Social capital, SES and health: an individual-level analysis

Abstract

Stimulated by the finding (Kawachi et al., 1997) that social capital in communities may mediate the relationship between income inequality and health status, this article describes relationships between individual-level elements of social capital — trust, commitment and identity in the social-psychological dimension; participation in clubs and associations and civic participation in the action dimension — and self-rated health status, before and after controlling for human capital (socioeconomic status measured by income and education), using survey data collected in Saskatchewan, Canada (n=534, 40% response rate). Income (P=0.001) and education (P<0.001) were related to health in the expected directions. Both income (P=0.002) and education (P=0.004) were related to health among the elderly; education (P=0.035) to health among the middle-aged; and neither among the youthful respondents. Frequency of socialization with work-mates (P=0.019) and attendance at religious services (P=0.034) had the strongest (and positive) relationships with health of the social engagement questions, even after controlling for human capital, and participation in clubs and associations was positively related to health among the elderly (P=0.009). But for commitment to one's own personal happiness (P=0.039), trust, commitment and identification of various kinds were not significantly related to health. Civic participation was also unrelated to health. The main conclusion is that little evidence was found for compositional effects of social capital on health. Secondary findings are that the relationship between SES and health was the same for men and women and strongest among the elderly; that socialization with colleagues from work is relevant and that attendance at religious services and participation in clubs are related to health for the elderly.

Introduction

Social capital has become a popular topic in the past decade and research linking it with health has come fast and furious. Social capital has been thought of as the web of cooperative relationships between citizens that facilitates resolution of collective action problems (Coleman, 1988) and those features of social structure, such as levels of interpersonal trust, norms of reciprocity and mutual aid, that act as resources for such collective action (Coleman, 1988, Putnam et al., 1993). It is generally thought to be a characteristic of social relationships rather than of individuals (Coleman, 1988), although the issue is a contentious one (Brehm and Rahn, 1997). Recently Woolcock (1998) provided social capital researchers with a comprehensive survey of social capital research and theorization that appears to encompass most of the emphases put on social capital by researchers from a wide variety of disciplines. Tracing influences back to Durkheim and Weber, among others, he identifies four main dichotomies that characterize social capital rich (or poor) ‘communities.’ According to Woolcock, then, we should be concerned with intra-community ties (integration within communities), inter-community ties (linkages between communities), embeddedness of state-society relations at the macro level (synergy) and institutional coherence, competence and capacity, also at the macro level (organizational integrity) (p. 168). For example, referring to intra-community ties, “[t]he more intensive the social ties and generalized trust within a given community, the higher its ‘endowment’ of (this form of) social capital” (Woolcock, 1998, p. 171).

A number of studies have linked the presence of social capital in communities, or states or even nations, with some interesting correlates. For example, Putnam et al. (1993), measuring social capital with an index composed of participation in clubs and associations, voting turnouts and newspaper readership, concluded that it was positively correlated with socioeconomic modernity and political performance in Italian regions and that it predates chronologically and therefore likely causally, both ‘outcomes’. Knack and Keefer (1997) used the World Values Survey to find, at the level of nation, that group memberships may be unrelated to trust and civic norms but that both trust and civic norms have significant impacts upon economic activity. Kennedy et al. (1998) concluded that, among the US states, social capital is related to the incidence of violent crime, as is income inequality and that social capital effectively mediates the relationship between income inequality and crime.

Similarly, Kawachi et al. (1997) found that, among US states, social capital mediates the relationship between income inequality and health status. They measured social capital using three trust questions and one indicator of participation in clubs and associations. Their conclusion was that greater income inequality decreases a state's store of social capital which in turn leads to poorer health of citizens. In particular, higher levels of trust and greater associational participation were related to lower levels of mortality from most of the major causes of death. Kawachi et al. (1999) found that individuals living in states with low social capital were at increased risk of poor self-rated health, even after controlling for individual risk factors (e.g. low income, low education, smoking, obesity, lack of access to health care).

So why might social capital have an influence upon health? Kawachi and Berkman (1998) distinguish between compositional and contextual effects and hypothesize attributes of these effects. It could be that more socially isolated individuals live in social capital poor areas and, since the relationship between social isolation and health is well documented, social capital poor areas might then have poorer aggregate health. It could also be true that trust held by individuals, or civic participation, for example, are directly related to health. There is evidence that psycho-social processes are sometimes related to health by providing affective support and a source of self-esteem (Wilkinson, 1996). However, although social support and social involvement in networks, both at the individual level, have been linked to a number of health status measures, the contextual nature of social capital leads one to suspect that social capital rich communities may have influences upon individual's health through pathways other than networking and receiving support from family members and friends.

The challenge, therefore, of social capital research is to identify contextual influences upon health — effects that are, unfortunately, less easily discerned empirically. According to Kawachi and Berkman (1998) (see also the World Bank's web-page on social capital) and considering the neighbourhood level in particular, social capital may influence (1) health related behaviours by promoting diffusion of health-related information and thus increasing the likelihood that healthy norms of behaviour are adopted and by exerting social control over deviant health-related behaviour and (2) access to services and amenities, since socially cohesive communities may be more successful at uniting to ensure that budget cuts do not affect local services. Referring to the state level “more cohesive states produce more egalitarian patterns of political participation that result in the passage of policies which ensure the security of all its members” (Kawachi and Berkman, 1998, p. 22) which then influence health. The performance of political institutions may also be related to levels of social capital, as described theoretically and demonstrated empirically by Putnam et al. (1993). “US data demonstrate that states with low levels of interpersonal trust are less likely to invest in human security and to be generous with their provisions for safety nets” (Kawachi and Berkman, 1998, p. 22). Veenstra and Lomas (1999) have detailed mechanisms through which social capital may affect the performance of governing institutions in health care specifically.

Is social capital entirely the property of social structure and social relationships or does it exist, at least in part, in individuals? Presumably individuals are the repository of societal norms and values, although they may not be aware of such. Social capital theory adamantly adheres to the perspective that social capital is more than aggregated characteristics of individuals, but certainly the individuals living in social capital rich communities reflect that fact by their personal participation patterns and their personal attitudes toward one another. If there is a relationship between social capital and the health of populations, as new research has indicated (Kawachi et al., 1997), then perhaps some of the variance in health status is explained by trust, civic norms, civic participation and social engagement professed and engaged in by individuals. The more complex task is to discover why social capital rich communities promote health in addition to the characteristics of individuals, certainly, but cross-sectional individual-level analysis can still shed some light on the relationship between social capital and health.

This article attempts to explore relationships among trust, social engagement and civic participation and health using cross-sectional data from a survey of randomly selected individuals in Saskatchewan, Canada, as another small step toward uncovering the complexities of the relationship between social capital and health. First, it highlights relationships between human capital (socioeconomic status measured by education and income, in particular) and self-rated health status among gender and age groups. Second, it explores relationships between some human parts of social capital (social and civic participation and the social-psychological constructs of trust, identity and commitment, in particular) and self-rated health status before and after controlling for socio-demographic and human capital effects. If a relationship exists between the human parts of social capital and health than we have evidence of a compositional effect of social capital upon health, especially if the relationship holds after controlling for human capital as well. If there are few relationships of this kind then the challenge is renewed to find the more intricate pathways through which trust in communities, for example, has an influence upon peoples' health.