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.     

Comparing social determinants of self-rated health across the United States and Canada

A large body of research shows that social determinants of health have significant impact on the health of Canadians and Americans. Yet, very few studies have directly compared the extent to which social factors are associated with health in the two countries, in large part due to the historical lack of comparable cross-national data. This study examines differences in the effect of a wide-range of social determinants on self-rated health across the two populations using data explicitly designed to facilitate comparative health research-Joint Canada/United States Survey of Health. The results show that: 1) sociodemographic and socioeconomic factors have substantial effects on health in each country, though the size of the effects tends to differ-gender, nativity, and race are stronger predictors of health among Americans while the effects of age and marital status on health are much larger in Canada; the income gradient in health is steeper in Canada whereas the education gradient is steeper in the U.S.; 2) Socioeconomic status (SES) mediates or links sociodemographic variables with health in both countries-the observed associations between gender, race, age, and marital status and health are considerably weakened after adjusting for SES; 3) psychosocial, behavioural risk and health care access factors are very strong determinants of health in each country, however being severely/morbidly obese, a smoker, or having low life satisfaction has a stronger negative effect on the health of Americans, while being physically inactive or having unmet health care needs has a stronger effect among Canadians; and 4) risk and health care access factors together play a relatively minor role in linking social structural factors to health. Overall, the findings demonstrate the importance of social determinants of health in both countries, and that some determinants matter more in one country relative to the other.     

Physician autonomy in the Federal Republic of Germany, Great Britain and the United States.

The concepts of 'professionalism' (including autonomy) and 'management' (involving the control of others) are logically opposed; but, in the field of health care, physicians and managers have largely co-existed without such opposition. International pressures for cost containment, however, now raise questions about the future nature of physician autonomy. This paper attempts, firstly, to conceptualize the nature of clinical autonomy as a number of independent components; secondly, to describe the nature of such autonomy in three countries in terms of these components; and, thirdly, to identify related questions for future research.     

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 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.     

Leveraging health capital at the workplace: An examination of health reporting behavior among Latino immigrant restaurant workers in the United States

This article examines the choices made by a sample of Latino immigrant restaurant workers in regard to their health management, particularly in response to illness and injury. I draw on 33 interviews with kitchen staff employed in the mainstream restaurant industry in San Jose, California, and Houston, Texas, in 2006 and 2007. I argue that workers must consider complex power relationships at work in weighing the advantages of calling in sick, using protective equipment, seeking medical care, or filing a workers’ compensation claim. These decisions implicate direct and opportunity costs, such as risk of job loss and missed opportunities for advancement. Workers consequently leverage their health capital to meet their economic needs, to assert their autonomy at the workplace, and to ultimately reject the stigma of illness and injury.     

The importance of social relationships for the association between social inequality and health among the aged

Zusammenfassung. Fragestellung: Im vorliegenden Beitrag wird zum einen untersucht, inwieweit der Zusammenhang zwischen sozialer Ungleichheit und Gesundheit im h?heren Lebensalter durch soziale Beziehungen im Sinne einer statusspezifischen Exposition vermittelt wird. Zum anderen wird analysiert, inwieweit sich unterschiedlich starke Zusammenh?nge zwischen sozialen Beziehungen und Gesundheit in unterschiedlichen Statusgruppen im Sinne einer statusspezifischen Vulnerabilit?t ergeben. Methoden: Datengrundlage ist eine bundesweite telefonische Befragung von 682 in Privathaushalten lebenden alten Menschen (60 Jahre und ?lter). Als Indikatoren für den sozialen Status werden Bildungsabschluss, Pro-Kopf-Einkommen und Berufsprestige herangezogen. Als Merkmale sozialer Beziehungen gehen zwei Indikatoren für soziale Kontakte (Freunde und Verwandte) sowie die wahrgenommene Verfügbarkeit, die Inanspruchnahme und die Ad?quatheit von emotionaler Unterstützung in die Analysen ein. Die Selbsteinsch?tzung der Gesundheit, eine Depressionsskala (CES-D) und eine Skala zur Abbildung funktionaler Einschr?nkungen dienen als Gesundheitsindikatoren. Ergebnisse: Aus den multiplen logistischen Regressionsanalysen geht hervor, dass die vermittelnden Effekte von sozialen Beziehungen im Hinblick auf den sozialen Gradienten der Gesundheit (subjektive Gesundheit, Depressivit?t und funktionale Einschr?nkungen) im h?heren Lebensalter insgesamt eher gering sind. Im Hinblick auf die differierende St?rke des Zusammenhanges zwischen sozialen Beziehungen und Gesundheit in unterschiedlichen Statusgruppen ergibt sich ein inkonsistentes Bild. Schlussfolgerungen: Durch die Analysen l?sst sich weder die Annahme stützen, dass der soziale Gradient der Gesundheit im Alter durch soziale Beziehungen erkl?rt werden kann; noch finden sich eindeutige Hinweise darauf, dass die gesundheitssch?digenden Wirkungen unzureichender sozialer Beziehungen in unteren sozialen Schichten st?rker sind.

