1 Department of Society, Human Development and Health, Harvard School of Public Health, Boston, USA
2 Magdalene College, Cambridge University, UK
Correspondence: Prof. Ichiro Kawachi, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA. E-mail: Ichiro.Kawachi{at}channing.harvard.edu.
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The three accounts of social capital |
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The novelty of the proposed framework by Szreter and Woolcock lies in distinguishing and unpacking the concept of social capital in its different forms, namely, bonding, bridging, and linking social capital.1 The distinction between bonding and bridging social capital has existed for some time,57 and is by now widely accepted in the field. Bonding social capital refers to trusting and co-operative relations between members of a network who are similar in terms of social identity (e.g. race/ethnicity), while bridging social capital refers to connections between those who are unlike each other yet are more or less equal in terms of their status and power.1 The bonding and bridging varieties of social capital could be consistent with either or both the social support and inequality accounts of social capital and its relationship to population health. But according to the political economy perspective on social capital, what is missing from the bonding/bridging distinction is an explicit recognition of vertical power differentials in social relations. It is to address this gap that Szreter and Woolcock introduce a third form of social capitalthe linking varietywhich they define as norms of respect and networks of trusting relationships between people who are interacting across explicit, formal, or institutionalized power or authority gradients in society.1 By bringing statesociety relations and power into the equation, Szreter and Woolcock argue that the concept of linking social capital can reconcile the political economy and neo-material perspectives with the remaining accounts of social capital found in public health. To what extent have they succeeded? Szreter and Woolcock have produced a framework for social capital that is both sophisticated and more complete than any of the three existing versions. Their proposed approach has the merit of incorporating not only power differentials in society, but also a dynamic dimension describing the antecedents of social capital informed by careful historical analysis.
Some gaps still remain to be fleshed out, however. In this commentary we draw attention to two additional issues that are not canvassed by Szreter and Woocock's proposed synthesis. The two issues relate to: (1) the distinction between individual versus collective conceptualizations of social capital; and (2) the methodological and empirical implications of adopting the bonding/bridging/linking distinction.
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Individual versus collective accounts of social capital |
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Is it legitimate to pack so much into the concept of social capital? Some have questioned whether social capital can withstand such brand-stretching or conceptual creep. For example, Portes8 warned that so many disparate social phenomena have been heaped upon the concept of social capital that the point is approaching at which social capital comes to be applied to so many events and in so many different contexts as to lose any distinct meaning (p. 2). For Portes, the greatest theoretical value of social capital lies at the individual level, and not as a structural property of aggregates such as communities or states.8
The critics have a point. Part of the reason why social capital has become a contested concept is no doubt because of the muddled usage of the term to refer sometimes to the individual (and hence private) benefits accessed through social connections, and on other occasions to the public (or positive spillover) benefits available to members of a collective. This confusion dates back to Coleman's seminal exposition of social capital in his textbook Foundations of Social Theory,9 in which he provided several compelling (but anecdotal) examples of the public goods aspects of social capital, but then proceeded to demonstrate the empirical utility of the concept by operationalizing it in terms of the intensity of parental commitment towards raising their own children (a private good).
What, then, is the theoretically appropriate unit of analysis of social capitalthe individual or the collective? At the individual level, we point out that there already exists a rich literature and language concerning the measurement of social networks and support.10 As noted by Szreter and Woolcock, a voluminous literature also exists on the associations between social networks/support and diverse health outcomes. By equating social capital with social networks and support, we would be simply re-labelling terminology, or pouring old wine into new bottles. The concept of social capital surely contributes something additional to the already well-established literature on social networks and support. The novel contribution of social capital, in our view, lies in its collective dimension, i.e. its potential to account for group-level influences on individual health. As we shall argue below, the question about the theoretically appropriate level for analysing the effects of social capital on health ought not to be couched in terms of a dichotomy (either individual level or the collective level)rather, it is both, implemented within a multi-level analytical framework. Conceptualizing social capital as a contextual variable, in turn, directs our attention toward group-level mechanismssuch as informal social control, collective efficacy, collective socialization, and social contagion11each of which has plausible linkages to health-related behaviours and to health outcomes. For example, in the 1995 Chicago city heat wave, to which Szreter and Woolcock refer,12 socially isolated individuals were at much greater risk of dying compared with well-connected individuals. However, over and above individual-level social isolation, the intensity of social interactions at the community-level also made a difference. Communities characterized by richer social interactions were also more effective at promoting perceptions of safety, thereby pulling isolated seniors (who were at greatest risk of succumbing from heat death) out of their homes and into emergency cooling stations.12 The same communities were also more likely to check on the welfare of its isolated residents during the emergency. In other words, socially isolated individuals had better chances of surviving the heat wave by living in a community with higher stocks of social capital.
