Social capital and health Social capital and health outcomes in Canadian youthoutcomes in Canadian youth

Frank J. ElgarCarleton University

Ottawa, Canada

Outline

• Three effects of social capital on health

• Study 1: social capital reduces health inequalities in children

• Study 2: social capital explains links between income inequality and health

• Social capital as a public policy tool

What is social capital?

• The value of social networks to individuals• “neighbourhoodiness”

• An expansive theoretical construct, appealing to governments and organisations• “has hard nosed economic feel while restating the

importance of the social” (Halpern, 2005)

• Measures include indices of civic participation, social cohesion, norms of reciprocity, and trust

Three effects of social capital on health

1. Direct effect on health

2. Indirect effect: reducing (moderating) social inequalities in health

3. Indirect effect: explaining (mediating) links between income inequality and health

The Gradient Effect

• Inequalities in health relate to socioeconomic status (SES).• SES is measured in terms of income, education,

and occupation

• It is not just that the poor are unhealthy• At every rung of the SES ladder, health outcomes

are better on the rung above and worse on the rung below

• Gradient effects can be traced to early childhood experiences and the cumulative effects of stress over the lifespan

The Gradient Effect

Literacy scores of 16-25 year olds by parents’ education

Adolescent mental health problems (SDQ score) and family affluence

Ravens-Sieberer U, Wille N, Erhart M, Nickel J, Richter M. Socioeconomic inequalities in mental health among adolescents in Europe. Copenhagan; WHO Regional Office for Europe; 2008

Can social capital flatten health gradients?

• Social capital might directly effect health through access to formal healthcare systems and to a lay referral network of family, friends, and peers who provide medical attention and advice when health concerns arise (Boyce et al, 2008).

• “Strengthening the social capital within communities may provide an important avenue for reducing socioeconomic disparities in health” (Kawachi, 2006, p. 120)

• A study found that trust and social cohesion reduced SES effectson children’s use of mental health services (van der Linden, Drukker, Gunther, Feron, & van Os, 2003)

• A longitudinal study found that mother’s community participation led to better child health outcomes, but only among children from low SES backgrounds (Nobels & Frankenberg, 2009)

Health Behaviour in School-aged Children (HBSC) study

• World Health Organisation collaborative study

• Measures physical, emotional and social health outcomes and contexts (families, peers, schools).

• School-based survey (class is the sampling unit)

• At least 4,500 pupils per country (age 11, 13, and 15)

Health Behaviour in School-aged Children: WHO collaborative

cross-national study www.hbsc.org

Study 1: Can social capital flatten health gradients?

• 9,717 Canadian children in grades 6 to 10 were surveyed in the 2005/2006 HBSC study.

• SES was measured using the HBSC Family Affluence Scale:• Does your family have a car or a van?

• Do you have your own bedroom for yourself?

• During the past 12 months, how many times did you travel away on holiday/vacation with your family?

• How many computers does your family own?

HBSC Social Capital Scale (Canada)

• We tested the effects of family affluence and social capital on five health outcomes in youth:• Psychological symptoms in past 6 months (feeling low,

irritability or bad temper, feeling nervous, difficulty sleeping)

• Somatic symptoms in past 6 months (headache, stomachache, backache, feeling dizzy)

• Injuries in past 12 months• Physical fights in past 12 months• Life satisfaction (Cantril’s [1965] ladder ranging from

0=worst possible life to 10=best possible life)

Methods

Results

Psychological symptoms: Somatic symptoms:

Psychological symptoms were more common among females. Somatic symptoms were more common among males.

Results

Injuries in past 6 months Physical fights in past 6 months

Injuries and fights were more common among males than females.

Results

Life satisfaction

Life satisfaction scores were higher in males than females in all grade levels.

Effects of family affluence in areas high and low in neighbourhood social capital on (a) psychological symptoms and (b) somatic symptoms. Betas represent simple effects of family affluence at low and high levels (mean +/- 1 SD) of social capital. Results were adjusted for effects of gender and grade level.

Results

Effects of family affluence in areas high and low in neighbourhood social capital on (c) injuries and (d) fighting. Betas represent simple effects of family affluence at low and high levels (mean +/- 1 SD) of social capital. Results were adjusted for effects of gender and grade level.

Results

Effects of family affluence in areas high and low in neighbourhood social capital on life satisfaction. Betas represent simple effects of family affluence at low and high levels (mean +/- 1 SD) of social capital. Results were adjusted for effects of gender and grade level.