---

Summary. The importance of social relationships for the association between social inequality and health among the aged Objectives: To analyse whether the association between social inequality and health among the aged is mediated through social relationships (differential exposure hypothesis). Moreover, it is examined whether the association between social relationships and health is stronger in lower socio-economic groups (differential vulnerability hypothesis). Methods: The analyses are based on a telephone survey of 682 older people (≥ 60 years) living in a private household in Germany. Education, income and occupational status are utilised as indicators of the socio-economic status. Quantitative (social contacts) as well as qualitative indicators (emotional support) of social relationships are used. Respondents were asked how often they meet their friends and relatives. Emotional support was measured by an instrument assessing the availability of a confidant and the perceived adequacy of the emotional support received. Self-rated health, depression (CES-D) and functional limitations are introduced as health indicators. Results: Multiple logistic regression analyses show that the mediating effect of social relationships on the association between socio-economic status and health (self-rated health, depression and functional limitations) among the aged is weak. Results concerning the differential health impact of social relationships in different socio-economic groups are inconsistent. Discussion: Results do not support the differential exposure hypothesis saying that social inequalities in health can be explained by social relationships. Results do not support the differential vulnerability hypothesis either as there is no evidence for a stronger association between social relationships and health in lower socio-economic groups.

---

Résumé. Le r?le des relations sociales dans le lien entre inégalités sociales et inégalités de santé chez les personnes agées Objectif: Examiner de quelle manière les relations sociales influencent le lien entre inégalités sociales et inégalités de santé chez les personnes agées (differential exposure hypothesis). Vérifier si l’association entre les relations sociales et la santé est plus forte dans des groupes ayant un statut socioéconomique bas (differential vulnerability hypothesis). Méthodes: Une enquête téléphonique a été menée auprès de 682 personnes de 60 ans et plus vivant à domicile en Allemagne. Les indicateurs du statut socioéconomique sont la formation, le salaire et le statut professionnel. En ce qui concerne les relations sociales, des indicateurs quantitatifs (contacts sociaux) et qualitatifs (support émotionnel) sont utilisés, par exemple la fréquence des contacts avec des amis et la famille, la disponibilité de l’entourage et la qualité du soutien émotionnel. Les indicateurs de santé sont le niveau de dépression (CES-D), les limitations fonctionnelles et la santé auto-évaluée. Résultats: Les relations sociales chez les personnes agées n’interviennent que dans l’association entre statut socioéconomique et santé (santé auto-estimée, dépression et limitations fonctionnelles). Les résultats concernant les différences d’association entre relations sociales et santé dans des groupes de statuts socio-économiques différents sont incohérents. Conclusions: Les résultats obtenus ne confirment ni l’hypothèse expliquant les inégalités de santé par le niveau de relations sociales, ni celle postulant que les effets négatifs pour la santé de relations sociales insuffisantes sont plus importants dans les couches sociales les plus défavorisées.

     

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.     

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.     

Migrating to electronic health record systems: A comparative study between the United States and the United Kingdom

The goal of this research is to compare the healthcare information technology (HIT)-related policies and infrastructures of two very differently-run countries: The United States (US) that owns the largest private healthcare system in the world, and the United Kingdom (UK) that has the largest public healthcare system worldwide. The paper specifically focuses on the differences between the two countries’ adoption of electronic healthcare record (EHR) systems, and their efforts toward interoperability, healthcare information security and privacy, and patient safety. Both authors on the paper are professionals in the HIT field and have firsthand experience designing and implementing electronic health record (EHR) systems. As a result, they both have a real-world grasp of HIT economics and the pressure of regulatory compliance. To complement their combined expertise and insight, the authors thoroughly reviewed the peer-reviewed and grey literature on healthcare policy. The paper’s findings suggest that although EHR implementation and adoption are on the rise in the US and the UK alike, both countries are facing considerable hurdles in executing their vision of establishing their respective nationwide EHR systems. To improve patient health and ensure patient safety, interoperability standards that enable seamless communication amongst differing healthcare systems and proper security and privacy regulations for data collection, data handling, and data sharing are paramount.     

Social capital, health and life satisfaction in 50 countries

We explored links between social capital and self-rated health and life satisfaction in a diverse sample of rich and developing countries. A four-factor measure of social capital was developed using data on 69,725 adults in 50 countries that were collected in the World Values Survey. Multilevel analyses showed links between country social capital and health and life satisfaction. However, cross-level interactions indicated that the benefits of social capital were greater in women than men, in older adults and in more trusting, affiliated individuals. Social inequalities in the contributions of social capital to population health are worthy of further study.     

The uninsured in the United States: a strategic critical management review

The purpose of this article is to provide a critical review on studies of access and utilization of the uninsured, and some related proposals regarding the health care reform debate. Also, an attempt is made to determine if conclusions or trends can be identified to develop the groundwork for effective policy initiatives to assure access to the 37 million uninsured persons in the United States.     