In the foregoing example, we glossed over the definition of community. There is no denying that more theoretical refinement is called for in a host of issues. For example, is it meaningful to conceptualize and measure social capital at the state level as we,13 and others,7 have done (and also as implied by Szreter and Woolcock's proposal to incorporate state-society relations in the definition of social capital)? What are meaningful indicators of social capital at different levels of spatial aggregationmeasures of trust, civic engagement, norms of reciprocity, or something else? Is trust a valid measure of social capital, or a consequence of it? Szreter and Woolcock do not address these questions, nor is there consensus on these issues in the usage of social capital within public health. Nevertheless, we have highlighted the individual/collective distinction in social capital as an issue that is logically prior to all of these other questions.
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Methodological implications |
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A noteworthy trend illustrated by the Tables is the rapid increase in empirical studies of social capital and health in recent years. As recently as 2001, Macinko and Starfield17 undertook a comprehensive literature review of the usage of social capital in public health, and found only 10 studies that provided empirical data. The remaining two dozen papers they identified were of a more conceptual nature, dominated by the debate between the neo-material and psychosocial interpretations of social capital. Of note, only one of the studies identified by Macinko and Starfield utilized a multi-level design.18 In the 2-year interval since their review, the number of empirical studies has tripled, including a rise in the number of multi-level studies (Tables 1 & 2). Indeed, there has been an exponential rise in the number of papers identified by the search term social capital on MEDLINE, with over 50 papers published in 2002 alone, as illustrated in Figure 1. Notwithstanding the contested nature of the concept, social capital appears to have entered the public health lexicon.
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Our summary Tables also do not include ethnographic or historical studies of social capital and health, of which there are an increasing number of examples.20,21 By omitting these studies, we emphatically do not mean to privilege quantitative approaches to studying the social capital/health connection over qualitative approaches. Indeed, a comprehensive understanding of social capital and population health is likely to be achieved only via the integration of different approaches, as illustrated by Szreter and Woolcock's analysis of 19th century Britain. We also note that the evidence base in Tables 1 and 2 is dominated by studies from developed (and Western) countries. It remains to be seen if the theory and measurement of social capitaldeveloped mainly within the context of rich and Western societiesfit equally well for developing countries.22
Greater theoretical and methodological sophistication within multi-level studies is also beginning to yield a more complex pattern of the associations between social capital and individual health. In particular, explicit tests of cross-level interactions have begun to demonstrate the simultaneous presence of both the beneficial and negative aspects of community social capital. In an analysis of the Social Capital Community Benchmark Survey involving 21 456 individuals nested within 40 US communities, Subramanian et al.23 found that individuals who reported high levels of trust of others in the community benefitted from living in places where others also shared the same opinion. The higher the level of trust within the community, the lower was the probability of reporting poor self-rated health among trusting individuals. On the other hand, a trend was found in the opposite direction for individuals expressing mistrust of others: the more trusting the community in which they lived, the worse their health status.23 In another study, Caughy and colleagues24 examined 200 African-American families with young children residing in 39 Baltimore neighbourhoods. They found that for children living in poor areas, having a mother with low community attachment was associated with lower levels of behavioural and mental health problems, whereas for children living in more affluent areas, having a mother with low levels of community attachment was related to higher rates of such problems. These intriguing but preliminary findings warrant further investigation. At minimum, they suggest that any intervention to strengthen social capital within communities is likely to be associated with both risks and benefits to different groups. We also emphasize that examining the interactions between individual and contextual exposures, and their effects on individual health, calls for an explicit multi-level methodological framework.
Last but not least, an additional methodological issue raised by the quantitative, empirical literature is whether it is legitimate to aggregate individual responses to surveys (inquiring about trust and perceptions of reciprocity, etc) to obtain area-based measures of social capital. That is, do spatial variations in social capitalmeasured via aggregated individual responses to social surveysreflect true contextual heterogeneity, or compositional confounding by the characteristics of residents? Here again, multi-level analysis yields useful clues. We analysed the Community Survey of the Project on Human Development in Chicago Neighborhoods, which surveyed 6300 residents living in the 343 neighborhoods of Chicago city.25 In individual-level analyses, levels of trust were found to vary systematically with socio-demographic characteristics such as age, race, marital status, and socioeconomic position (income and educational attainment). Some of the neighbourhood variations in levels of trust could be accounted for by the compositional differences in these characteristics of residents. However, even after controlling for such compositional differences, we found evidence for significant neighbourhood variation in aggregated perceptions of trust, thus substantiating the notion of social capital as a true contextual construct.25
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A future for social capital in public health? |
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References |
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2 Marmot M, Wilkinson RG. Psychosocial and material pathways in the relation between income and health: a response to Lynch et al. BMJ 2001;322:123336.
