Commentary: Reconciling the three accounts of social capital

Ichiro Kawachi1, Daniel Kim1, Adam Coutts2 and SV Subramanian1

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 subject matter of social capital tends to arouse passions. After years of debate that often generated more heat than light, Szreter and Woolcock1 have come up with a conceptual framework for examining social capital and health which promises to reconcile the opposing camps. They identify three existing accounts of social capital as it relates to population health, which they refer to respectively as the ‘social support’ perspective, the ‘inequality’ thesis, and the ‘political economy’ approach. As noted by Szreter and Woolcock, an often polarized debate has taken place within public heath between proponents of the ‘inequality’ thesis and the ‘political economy’ approach, with the former group additionally tending to emphasize the ‘psychosocial’ interpretation of the mechanism linking social capital to health,2 as opposed to the ‘neo-material’ interpretation favoured by the latter group.3 We have argued elsewhere4 that the ‘debate’ between the psychosocial and neo-material positions poses an unnecessary distraction. We concur with Szreter and Woolcock's view that in the absence of compelling empirical evidence to distinguish between them, ‘it would seem most sensible to assume that both viewpoints could be valid.’1

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,5–7 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 capital—the ‘linking’ variety—which 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 state–society 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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One important disagreement in both the theoretical and empirical literatures on social capital relates to the differences between those who view social capital as an individual attribute versus those who view it as a property of collectives (for example, communities or entire societies). This individual/collective distinction is almost orthogonal to the bonding/bridging/linking distinction identified by Szreter and Woolcock. Whilst noting that the centre of gravity in existing definitions of social capital is tilted toward the individual end, Szreter and Woolcock tend to hedge their bets by adopting a position somewhere in between the micro and macro ends of the spectrum. In other words, they recognize that individuals can draw upon resources through their connections to others (the ‘social support’ mechanism), but at the same time, they argue for the need to include the nature and extent of state–society relations as a necessary part of the theory and definition of social capital.

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 capital—the 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 mechanisms—such as informal social control, collective efficacy, collective socialization, and social contagion11—each 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 aggregation—measures 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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A second set of issues raised by Szreter and Woolcock's proposed framework relates to measurement and methodology. If we adopt the bonding/bridging/linking distinction, how do we measure it? In Tables 1 and 2, we have summarized the existing empirical studies on the social capital/health connection. The Tables illustrate the diversity in both the study designs and choice of indicators used to measure social capital across published studies. Table 1 summarizes the ecological evidence, while Table 2 summarizes the multi-level studies. We have not included in the Tables the few published studies of social capital and health that were conducted exclusively at the individual level. These studies tend to measure individual perceptions of social capital within their communities, or individual levels of social participation.14,15 To be consistent, including these studies in the Tables would have meant also including other individual-level studies of social networks/support and health outcomes, of which there are hundreds.


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Table 1 Ecological studies of social capital and health

 

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Table 2 Multi-level studies of social capital and health

 
With few exceptions, the ecological studies have consistently found an association between social capital and population health outcomes regardless of the spatial level of aggregation, e.g. US states, health districts in Canada, counties in Hungary, or neighbourhoods in Chicago (Table 1). The ecological data are susceptible to either the individualist or collective interpretations of social capital. However, if social capital is to be conceptualized as a contextual variable, we note that the most appropriate study design and analytical approach is within a multi-level framework,16 i.e. individuals (and their health outcomes) nested within areas (e.g. neighbourhoods, states) that vary with respect to their levels of social capital.

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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Figure 1 ‘Social capital’ indexed papers in MEDLINE, 1992–2002

 
Aside from noting the mounting enthusiasm with which the concept has been applied to the analysis of diverse health problems, have we come any closer to a standardized approach to measure social capital? As indicated on column 5 of Tables 1 & 2, there is still lack of uniformity across studies in the choice of indicators to measure social capital. Most studies have used some combination of measures of trust, perceived reciprocity, and social participation, aggregated to the community or state level. However, other proxy measures have also been used, including volunteerism, community attachment, and even electoral participation. No doubt the heterogeneity of indicators used to measure social capital reflects both the recency of the concept (which was originally imported into public health via sociology, political science, and criminology), as well as the reliance of investigators on secondary sources of data (i.e. surveys carried out for purposes other than public health).17 As noted by Harpham and colleagues,19 only recently have social capital methods and instruments in public health started to catch up with theory. Future development and validation of instruments that are specifically tailored to health promises to pave the way for greater methodological consistency and rigour across studies of social capital.19 Most importantly from the perspective of this commentary, none of the studies in Tables 1 or 2 attempted to distinguish between the bonding/bridging/linking forms of social capital. In fact, there are few existing instruments to measure bridging social capital, and none (that we are aware of) that taps linking social capital. In short, to take on board Szreter and Woolcock's new framework calls for some urgent questionnaire and instrument development.

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 capital—developed mainly within the context of rich and Western societies—fit 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 capital—measured via aggregated individual responses to social surveys—reflect 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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Unbridled enthusiasm for the adoption of social capital in public health has generated a backlash in recent years. Some of the criticisms—for example, the perception that social capital is a ‘cheap’ solution for solving public health problems, or the tendency to view social capital as a panacea whilst ignoring its negative aspects—are well justified. At the same time, other debates such as the polarization of views representing the ‘neo-material’ and ‘psychosocial’ camps have not been very productive, especially in the absence of empirical evidence (indeed the inability of empirical data) to conclusively reject the validity of either view in favour of the other. Szreter and Woolcock have performed a valuable service to the field by attempting to reconcile the three accounts of social capital through their new framework. That is not to minimize or downplay in any way the formidable conceptual and methodological obstacles that remain, some of which we have highlighted in this commentary. But we hope that Szreter and Woolcock's contribution has at least cleared the way for researchers to tackle these challenges, because for better or for worse (in terms of population health outcomes), social capital is here to stay.


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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;57:114–19.[Abstract/Free Full Text]

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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;157:774–83.[Abstract/Free Full Text]