Results

Study 1: Can social capital flatten health gradients?

• These results indicate that social capital moderatesSES differences in symptoms, injuries, fighting, and life satisfaction.

• Building social capital, particularly in deprived neighbourhoods, is one avenue for reducing inequalities in children’s health.

• However, there might be a downside to social capital in that reverses SES differences in some outcomes (risk behaviour)

Study 2: Can social capital explains links between income inequality and health?

• Health problems that are associated with SES are more common in countries that have wider distributions of wealth.

• International differences in income inequality (gap between the rich and poor) correlate with:• Shorter life expectancy

• Mortality

• Mental and physical health problems

• Violence, crime, and other social problems

Copyright ©2000 BMJ Publishing Group Ltd.

Ross, NA et al. Relation between income inequality and mortality in Canada and in the United States: cross sectional assessment using census data and vital statistics. BMJ 2000;320:898-902

Income inequality and mortality among working age men in US states and Canadian provinces (r=-0.81)

Copyright ©2007 BMJ Publishing Group Ltd.

Pickett KE, Wilkinson RG. Child wellbeing and income inequality in rich societies: ecological cross sectional study. BMJ. 2007 Nov 24;335(7629):1080

Correlation between income inequality and the Unicef index of child wellbeing in 23 rich countries

Income inequality and school bullying by 11-year-olds in 37 countries (r =0.62)

Elgar FJ, Craig W, Boyce W, Morgan A, Vella-Zarb R. Income Inequality and School Bullying: Multilevel Study of Adolescents in 37 Countries. J Adol Health, in press.

Study 2: Can social capital explains links between income inequality and health?

• Debate on causal mechanisms focuses on two paths:

1. Social capital (psychosocial path)• Income inequality intensifies social hierarchies, class

conflict and feelings of relative deprivation while eroding trust and cooperation.

2. Public spending (neomaterialist path)• Inequality inhibits government spending on services

and infrastructure that serve the common good

Study 2: Can social capital explains links between income inequality and health?

Study 2: Can social capital explain links between income inequality and health?

• International Social Survey Program (www.issp.org):• 48,641 adults surveyed in 33 countries about trust

• WHO Information System:• Health spending (% of GDP)• Healthy life expectancy

• World Bank world development indicators database:• Gross national income (GNI) per capita

• United Nations Development Programme:• Income inequality (Gini index)

Study 2: Can social capital explain links between income inequality and health?

Income inequality Trust

Health spending

Healthy life

expectancy

Income inequality

_

Trust -0.49P=0.004

_

Health spending 0.25P=0.17

0.23P=0.23

_

Healthy life expectancy

-0.66P<0.001

0.54P=0.001

0.21P=0.25

_

Note: Partial correlations shown, controlling for Log10GNI per capita.

Income inequality and trust in 33 countries (r = -0.49)

Models of the association between income inequality and healthy life expectancy mediated by trust (above) and health spending (below). Values represent unstandardised coefficients ±SE. Associations were controlled for differences in Log10GNI per capita.

Study 2: Can social capital explain links between income inequality and health?

• Trust contributes to 13.2 years of additional healthy life.

• Income inequality relates to shorter life expectancy.

• Trust mediates some of this association but health spending does not.

• Societies with low levels of trust may lack the capacity to create the kind of social supports and connections that promote successful ageing.

Future research

• Social capital research requires experimental and longitudinal studies to firmly establish its benefits for public health• Example: peer-led interventions to prevent smoking

uptake in youth (Campbell et al, Lancet 2008; 371: 1595-1602)

• We also need age-appropriate, theory-driven assessments of social capital and social networks

• And we need to explore the causal mechanisms that account for effects of social capital on health

Social capital as a policy tool

• Government policies influence the development of social capital in two ways:

1. Indirectly affecting how social relations are formed (e.g., public transport, housing, parental leave and education, day care, recreational facilities)

2. Integrating and promoting social capital-building activities (e.g., mentoring, organised support networks, brokering community partnerships)

Three key areas for public policy

1. Populations at risk of social exclusion • eg, youth at risk, single mothers, new immigrants

2. Supporting life-course transitions• eg, school to university, entry into labour market,

retirement, old age

3. Promoting community development• eg, coordinated approaches to delivering services

For more information:

www.policyresearch.gc.ca placebo.carleton.ca