3 Lynch J, Davey Smith G, Kaplan G, House J. Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. BMJ 2000;320:120004.
4 Kawachi I, Subramanian SV, Almeida-Filho N. A glossary for health inequalities. J Epidemiol Community Health 2002;56:64752.
5 Gittell R, Vidal A. Community Organizing: Building Social Capital as a Development Strategy. Thousand Oaks, CA: Sage Books, 1998.
6 Narayan D. Bonds and Bridges. Social Capital and Poverty. Washington DC: The World Bank Policy Research Working Paper No. 2167, 1999.
7 Putnam RD. Bowling Alone. The Collapse and Revival of American Community. New York: Simon & Schuster, 2000.
8 Portes A. Social capital: its origins and applications in modern sociology. Annu Rev Sociol 1998;24:124.[CrossRef][ISI]
9 Coleman JS. The Foundations of Social Theory. Cambridge, MA: The Belknap Press of Harvard University Press, 1990.
10 Cohen S, Underwood LG, Gottlieb BH (eds). Social Support Measurement and Intervention. A Guide for Health and Social Scientists. New York: Oxford University Press, 2000.
11 Sampson RJ. Neighborhood-level context and health: Lessons from sociology. In: I Kawachi, Berkman LF (eds). Neighborhoods and Health. New York: Oxford University Press, 2003, pp. 132146.
12 Klinenberg E. Heat Wave. A Social Autopsy of Disaster in Chicago. Chicago: Chicago University Press, 2002.
13 Kawachi I, Kennedy BP, Lochner K, Prothrow-Stith D. Social capital, income inequality, and mortality. Am J Public Health 1997;87:149198.[Abstract]
14 Rose R. How much does social capital add to individual health? A survey of Russians. Soc Sci Med 2000;51:142135.[CrossRef][ISI][Medline]
15 Veenstra G. Social capital, SES and health: an individual-level analysis. Soc Sci Med 2000;50:61929.[CrossRef][ISI][Medline]
16 Subramanian SV, Jones K, Duncan C. Multilevel methods for public health research. In: Kawachi I, Berkman LF (eds). Neighborhoods and Health. New York: Oxford University Press, 2003, pp. 65111.
17 Macinko J, Starfield B. The utility of social capital in research in health determinants. Milbank Q 2001;79:387427.[CrossRef][ISI][Medline]
18 Kawachi I, Kennedy BP, Glass R. Social capital and self-rated health: A contextual analysis. Am J Public Health 1999;89:118793.[Abstract]
19 Harpham T, Grant E, Thomas E. Measuring social capital within health surveys: key issues. Health Policy Plann 2002;17:106111.
20 Cattell V. Poor people, poor places, and poor health: the mediating role of social networks and social capital. Soc Sci Med 2001;52:150106.[CrossRef][ISI][Medline]
21 Campbell C, Williams B, Gilgen D. Is social capital a useful conceptual tool for exploring community level influences on HIV infection? An exploratory case study from South Africa. AIDS Care 2002;14:4155.[CrossRef][ISI][Medline]
22 Krishna A. Active Social Capital: Tracing the Roots of Democracy and Development. New York: Columbia University Press, 2002.
23 Subramanian SV, Kim DJ, Kawachi I. Social trust and self-rated health in US communities: a multilevel analysis. J Urban Health 2002;79(Suppl.1):S21S34.
