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 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.     

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, community size and utilization of health services: a lagged analysis

Objectives

We examine the relationship between social capital, community size and GP visits, and conceptualize social capital as a stock variable measured at a prior point in time.

Methods

Data from the 2002 Canadian Community Health Survey and the 2001 Canadian Census are merged with GP visit data from the Ontario Health Ministry. Negative binomial regression is used to measure the impact of community-level (CSC) and individual-level social capital (ISC) on GP visits. CSC is measured with the Petris Index using employment levels in religious and community-based organizations, and ISC is measured along multiple dimensions.

Results

The effect of social capital varies by community size. A one standard deviation increase in the Petris Index in larger communities (population > 100,000) leads to a 2.6% decrease in GP visits with an annual offset in public spending of $66.4M. Tangible social support—a measure of ISC—also exhibited large effects on GP visits. In smaller communities (population 10,000-100,000), only increased ISC exhibited an impact on GP visits. Age had no effect on the association between social capital and GP visits.

Conclusions

Each form of social capital likely operates through different mechanisms and impact differs by community size. Stronger CSC likely obviates some physician visits in larger communities that involve counseling/caring services while some forms of ISC may act similarly in smaller communities.     

Social capital and perceived health in Japan: An ecological and multilevel analysis

Numerous empirical studies, largely conducted in Western societies, have linked social capital to health outcomes. However, few studies thus far have been conducted in northeastern Asian countries, particularly Japan. Therefore, whether social capital is a determinant of health in Japanese society remains unclear. This study attempted to provide new evidence for the impact of social capital on health in Japan by analyzing original survey data with two different statistical models. In total, 1910 subjects were randomly selected from 210 enumeration districts (EDs) considered in the 2000 population census. In the present study, after excluding missing data on the outcome and predictor variables, we conducted an analysis of 1157 individuals nested within 206 EDs. Ecological and multilevel regression analyses were performed to examine the association between social capital and health, measured by the General Health (GH) perception item (a subcategory of Short Form 36 (SF-36)), and to estimate the impact of aggregated indicators of social capital on health. We developed an original Japanese version of three social capital items (perceived helpfulness, kindness, and greeting) based on previous studies and expert opinions and prepared a social cohesion index that integrated these three social capital items. The ecological model, after adjusting for sociodemographic factors, revealed that perceived helpfulness and greeting, along with the social cohesion index, were observed to have statistically significant associations with GH. The multilevel model, after adjusting for individual social capital perceptions, indicated that the two aggregated indicators of community social capital (kindness and greeting), along with the social cohesion index, showed a statistically significant association with GH. These results showed the existence of a contextual effect of social capital on health outcomes, although individual differences in social capital perceptions in Japan were considered.     

Social inequality and health: the role of social capital

The aim of the article is to examine whether and to what degree the unequal distribution of social capital in the population explains the relationship between socioeconomic position and health in Norway. Theoretical insight and empirical evidence seem to suggest that social capital mediates the effect of socioeconomic position on health outcomes. However, only a few studies have addressed this question and those that have done so have used few and simple indicators of social capital. This study is based on a nationwide cross-sectional survey (N = 3190) commissioned by Statistics Norway. The survey was designed to cover a comprehensive set of variables measuring different aspects of the theoretical construct of social capital. Two health outcomes, self-perceived health and longstanding illness, were analysed. The results showed that the mediating role of social capital between socioeconomic position and health was negligible for both health outcomes. After controlling for socio-demographic variables and socioeconomic position, only neighbourhood satisfaction and generalised trust showed a significant association with self-perceived health, whereas none of the social capital variables had any significant association with longstanding illness. Some theoretical and methodological implications of the results are discussed.     

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 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.     

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.     

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.     

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.     

Social capital and the utilization of maternal and child health services in India: A multilevel analysis

This study examines the association between social capital and the utilization of antenatal care, professional delivery care, and childhood immunizations using a multilevel analytic sample of 10,739 women who recently gave birth and 7403 children between one and five years of age in 2293 communities and 22 state-groups from the 2005 India Human Development Survey. Exploratory factor analysis was used to create and validate six social capital measures that were used in multilevel logistic regression models to examine whether each form of social capital had an independent, contextual effect on health care use. Results revealed that social capital operated at the community level in association with all three care-seeking behaviors; however, the results differed based on the type of health care utilized. Specifically, components of social capital that led to heterogeneous bridging ties were positively associated with all three types of health care use, whereas components of social capital that led to strong bonding ties were negatively associated with the use of preventive care, but positively associated with professional delivery care.     

