Social Capital: Does it Add to the Health Inequalities Debate?

This paper empirically examines the relationship between advantage, social capital and health status to assess (a) whether social capital adds explanatory power to what we already know about the relationship between advantage and health and (b) whether social capital adds anything beyond its component parts, namely social participation and trust. It uses 2 measures of advantage (income and education), 5 measures of participation (informal network size, number of community activities, formal group membership, informal group membership, and service use), 3 measures of trust (trust, sense of belonging, and willingness to participate) and 3 indicators of health (perceived health, mental health, and physical function). Cross sectional data are analyzed from a sample of 918 middle-aged individuals, using multi-variate analyses. Results show that there were no direct associations between informal or formal group membership, community activities attended, or trust with any of the 3 health variables examined. A test of interaction terms combining trust and participation variables into several combined social capital variables also failed to show any relationship with any of the 3 health measures. That is, no support was found for a direct relationship between the separate components or combined measures of social capital and health. Income, however, was directly important for both perceived health and physical function although not for mental health. However, data reveal indirect affects for trust and not participation or interaction terms, through self-efficacy for all 3 domains of health and through perceived expressive support for mental health. As such, the data suggest the concept of social capital adds nothing to its component parts when examining individual level of health and furthermore that trust, but not participation, has a significant, indirect relationship to some domains of health. Such findings confirm the importance of income, a measure of socio-economic status, as well documented within the social determinants of health literature. It questions the use of the concept of social capital and points to the need for greater research examining indirect pathways to health and a greater focus on the role played by trust.