Social capital and health: a review of prospective multilevel studies

Background

This article presents an overview of the concept of social capital, reviews prospective multilevel analytic studies of the association between social capital and health, and discusses intervention strategies that enhance social capital.

Methods

We conducted a systematic search of published peer-reviewed literature on the PubMed database and categorized studies according to health outcome.

Results

We identified 13 articles that satisfied the inclusion criteria for the review. In general, both individual social capital and area/workplace social capital had positive effects on health outcomes, regardless of study design, setting, follow-up period, or type of health outcome. Prospective studies that used a multilevel approach were mainly conducted in Western countries. Although we identified some cross-sectional multilevel studies that were conducted in Asian countries, including Japan, no prospective studies have been conducted in Asia.

Conclusions

Prospective evidence from multilevel analytic studies of the effect of social capital on health is very limited at present. If epidemiologic findings on the association between social capital and health are to be put to practical use, we must gather additional evidence and explore the feasibility of interventions that build social capital as a means of promoting health.Key words: health, literature review, multilevel analysis, prospective study, social capital     

A multilevel analysis of social capital and self-reported health: evidence from Seoul,South Korea

Background  

This study aims to resolve two limitations of previous studies. First, as only a few studies examining social capital have been conducted in non-western countries, it is inconclusive that the concept, which has been developed in Western societies, applies similarly to an Asian context. Second, this study considers social capital at the individual-level, area-level and cross-levels of interaction and examines its associations with health while simultaneously controlling for various confounders at both the individual-level and area-level, whereas previous studies only considered one of the two levels. The purpose of this study is therefore to examine the associations between social capital and health by using multilevel analysis after controlling for various confounders both at the individual and area-levels (i.e., concentrated disadvantage) in non-western countries.     

Does low workplace social capital have detrimental effect on workers' health?

While the majority of studies of social capital and health have focused on conceptualizing social capital at the geographic level, evidence remains sparse on workplace social capital. We examined the association between workplace social capital and health status among Japanese private sector employees in a cross-sectional study. By employing a two-stage stratified random sampling procedure, 1147 employees were identified from 46 companies in Okayama in 2007. Workplace social capital was measured based on two components; trust and reciprocity. Company-level social capital was based on aggregating employee responses and calculating the proportion of workers reporting mistrust and lack of reciprocity. Multilevel logistic regression analysis was conducted using Markov Chain Monte Carlo methods to explore whether individual- and company-level mistrust and lack of reciprocity were associated with poor self-rated health. Odds ratios (ORs) and 95% credible intervals (CIs) for poor health were obtained for each variable. Workers reporting individual-level mistrust and lack of reciprocity had approximately double the odds of poor health even after controlling for sex, age, occupation, educational attainment, smoking, alcohol use, physical activity, body mass index, and chronic diseases. While we found some suggestion of a contextual association between company-level mistrust and poor health, no association was found between company-level lack of reciprocity and health. Despite the thorough examination of cross-level interaction terms between company-level social capital and individual characteristics, no clear patterns were observed. Individual perceptions of mistrust and lack of reciprocity at work have adverse effects on self-rated health among Japanese workers. Although the present study possibly suggests the contextual effect of workplace mistrust on workers' health, the contextual effect of workplace lack of reciprocity was not supported.     

Social capital at work as a predictor of employee health: multilevel evidence from work units in Finland

The majority of previous research on social capital and health is limited to social capital in residential neighborhoods and communities. Using data from the Finnish 10-Town study we examined social capital at work as a predictor of health in a cohort of 9524 initially healthy local government employees in 1522 work units, who did not change their work unit between 2000 and 2004 and responded to surveys measuring social capital at work and health at both time-points. We used a validated tool to measure social capital with perceptions at the individual level and with co-workers' responses at the work unit level. According to multilevel modeling, a contextual effect of work unit social capital on self-rated health was not accounted for by the individual's socio-demographic characteristics or lifestyle. The odds for health impairment were 1.27 times higher for employees who constantly worked in units with low social capital than for those with constantly high work unit social capital. Corresponding odds ratios for low and declining individual-level social capital varied between 1.56 and 1.78. Increasing levels of individual social capital were associated with sustained good health. In conclusion, this longitudinal multilevel study provides support for the hypothesis that exposure to low social capital at work may be detrimental to the health of employees.     

