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Social Capital/Social Support

Voter registration and participation rates


I. FACTORS ATTRIBUTABLE TO HEALTH

“Social capital” refers to those features of social relationships—such as interpersonal trust, norms of reciprocity, and membership of civic organizations—which act as resources for individuals and facilitate collective action for mutual benefit. It refers to the social, non-economic resources available to people through their relationships with others as being part of social groups, networks, or communities. There is no single accepted definition of social capital. Labeling it as “capital” gets at its central idea: that social relations and connections can be a resource to people, separate from the direct control of economic resources (or economic capital). It can be conceived as a characteristic of individuals but is usually considered to be a collective property of communities or groups, which is how it is used here.

Social capital is important to community participation in improving health or eliminating disparities, because it is an important feature allowing collective community action to improve local conditions. It may help communities with few economic resources help each other get by, especially in times of economic downturns or dislocations. Communities with more social capital may have greater capacity to mobilize for social, political, or interpersonal actions to improve their health conditions.

The availability of benefits of social capital to community members might be unevenly distributed through processes of social inclusion or exclusion, including discrimination, in which case that part of the population may be more in need of such mobilization, but possibly less likely to participate and be represented in such actions.

Social capital has long been studied by social scientists who have characterized it in various ways, including its structural, relational, or cognitive dimensions; or bonding (intragroup) or bridging (intergroup) social capital. Social capital (or components of it) can be measured as distributions of individual-level, community, social relational characteristics (e.g., neighborhood trustworthiness or willingness to provide mutual aid), or by community-level, structural indicators like levels of civic organizational capacity or participation. It has become much more widely used as an important social determinant of health in the past decade or so. Health research has commonly measured the relational dimension of social capital, based on the character of social ties: e.g., trust, reciprocity, cooperation, or identification with a group or network.

There are at least three ways in which assessing social capital can be important for monitoring or intervening on conditions affecting health and health inequities:

+ As a factor related to health outcomes, either directly or as a moderating or exacerbating factor in the health impacts of other living conditions.

+ As a real or potential resource in the capacity to mobilize communities to participate in health interventions on their own behalf.

+ As another measure of the social inequities underlying health inequities across different parts of a local health jurisdiction’s population.


Social Capital and Social Cohesion

The concept of social cohesion is closely related to social capital—many of the components of social capital mentioned above overlap with components of measures of social cohesion. Cohesion generally refers to the degree of shared commitment to a common task and to the group. The European Organization for Economic Cooperation and Development conceptualizes social capital as related to social inclusion (the extent to which no parts of the population are systematically excluded from access to community resources, often through acts of discrimination) and social mobility (the capacity of members of disadvantaged populations to improve their conditions) in that these three characteristics are needed to produce a socially cohesive society. Social exclusion can make community social capital less available to some parts of the community, or concentrate some excluded groups into communities with less social (and economic) capital. Thus, the distribution of access to social capital is a key component of social and health inequity.

High ratings on measures like trusting neighbors or seeing them as willing to help each other can be interpreted through either a social cohesion lens to mean people feel a common commitment to each other, or through a social capital lens to mean that they are more likely to see others as a resource and potentially to use or work with them for an individual or common purpose.


Social Capital and Social Support

When a person’s particular relationships, through their social networks, provide them with one or several individuals who can provide them various kinds of resources, then it is generally referred to as social support. Individuals in communities with low levels of social capital may still get needed personal support through their personal social connections, but may find it difficult to act together as a community on their own behalf to improve conditions.

Social support can include a number of separate dimensions (e.g., emotional, informational, appraisal, or tangible support) that have been found in research to be related to health, including physical health and mortality but most strongly to psychological well-being and social functioning. It is measured by questions asking about the availability to the person of someone to provide the type of support of interest, either in general or in times of need (see the Maternal and Infant Health Assessment questions in Table 4).

Dimensions of individuals’ social support (including networks, connections, or isolation) have been measured and found to be associated with increased risk or protection from various physical and mental health outcomes in different populations. Those dimensions include:

+ Structure of relationships (e.g., partner, family, friend, co-workers).

+ Quality or intensity of relationship (e.g., good or poor, frequent or infrequent, routine interactions or availability in time of need).

+ Function of relationship (e.g., positive interactions, relaxation, emotional support, tangible support).

Studies have shown that different components of social support matter differently to the risk of ill health or recovery of different parts of the population (such as men or women, low income or high income, older or younger) or in different contexts (such as for those experiencing stressful life events, job strain, or economic insecurity).

Evidence suggests that social support and social capital might affect health either directly, or through moderating effects on the likelihood that certain conditions (such as low income, job strain, economic insecurity, or other stressful experiences) can produce ill health or influence recovery from it. In addition to its impact on adults, there is evidence that social capital influences the health and well-being of children and adolescents and at least the mental health of the elderly.

The potential impact of social capital has mostly been studied in low-income populations or neighborhoods. In disadvantaged populations with low levels of access to material resources, social capital or social support may be especially important to measure to identify vulnerability or resilience factors. The assessment of community social capital can help identify areas and subpopulations of social exclusion and segregation. This offers the opportunity to improve factors such as trust, capacity, and social connections that, in return, could allow for improving access to existing social resources and for community mobilization to address concerns affecting health.

People’s experience of the availability of social capital and social support is an important component of civil society in a democracy. It represents the feeling of being part of a society. That membership can help people find ways to meet their needs in ordinary or unusual circumstances that they cannot manage adequately by themselves with the material resources regularly available to them through family or work. Resources available through public programs may be economic resources, but are also like social capital in that they express (or their absence denies) the public’s will to provide resources to its members who are qualified for them.


