nurses' mental problems effectively; relieving the turnout and mental problem can decrease nurses' turnover intention finally.     

Measuring dimensions of social capital: evidence from surveys in poor communities in Nicaragua

A dominant perspective in social capital research emphasizes a "structural" dimension of social capital, consisting of network connections, and a "cognitive" dimension, consisting of attitudes toward trust. Correspondingly, membership in organizations (i.e., membership density) and general trust in people (i.e., social trust) are two indicators commonly used to relate structural and cognitive social capital, respectively, to a variety of health and other outcomes. This study analyzed relationships between membership density, social trust and a more comprehensive set of household-level social capital indicators as well as selected civic and health behaviors in the context of Nicaragua. The sample of respondents was drawn from 6 communities and interviews were conducted with 482 heads of households, resulting in data on 2882 individuals. Factor analyses suggest that membership density loaded strongly (loading=0.81) onto an "organizational participation" factor which contained a number of qualitative characteristics of involvement, including bridging social capital. Further, this structural dimension of social capital appears to be a construct consisting of more than just informal social networks. However, factor analyses suggest that distinctions between levels of trust are warranted in Nicaragua: social trust loaded weakly (loading=0.32) onto a factor characterized by institutional trust in a factor analysis of trust items, and well below 0.30 in a factor analysis of both structural and cognitive dimensions of social capital. A nuanced understanding of these household-level indicators of structural and cognitive social capital held implications for civic and health behaviors. While membership density and institutional trust were positively related to an index of political engagement, social trust was either not related or negatively associated (among urban respondents). Similarly, social trust was associated with over 50% reduced odds of an additional childhood vaccinations whereas institutional trust was associated with increased odds (OR=1.7) of an additional vaccination. The findings highlight the complexity of social capital and the importance of exploring more comprehensive indicators.     

Social capital and health in Australia: An overview from the household,income and labour dynamics in Australia survey

Social capital is associated with better health, but components of social capital and their associations with different types of health are rarely explored together. The aim of this study was to use nationally representative data to develop population norms of community participation and explore the relationships between structural and cognitive components of social capital with three forms of health – general health, mental health and physical functioning. Data were taken from Wave 6 (2006) of the Household, Income and Labour Dynamics in Australia Survey. Using individual-level data, the structural component of social capital (community participation) was measured using a twelve-item short-form of the Australian Community Participation Questionnaire, and the cognitive component (social cohesion) by sense of belonging, tangible support, trust and reciprocity. Three subscales of the SF-36 provided measures of health. Multiple hierarchical regression modelling was used to investigate multivariate relationships among these factors. Higher levels of participation were related to higher levels of social cohesion and to all three forms of (better) health, particularly strongly to mental health. These findings could not be accounted for by sex, age, Indigenous status, education, responsibility for dependents, paid work, living alone or poverty. Controlling for these and physical health, structural and cognitive components of social capital were each related to mental health, with support for a possible mediated relationship between the structural component and mental health. Social capital was related to three forms of health, especially to mental health. Notable gender differences in this relationship were evident, with women reporting greater community participation and social cohesion than men, yet worse mental health. Understanding the mechanisms underlying this apparent anomaly needs further exploration. Because community participation is amenable to intervention, subject to causal testing, our findings may assist in the development of programs which are effective in promoting social cohesion and, thereby, mental 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.     

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.     

影响农村妇女孕产期保健的社会因素分析

目的:探讨影响农村妇女孕产期保健的社会因素。方法:采用定性研究方法,根据目的抽样的原则,抽取孕产期保健服务的提供者、利用者以及地方级别的关键知情人士进行焦点小组访谈、个人深入访谈和关键人物访谈。结果:家庭经济贫困的妇女相对经济好的妇女更不容易利用保健服务;新型农村合作医疗可以吸引妇女到医院分娩,提高住院分娩率,降低母婴死亡率;交通对孕产妇利用保健服务有很大的影响;计划生育政策是计划外生育妇女利用孕产期服务最主要的障碍;流动妇女对孕产期保健服务的利用率低;当地农村仍奉行一些关于生孩子的传统习俗。结论:建议政府制定相关政策限制日益增长的医疗费用;加强流动人口和计划外生育妇女的管理;对农村妇女进行孕产期健康教育;扩大新型农村合作医疗的覆盖范围。     

中国农村互助医疗

哈佛大学领导的项目小组在对中国西部农村问题进行了深入的诊断分析和原因分析之后，提出了通过建立农村互助医疗制度来解决中国西部农村基本卫生和因病致贫问题的初步设想。详细描述了农村互助医疗制度的理论基础和基本框架，并且深入探讨了如何通过试点获得可操作性知识和经验及其实施效果。目标是通过农村互助医疗制度的实施，降低农村居民享受基本医疗的成本，提高基本医疗的质量，减缓农村因病致贫的现象。     

Toward an institutional perspective on social capital health interventions: lay community health workers as social capital builders

This article argues that social capital health research should move beyond a mere focus on social cohesion and network perspectives to integrate an institutional approach into the development of social capital health interventions. An institutional perspective, which is unique in its emphasis on linking social capital in addition to the bonding and bridging forms, contextualises social capital, allowing researchers to confront the complexity of social relationships. This perspective allows for the construction of interventions that draw on the resources of diverse actors, particularly the state. One intervention strategy with the potential to create community linkages involves lay community health workers (LCHWs), individuals who are trained to perform a variety of health-related functions but lack a formal professional health education. This article begins with a review of the institutional social capital-building literature. It then goes on to briefly review the social capital and health literature and discuss the state of intervention research. Thereafter, it describes LCHWs and discusses studies that have utilised LCHWs to tackle community health problems. In doing so, this article presents an institutional-based systematic framework for how LCHWs can build social capital, including a discussion of the ways in which LCHWs can successfully promote bonding, bridging and linking social capital.