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 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.     

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 in working life and the health of employees

It is commonly assumed that social capital influences health, but only few studies have examined this hypothesis in the context of the workplace. The present prospective cohort study of 6028 public sector employees in Finland investigated social capital as a workplace characteristic which potentially affects employee health. The two indicators of social capital were trust in the labour market, measured by security of the employment contract, and trust in co-worker support. Self-rated health status and psychological distress were used as indicators of health. The combination of subsidised job contract and low co-worker support (i.e. the lowest category of social capital) was associated with poorer health prospects than the combination of permanent employment and high support (the highest social capital category) in an age-adjusted model, but this association disappeared in logistic regression analysis adjusted by sociodemographic background factors and baseline health. Fixed-term employment predicted better self-rated health and less psychological distress when compared with permanent employment. Co-worker support was most common in permanent and least common in subsidised employees and it was associated with better self-rated health in women. Our findings suggest only partial support for the hypothesis of work-related social capital as a health resource.     

Social capital and health in the least developed countries: A critical review of the literature and implications for a future research agenda

Research on the linkage between social capital and health has grown in recent years; however, there is a dearth of evidence from resource-poor countries. This review examines the association between social capital and physical health (including health behaviours) in the least developed countries (LDCs). Citations were searched using three databases from 1990 to 2011 using the keyword ‘social capital’ combined with the name of each of the 48 LDCs. Of the 14 studies reviewed, 12 took place in Africa and 2 in South Asia. All used cross-sectional study designs, including five qualitative and nine quantitative studies. The literature reviewed suggests that social capital is an important factor for improving health in resource-poor settings; however, more research is needed in order to determine the best measures for social capital and elucidate the mechanisms through which social capital affects health in the developing world. Future research on social capital and health in the developing world should focus on applying appropriate theoretical conceptualisations of social capital to the developing country context, adapting and validating instruments for measuring social capital, and examining multilevel models of social capital and health in developing countries.     

Economic inequality, working-class power, social capital, and cause-specific mortality in wealthy countries.

This study tests two propositions from Navarro's critique of the social capital literature: that social capital's importance has been exaggerated and that class-related political factors, absent from social epidemiology and public health, might be key determinants of population health. The authors estimate cross-sectional associations between economic inequality, working-class power, and social capital and life expectancy, self-rated health, low birth weight, and age- and cause-specific mortality in 16 wealthy countries. Of all the health outcomes, the five variables related to birth and infant survival and nonintentional injuries had the most consistent association with economic inequality and working-class power (in particular with strength of the welfare state) and, less so, with social capital indicators. Rates of low birth weight and infant deaths from all causes were lower in countries with more "left" (e.g., socialist, social democratic, labor) votes, more left members of parliament, more years of social democratic government, more women in government, and various indicators of strength of the welfare state, as well as low economic inequality, as measured in a variety of ways. Similar associations were observed for injury mortality, underscoring the crucial role of unions and labor parties in promoting workplace safety. Overall, social capital shows weaker associations with population health indicators than do economic inequality and working-class power. The popularity of social capital and exclusion of class-related political and welfare state indicators does not seem to be justified on empirical grounds.     

An exploration of workplace social capital as an antecedent of occupational safety and health climate and outcomes in the Chinese education sector

Purpose

It is widely acknowledged that teachers are at greater risk of work-related health problems. At the same time, employee perceptions of different dimensions of organizational climate can influence their attitudes, performance, and well-being at work. This study applied and extended a safety climate model in the context of the education sector in Hong Kong. Apart from safety considerations alone, the study included occupational health considerations and social capital and tested their relationships with occupational safety and health (OSH) outcomes.

Methods

Seven hundred and four Hong Kong teachers completed a range of questionnaires exploring social capital, OSH climate, OSH knowledge, OSH performance (compliance and participation), general health, and self-rated health complaints and injuries. Structural equation modeling (SEM) was used to analyze the relationships between predictive and outcome variables.