II. DATA SOURCE AND METHODOLOGY FOR HEALTH EQUITY ANALYSIS

There is no single accepted definition of social capital. Because of this and because several components of both social support and social capital have been associated with different health risks or protections in different populations, there are not single, standardized measures of each. There is also no source of population-wide data for either social capital or social support that is currently regularly available for California or Bay Area counties.
Nevertheless, both collective social capital and individual social support are important enough determinants of health and health inequities to include them here despite the lack of a single defined indicator or population-level data source to recommend, as this guide does for the other SDOH. In this case, we recommend:

(a) Long-term development of a common population-level data source, such as the California Health Interview Survey (CHIS), for social capital measures of community-level resources for social participation or action, and also for the availability to individuals of tangible, social or emotional social support.

(b) Short-term interim use and development of local data sources for information on social capital and social support for all or (especially vulnerable) parts of populations. Useful local sources may be available to cover the whole population periodically (such as CHIS 2003 or CHIS 2011–12), through individual county-level surveys (such as in San Mateo County or Santa Clara County), or for particular subpopulations (such as the MIHA survey of post-partum women or California Healthy Kids Survey (CHKS) surveys of school children).

Other subpopulation data may be available through sources like: public health nursing home visit assessments of social support needs for high-risk pregnant women; local targeted needs assessments; or non-health related community satisfaction or characteristic survey, such as the San Francisco Controller’s regular survey of public satisfaction with and participation in community services.

Potential indicators of social capital that could be compared across socioeconomic environments include the number and density of community and voluntary organizations in a defined geographic area, and by the participation level of community members in these organizations. In addition, voter registration and participation can serve as markers for civic engagement and potential for engaging in collective action.

As discussed for indicators throughout this guide, data on social capital or social support should be analyzed by strata for which health inequities are known to exist, including race/ethnicity, income level, jurisdiction or neighborhood, age, and family type (especially single-person and single-parent households).

Some currently available data sources are shown in Table 4.

Table 4: Data Sources for Social Capital Questions

social_capital_Table-04

III. BAY AREA LOCAL HEALTH DEPARTMENT EXAMPLES


Several existing local health-related programs involve building social capital and social support. Emergency preparedness builds on or tries to build up social cohesion so it is a resource (social capital) that can be mobilized in emergencies through neighborhood teams and other aspects of volunteering and providing mutual assistance. Public health nurses in home visits to high-risk pregnant women assess their level of social support or isolation and try to connect those in need to community resources. Black Infant Health (BIH) has recently moved to a group-based model of participation, partly to improve the level of interpersonal and community connections of participants. The CenteringPregnancy model provides group prenatal care, which promotes participants’ becoming interpersonal resources for each other both during and after the life of the group. The below example explicitly addresses neighborhood social capital.


City–County Neighborhood Initiative (CCNI)
Alameda County Public Health Department

In 2003, the Oakland CCNI was formed as a partnership between the Alameda County Public Health Department, the City of Oakland, and a broad range of community-based organizations and neighborhood resident groups. The initiative’s long-term goal is to fight health inequities in two low-income areas of Oakland, California. CCNI partners include resident groups, community-based organizations, faith-based organizations, educational institutions, and the Oakland Unified School District. Using a community resident engagement approach, public health and city agency staff work closely with groups of residents to increase their social, economic and political power.

Since research has demonstrated the correlation between social capital and neighborhood health and safety, building social capital among community residents has been an important implementation strategy. CCNI evaluation has tracked the development of social capital at baseline and throughout the intervention using qualitative and quantitative methods, including one-on-one interviews with stakeholders, and community-wide surveys.

Evaluation findings over the first six years of the project indicate that three types of social capital have been built:

+ Bonding relationships between immediate family members, neighbors, and close friends.

+ Bridging relationships with people who are from different family and peer groups.

+ Linking relationships between individuals and those in higher positions of influence outside of the community.

Community members have influenced city and county level policymakers to make policy changes, particularly related to street safety and neighborhood parks.

Evaluation findings further indicate that residents have become more empowered, as demonstrated by increased leadership, greater involvement in neighborhood events and stronger linkages with each other, community groups, and institutions. Neighborhoods have improved, as indicated by greater access to health-promoting resources (such as immunizations and good schools), decreased crime, increased disaster preparedness, renovated parks and open spaces and increased traffic safety. Residents have also perceived that City and County institutions have become more responsive to their needs. The Robert Wood Johnson Foundation highlighted this effort as a great example of how to engage partners and “pillars of the community”; http://www.rwjf.org/en/blogs/new-public-health/2012/10/engaging_partnersan.html. For more information, visit http://www.acphd.org/social-and-health-equity/partnerships-and-communities-collaboration/ccni.aspx.



REFERENCES

Baum FE, Bush RA, Modra CC, Murray CJ, Cox EM, Alexander KM, Potter RC. 2000. Epidemiology of Participation: An Australian Community Study. Journal of Epidemioly and Community Health 54(6):414-423.

Berkman LF, Syme SL. 1979. Social Networks, Host Resistance, and Mortality: A Nine-year Follow-up Study of Alameda County Residents. American Journal of Epidemioly 109(2):186-204.

Braveman PA, Egerter S, Woolf SH, Marks JS. 2011. When Do We Know Enough to Recommend Action on the Social Determinants of Health? American Journal of Preventive Medicine 40(1S1):S58-S66 .

Gilbert KL, Quinn SC, Goodman RM, Butler J, Wallace J. 2013. A Meta-analysis of Social Capital and Health: A Case for Needed Research. Journal of Health Psychologygy 18(11):1385-1399.

Hero RE, Tolbert CJ. 1996. A Racial/ethnic Diversity Interpretation of Politics and Policy in the States of the U.S. American Journal of Political Science 40(3):851-871.

Kawachi I. Social capital and community effects on population and individual health. Ann N Y Acad Sci. 1999; 896: 120-130.