美国卫生费用持续上涨的原因及控制措施

目前美国的卫生费用基数庞大,1998年占GDP的14%,造成卫生经费持续上涨的原因除通货膨胀外,还与以下因素有关;第三方付费的方式、不完善的市场、新技术的应用、人口老龄化,卫生保健模式、多方付费系统,庞大的管理费用、防卫性医疗、浪费等,在美国控制医疗费用的措施包括政府行为和市场竞争机制两方面,比如;资源配置许可制度、对外国医科毕业生的限制政策、采用DRG付费方式、管理型保健医疗等。     

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。     

Relative deprivation in income and self-rated health in the United States

Absolute income is robustly associated with health status. Few studies have, however, examined if relative income is independently associated with health. We examined if, over and above the effects of absolute income, individual relative deprivation in income as well as position in the income hierarchy is associated with individual poor health in the U.S. Using three rounds of the Current Population Surveys (CPS), we analyzed the association between self-rated health (1 = fair/poor, 0 = otherwise) and the Yitzhaki index of relative deprivation in income and percentile position in the income hierarchy across 17 reference groups. Over and above the effects of absolute income, the odds ratio for reporting poor health among individuals in the highest quintile of relative deprivation compared to the lowest quintile ranged between 2.18 and 3.30, depending on the reference groups used. A 10 percentile increase in income position within reference groups was associated with an odds ratio of poor health of 0.89. Relative deprivation appeared to explain between 33 and 94% of the association between individual income and self-rated health. Relative deprivation in income is independently associated with poor health over and above the well established effects of absolute income on health. Relative deprivation may partly explain the association between income inequality and worse population health status.     

Cultural health capital and the interactional dynamics of patient-centered care

As intuitive and inviting as it may appear, the concept of patient-centered care has been difficult to conceptualize, institutionalize and operationalize. Informed by Bourdieu's concepts of cultural capital and habitus, we employ the framework of cultural health capital to uncover the ways in which both patients' and providers' cultural resources, assets, and interactional styles influence their abilities to mutually achieve patient-centered care. Cultural health capital is defined as a specialized collection of cultural skills, attitudes, behaviors and interactional styles that are valued, leveraged, and exchanged by both patients and providers during clinical interactions. In this paper, we report the findings of a qualitative study conducted from 2010 to 2011 in the Western United States. We investigated the various elements of cultural health capital, how patients and providers used cultural health capital to engage with each other, and how this process shaped the patient-centeredness of interactions. We find that the accomplishment of patient-centered care is highly dependent upon habitus and the cultural health capital that both patients and providers bring to health care interactions. Not only are some cultural resources more highly valued than others, their differential mobilization can facilitate or impede engagement and communication between patients and their providers. The focus of cultural health capital on the ways fundamental social inequalities are manifest in clinical interactions enables providers, patients, and health care organizations to consider how such inequalities can confound patient-centered care.     

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

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

Social capital and health and well-being in East Asia: a population-based study

How individual-level social capital relates to adult health and well-being was examined using data from a cross-sectional interview survey in East Asia (Japan, South Korea, Singapore, five areas in Mainland China, and Taiwan) in 2002-2004. The number of self-reported somatic symptoms, subjective health satisfaction, life satisfaction and social capital indicators, as well as socio-economic status (SES), were analyzed by a logistic regression model. Adjusting for SES, social capital measured by belonging to organizations and weakness in "norms of reciprocity" were related to a greater number of self-reported somatic symptoms (p<0.001 for both). Lack of trust in organizations (p<0.001) and of a person to consult (p=0.012) were related to poor health satisfaction. Lower "interpersonal trust" (p=0.016), weakness in "norms of reciprocity" (p<0.001) and lack of trust in organizations (p<0.001) were related to poor life satisfaction. Gender inequality was observed across countries, but the relationships varied according to the health indicator. Specifically, self-reported somatic symptoms were more numerous and health satisfaction was worse in women (p<0.001), but life satisfaction was worse in men (p=0.017). The analyses provide evidence that dimensions of social capital are positively associated with self-reported somatic symptoms and overall well-being in East Asian countries.     

Bonding and bridging neighborliness: An individual-level study in the context of health

Although previous research provides a compelling picture of social capital's role in predicting health outcomes, only a modicum of research has tested the more detailed roles of the dimensions of bonding and bridging social capital, with no research focusing exclusively on bonding and bridging neighborliness or ethnicity. To help fill this gap in the literature, the current study measures individual-level bonding and bridging neighborliness for four U.S. ethnic groups—and then, with cross-sectional data from a 2007 national telephone survey of U.S. adults, employs ordinal logistic regression and OLS regression to test the individual-level predictors of self-rated health and stress, when controlling for BMI and demographics. Bonding neighborliness was associated with self-rated health and inversely associated with stress, whereas bridging neighborliness was not significantly linked to either health outcome. When also controlling for neighborhood composition, the bonding neighborliness findings remained generally consistent, while the association between bridging neighborliness and self-rated health gained significance. These results indicate the protective effects that bonding neighborliness can have on health outcomes, as well as the more modest protective effects of bridging neighborliness. These findings have implications for future research and practice, highlighting the potential of health interventions and policies that target the development of bonding social capital.     

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.