Results

SEM analysis revealed a high level of goodness of fit, and the hypothesized model including social capital yielded a better fit than the original model. Social capital, OSH climate, and OSH performance were determinants of both positive and negative outcome variables. In addition, social capital not only significantly predicted general health directly, but also had a predictive effect on the OSH climate–behavior–outcome relationship.

Conclusions

This study makes a contribution to the workplace social capital and OSH climate literature by empirically assessing their relationship in the Chinese education sector.     

Multi-level,cross-sectional study of workplace social capital and smoking among Japanese employees

Background  

Social capital is hypothesized to be relevant to health promotion, and the association between community social capital and cigarette smoking has been examined. Individual-level social capital has been found to be associated with smoking cessation, but evidence remains sparse on the contextual effect of social capital and smoking. Further, evidence remains sparse on the association between smoking and social capital in the workplace, where people are spending an increasing portion of their daily lives. We examined the association between workplace social capital and smoking status among Japanese private sector employees.     

Social capital and health: Does egalitarianism matter? A literature review

The aim of the paper is to critically review the notion of social capital and review empirical literature on the association between social capital and health across countries. The methodology used for the review includes a systematic search on electronic databases for peer-reviewed published literature. We categorize studies according to level of analysis (single and multilevel) and examine whether studies reveal a significant health impact of individual and area level social capital. We compare the study conclusions according to the country's degrees of economic egalitarianism. Regardless of study design, our findings indicate that a positive association (fixed effect) exists between social capital and better health irrespective of countries degree of egalitarianism. However, we find that the between-area variance (random effect) in health tends to be lower in more egalitarian countries than in less egalitarian countries. Our tentative conclusion is that an association between social capital and health at the individual level is robust with respect to the degree of egalitarianism within a country. Area level or contextual social capital may be less salient in egalitarian countries in explaining health differences across places.     

Self-assessed health--a case study of social differentials in Soweto,South Africa

The study of the relationship between health and social differentials as a focus of research is not new. However, most of the studies originate in the Western-developed world and are thus informed by this specific social and cultural context. The aim of the paper was to analyse the relationship between health and a range of social factors in a specific social context of a relatively deprived community in South Africa. It is based on a secondary analysis of data collected in a comprehensive social survey of Soweto conducted in 1997. A total of 2947 interviews were used for the current analysis. An attempt was made to explore basic measures of social inequality as well as more sophisticated indicators of social relationships and access to "social resources" and how they are linked to people's perception of their own health. The results reveal a clear relationship between health and a range of socio-economic indicators of inequalities. Health is significantly associated with a good "perception about the living environment" and "access to social resources". This paper presents an interesting scenario which -while reaffirming the already established connection between social differentials and health-also sheds light on a different social context and specific relationships with regard to health. It also points towards the ways people try to cope with the psycho-social stressor emanating from their specific context.     

Location, location, location: contextual and compositional health effects of social capital in British Columbia, Canada

After decades of epidemiological exploration into individual-level risk factors for ill health, a recent surge of interest in the health effects of socially patterned attributes of geographically defined 'places' has given the structural side of the agency-structure debate new prominence in population health research. Utilizing two original data sets, one pertaining to features of communities in British Columbia, Canada and the other to characteristics of individuals living in them, this article distinguishes the health effects of socially patterned attributes of communities, including the social capital of communities, from the health effects of characteristics of residents that contribute to social capital, e.g., trust and participation in voluntary associations. Results from multilevel analysis demonstrated that, of three different individual-level measures of health and well-being (and including measures of long-term limiting illness and self-rated health), only a measure of depressive symptoms had variability that could be reasonably attributed to the level of the community. The social capital of communities in the form of the availability of public spaces explained some of this variability, but in the direction contrary to expectations. Overall, location (community of residence) did little to explicate health inequalities in this context. The strongest predictors of health in multivariate and multilevel models were characteristics of individual survey respondents, namely, income, trust in politicians and governments, and trust in other members of the community. Breadth of participation in networks of voluntary association was not significantly related to health in multivariate models.     