24 Caughy MO, O'Campo PJ, Muntaner C. When being alone might be better: neighborhood poverty, social capital, and child mental health. Soc Sci Med 2003;57:22737.[CrossRef][ISI][Medline]
25 Subramanian SV, Lochner KA, Kawachi I. Neighborhood differences in social capital: a compositional artifact or a contextual construct? Health Place 2003;9:3344.[CrossRef][ISI][Medline]
26 Kennedy BP, Kawachi I, Prothrow-Stith D, Lochner K, Gupta V. Social capital, income inequality, and firearm violent crime. Soc Sci Med 1998;47:717.[CrossRef][ISI][Medline]
27 Wilkinson RG, Kawachi I, Kennedy BP. Mortality, the social environment, crime and violence. Sociol Health Illness 1998;20:57897.[CrossRef][ISI]
28 Kennedy BP, Kawachi I, Brainerd E. The role of social capital in the Russian mortality crisis. World Development 1998;26:202943.[CrossRef][ISI]
29 Lynch JW, Davey Smith G, Hillemeier M, Shaw M, Ragunathan T, Kaplan GA. Income inequality, psychosocial environment and health: comparisons across wealthy nations. Lancet 2001:358:194200.[CrossRef][ISI][Medline]
30 Galea S, Karpati A, Kennedy B. Social capital and violence in the United States, 19741993. Soc Sci Med 2002;55:137383.[CrossRef][ISI][Medline]
31 Gold R, Kennedy B, Connell F, Kawachi I. Teen births, income inequality, and social capital: developing an understanding of the causal pathway. Health Place 2002;8:7783.[CrossRef][ISI][Medline]
32 Veenstra G. Social capital and health (plus wealth, income inequality and regional health governance). Soc Sci Med 2002;54:84968.[CrossRef][ISI][Medline]
33 Lochner KA, Kawachi I, Brennan RT, Buka SL. Social capital and neighborhood mortality rates in Chicago. Soc Sci Med 2003;56:1797805.[CrossRef][ISI][Medline]
34 Crosby RA, Holtgrave DR, DiClemente RJ, Wingood GM, Gayle JA. Social capital as a predictor of adolescent's sexual risk behavior: a state-level exploratory study. AIDS Behav 2003;7:24552.[CrossRef][ISI][Medline]
35 Holtgrave DR, Crosby RA. Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS in the United States. Sex Transm Infect 2003;79:6264.
36 Skrabski A, Kopp M, Kawachi I. Social capital in a changing society: cross-sectional associations with middle aged female and male mortality rates. J Epidemiol Community Health 2003;57:11419.
37 Kennelly B, O'Shea E, Garvey E. Social capital, life expectancy and mortality: a cross-national examination. Soc Sci Med 2003;56:236777.[CrossRef][ISI][Medline]
38 Helliwell JF. Well-being and social capital: does suicide pose a puzzle? Accessed on November 5, 2003 from http://www.wcfia.harvard.edu/conferences/socialcapital/Happiness%20Readings/Helliwell_2003.pdf
39 Skrabski A, Kopp M, Kawachi I. Social capital and collective efficacy in Hungary: cross-sectional associations with middle-aged female and male mortality rates. J Epidemiol Community Health (in press)
40 Holtgrave DR, Crosby RA. Social determinants of tuberculosis case rates in the United States. (in press)
41 Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science 1997;277:91824.
42 Weitzman ER, Kawachi I. Giving means receiving: the protective effect of social capital on binge drinking on college campuses. Am J Public Health 2000;90:193639.
43 Subramanian SV, Kawachi I, Kennedy BP. Does the state you live in make a difference? multilevel analysis of self-rated health in the US. Soc Sci Med 2001;53:919.[CrossRef][ISI][Medline]
44 Browning CR, Cagney KA. Collective efficacy and health: neighborhood social capital and self-rated physical functioning in an urban setting. J Health Soc Behav 2002;43:38399.[ISI][Medline]
45 Hendryx MS, Ahern MM, Lovrich NP, McCurdy AR. Access to health care and community social capital. Health Serv Res 2002;31:1, 85101.[CrossRef]
46 Drukker M, Kaplan C, Feron F, Os van J. Children's health-related quality of life, neighborhood socioeconomic deprivation and social capital. A contextual analysis. Soc Sci Med 2003; 7:82541.[CrossRef]
47 Lindstrom M, Merlo J, Ostergren P-O. Social capital and sense of insecurity in the neighborhood: a population based multilevel analysis in Malmo, Sweden. Soc Sci Med 2003;56:111120.[CrossRef][ISI][Medline]
48 Lindstrom M, Moghaddassi M, Merlo J. Social capital and leisure time physical activity: a population based multilevel analysis in Malmo, Sweden. J Epidemiol Community Health 2003;57:2328.
49 van der Linden J, Drukker M, Gunther N, Feron F, van Os J. Children's mental health service use, neighbourhood socioeconomic deprivation, and social capital. Soc Psychiatry Psychiatr Epidemiol 2003;38:50714.[CrossRef][ISI][Medline]
50 Wen M, Browning CR, Cagney KA. Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health. Soc Sci Med 2003;57:84360.[CrossRef][ISI][Medline]
51 Fischer JK, Li F, Michael Y, Cleveland M. Neighborhood influences on physical activity among older adults: a multi-level analysis. J Aging Physical Activity 2004;11:4967.
52 Martin KS, Rogers BL, Cook JT, Joseph HM. Social capital decreases risk of hunger. Soc Sci Med in press.
53 Merlo J, Lynch JW, Yang M, Lindstrom M, Ostergren PO, Rasmusen NK, Rastam L. Effect of neighbourhood social participation on individual use of hormone replacement and anti-hypertensive medications: a multi-level analysis. Am J Epidemiol 2003;157:77483.