Kawachi I, Kennedy BP, et al. Social capital and self-rated health: a contextual analysis. American Journal of Public Health. 1999;89:1187-1193.
The authors explore the association between social capital and self-rated health. Self-rated health data for individuals living in 39 U.S. states and social capital indicators, aggregated to the state level, were used. The authors found that individual-level factors (e.g., low income, low education, smoking) were strongly associated with self-rated poor health. Even after adjusting for these proximal variables, however, they found a contextual effect of low social capital on risk of self-rated poor health. The largest effect of social capital was on the lowest-income people.
The authors suggest five mechanisms through which social capital may influence health in neighborhoods: 1) promoting more rapid dissemination of health information; 2) norms encouraging healthy behaviors; 3) exerting social control over deviant health-related behavior, or collective efficacy to prevent crime; 4) increasing access to local services through political processes; and 5) psychosocial processes. They cite research that socially isolated individuals who live in cohesive communities are in better health than are socially isolated individuals in noncohesive communities. Finally, they hypothesize that social capital may be good for health because it leads to egalitarian patterns of political participation. A state is a large area with heterogeneous communities that is more prone to bias than are more homogeneous units like census tracts. Nonetheless, this study provides an important ecological framework from which to examine the relationship between social capital and health.
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