工作场所社会资本与流动人口吸烟及自评健康关系的多水平分析

目的探讨工作场所社会资本与流动人口吸烟和自评健康的关系,为工作场所健康促进提供依据。方法采用多阶段抽样的方法,于2012年7月—2013年1月在上海市77家工作场所通过问卷调查流动人口的人口学特征、吸烟、问题饮酒、自评健康和工作场所社会资本等指标。运用多水平Logistic回归分析探讨个体工作场所社会资本和群组工作场所社会资本与吸烟和自评健康的关系。结果研究对象的吸烟率为25.2%。多水平分析结果显示：控制社会人口学特征后,以个体工作场所社会资本位于第4四分位数的研究对象作为参考,位于第3四分位数、第2四分位数和第1四分位数的研究对象吸烟的OR值分别为：1.15（95%CI：1.02-1.41）,1.24（95%CI：1.13-1.57）,1.51（95%CI：1.20-1.89）。22.3%的研究对象自评健康状况不佳。多水平分析结果显示：控制社会人口学特征后,以个体工作场所社会资本位于第4四分位数的研究对象作为参考,位于第3四分位数、第2四分位数和第1四分位数的研究对象自评健康自评不佳的OR值分别为：1.49（95%CI：1.21-1.83）,2.85（95%CI：2.30-3.54）,3.03（95%CI：2.43-3.76）。群体工作场所社会资本与吸烟和自评健康均无关联。结论个体工作场所社会资本是流动人口吸烟和自评健康的影响因素,在工作场所重建社会资本可以促进流动人口的健康水平。     

Poor people, poor places, and poor health: the mediating role of social networks and social capital

This paper explores the dynamics between poverty and exclusion; neighbourhood, and health and well being by considering the role of social networks and social capital in the social processes involved. It is based on qualitative research taking two deprived areas as exemplary case studies, and involving depth interviews with residents. Neighbourhood influences on networks and social capital were explored, network typologies developed reflecting structural and cultural aspects of individual's networks, and pathways implicated in health effects considered. The complexity of social capital is addressed. The role of three factors in influencing social networks and social capital are demonstrated: neighbourhood characteristics and perceptions; poverty and social exclusion, and social consciousness. Perceptions of inequality could be a source of social capital as well as demoralisation. Different network structures-dense and weak, homogeneous and heterogeneous- were involved in the creation of social capital and had implications for well being. Coping, enjoyment of life and hope are identified as benefits. Although participation in organisations was confirmed as beneficial, it is suggested that today's heterogeneous neighbourhoods also require regenerated local work opportunities to develop bridging ties necessary for the genesis of inclusive social capital and better health. Despite the capacity of social capital to buffer its harsher effects, the concept is not wholly adequate for explaining the deleterious effects of poverty on health and well being.     

Neighbourhood social capital and common mental disorder: testing the link in a general population sample

General population multilevel studies of social capital and mental health are few in number. This multilevel study examined external measures of neighbourhood social capital and common mental disorders (CMD). Main effects and stress buffering models were tested. Based on data from over 9000 residents in 239 neighbourhoods in England and Scotland, there was no evidence of a main effect of social capital. For people living in deprived circumstances only, associations between neighbourhood social capital and CMD were seen. Elements of bridging social capital (contact amongst local friends) were associated with lower reporting of CMD. Elements of bonding social capital (attachment to neighbourhood) were associated with higher reporting of CMD. Findings provide some support for the hypothesis that social capital may protect against CMD, but indicate that initiatives should be targeted to deprived groups, focus on specific elements of social capital and not neglect the important relationship between personal socioeconomic disadvantage and CMD.     

Neighborhood social capital and individual health

Neighborhood social capital is increasingly considered to be an important determinant of an individual's health. Using data from the Netherlands we investigate the influence of neighborhood social capital on an individual's self-reported health, while accounting for other conditions of health on both the level of the neighborhood and the individual. We use national representative data ('The Housing and Living Survey', 2006) on the Netherlands with 61,235 respondents in 3273 neighborhoods. The cross-sectional data were combined with information provided by Statistics Netherlands on neighborhoods, i.e., the percentage of residents in the highest income quintile per neighborhood and the municipality's degree of urbanity. The association of neighborhood social capital with individual health was assessed by multilevel logistic regression analysis. Our results show that neighborhood social capital is positively associated with health. Interestingly, residents in urban neighborhoods benefit particularly from their neighborhood social capital.     

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。