Associations of social capital with binge drinking in a national sample of adults: The importance of neighborhoods and networks

BackgroundWhile considerable research on adult binge drinking has focused on social influences, the potential role of social capital has been largely overlooked. This study examines the role of social capital, assessed in terms of both neighborhood and social network characteristics, in understanding adult binge drinking.MethodsAdults ages 30–80 were randomly drawn from the RAND American Life Panel and completed an online survey (analytic sample n = 1383). The main predictor variables were neighborhood cohesion, neighborhood order, and social network density. Associations of social capital with past month binge drinking (any, number of days) were examined, controlling for demographic characteristics.ResultsZero-inflated negative binominal regression analysis indicated that any binge drinking was more likely among adults who lived in highly ordered neighborhoods and who had denser social networks but was negatively associated with neighborhood cohesion. However, binge drinking was more frequent among those who lived in neighborhoods lacking order and who had sparser social networks, but had no association with neighborhood cohesion. Age was not found to moderate associations of social capital with binge drinking.ConclusionsGiven that the associations of social capital with adult binge drinking behavior appear to differ by level of influence and type of drinking behavior, there is a need to gain a more nuanced understanding of these complex associations, including the mechanisms through which they operate.     

Building social capital in post-conflict communities: Evidence from Nicaragua

Studies of social capital have focused on the static relationship between social capital and health, governance and economic conditions. This study is a first attempt to evaluate interventions designed to improve the levels of social capital in post-conflict communities in Nicaragua and to relate those increases to health and governance issues. The two-year study involved a baseline household survey of approximately 200 households in three communities in Nicaragua, the implementation of systematic interventions designed to increase social capital in two of the locales (with one control group), and a second household survey administered two years after the baseline survey. We found that systematic interventions promoting management and leadership development were effective in improving some aspects of social capital, in particular the cognitive attitudes of trust in the communities. Interventions were also linked to higher levels of civic participation in governance processes. As in other empirical studies, we also found that higher levels of social capital were significantly associated with some positive health behaviors. The behavioral/structural components of social capital (including participation in groups and social networks) were associated with more desirable individual health behaviors such as the use of modern medicine to treat children's respiratory illnesses. Attitudinal components of social capital were positively linked to community health behaviors such as working on community sanitation campaigns. The findings presented here should be of interest to policy makers interested in health policy and social capital, as well as those working in conflict-ridden communities in the developing world.     

Social capital and access to primary health care in developing countries: Evidence from Sub-Saharan Africa

We test for a causal role of social capital, as measured by self-reported trust, in determining access to basic health facilities in Sub-Saharan Africa. To skirt the reverse-causality problems between social capital and basic health, we rely on instrumental-variable (IV) estimates. A one standard-deviation increase in trust is predicted to lead to a 0.22 standard-deviation fall in doctor absenteeism, a 0.31 standard-deviation fall in waiting time and a 0.30 standard-deviation fall in bribes. As a robustness check, we also use a different database regarding a different health issue, access to clean water. We find that a one standard-deviation rise in trust leads to a 0.33 standard-deviation rise in access to clean water. The variety of public goods considered provides insights about the possible channels through which social capital is converted into health improvements.     

Experience corps: Design of an intergenerational program to boost social capital and promote the health of an aging society

Population aging portends a crisis of resources and values. Desired solutions could include intergenerational strategies to harness the untapped potential of older adultsto address societal needs and to generate health improvements for older adults. Despite the desire of many older adults to remain socially engaged and productive, the creation of productive roles has lagged. This report describes the conceptual framework and major design features of a new model of health promotion for older adults called Experience Corps^®. Experience Corps operates at, and leads to benefits, across multiple levels, including individuals, schools, and the larger community. At the individual level, we propose a model based on Erikson’s concept of generativity to explain bow and why experience Corps works. At the level of schools, we propose a parallel model based on social capital. Experience Corps is a volunteer service program designed to improve the lives of urban childre and to yield health improvement for older persons. It illustrates how population aging creates new opportunities to address difficult social problems. This article explores how the linkage of concepts at multiple levels motivates a potentially cost-effective, feasible, and high-impact program.     

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。     

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.     

A multilevel analysis of social capital and self-rated health: Evidence from the British Household Panel Survey

Social capital is often described as a collective benefit engendered by generalised trust, civic participation, and mutual reciprocity. This feature of communities has been shown to associate with an assortment of health outcomes at several levels of analysis. The current study assesses the evidence for an association between area-level social capital and individual-level subjective health. Respondents participating in waves 8 (1998) and 9 (1999) of the British Household Panel Survey were identified and followed-up 5 years later in wave 13 (2003). Area social capital was measured by two aggregated survey items: social trust and civic participation. Multilevel logistic regression models were fitted to examine the association between area social capital indicators and individual poor self-rated health. Evidence for a protective association with current self-rated health was found for area social trust after controlling for individual characteristics, baseline self-rated health and individual social trust. There was no evidence for an association between area civic participation and self-rated health after adjustment. The findings of this study expand the literature on social capital and health through the use of longitudinal data and multilevel modelling techniques.     

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。