Neighbourhood life and social capital: the implications for health

Abstract

Social capital has been linked to health outcomes, though there are some inconsistencies in the research and the link is dependent on the measures of social capital and health used. In this paper, we argue that social capital is multifaceted and its relationship with health is complex. We explore the relationship between a number of elements of neighbourhood life and neighbourhood-based social capital, and health, using both qualitative and quantitative methods. The paper reports on a study of the Western suburbs of Adelaide and the analysis of 2400 questionnaires and 40 in-depth interviews. A partial least-square path analysis was undertaken with the questionnaire data. It considered the impact of perceptions of the physical environment, neighbourhood connections, neighbourhood trust, reciprocity, perceived safety and local civic action, and a number of demographic variables, on physical and mental health as measured by the SF-12. Of the neighbourhood-related variables, only perceived neighbourhood safety was related to physical health, with neighbourhood safety and neighbourhood connections related to mental health. Of the demographic variables, higher-income level and educational achievement were related to better physical and mental health. In addition, physical health was lower and mental health higher within older age groups. The inter-relationships between the neighbourhood variables and demographic differences in experience of neighbourhood were also examined. The thematic analysis of the interviews linked a number of social aspects of neighbourhood, the physical neighbourhood environment, perceptions of safety, civic activities and availability of local services, to health outcomes. The paper concludes that there is a need for more complex measures of social capital and that socio-economic factors are of relatively greater importance in determining health.

Introduction

Trust, connection and reciprocity, the constructs underlying social capital, have been under increasing scrutiny as determinants of health. The picture of social capital emerging from the accumulating research is one of complexity in which socio-economic factors interact with the culture of local communities to determine levels of both health and social capital. Our paper uses path analysis and in-depth face-to-face interview data to consider the effects of social capital on health within neighbourhoods in suburban Adelaide and explores the complex and multidimensional nature of social capital.

Social capital, conceived at both the individual- and community level, has been linked with health, though the inconsistencies in conceptualising and measuring social capital make it difficult to assess this relationship (Hawe & Shiell, 2000; Macinko & Starfield, 2001). Two main schools of thought influence debates about social capital (Baum & Ziersch, 2003). Robert Putnam (1995) conceived of social capital as a community-level resource and a distinctly social feature that is reflected in the structure of social relationships and so is both a public good and an ecologic characteristic. He defined social capital as: ‘features of social organisation such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit’ (1995, p. 67). Pierre Bourdieu (1986), in contrast, focused on the resources that accrue to individuals as a result of their membership of social networks. He defined social capital as ‘the aggregate of the actual or potential resources which are linked to possession of a durable network of more or less institutionalised relationships of mutual acquaintance and recognition’ (p. 248). The comparative role of material factors and social capital in determining health outcomes has been extensively debated. Lynch, Due, Muntaner, and Smith (2000) maintain that the focus on social capital and health may, even if inadvertently, downplay the crucial importance of material factors on health inequities.

Social capital has been measured at the local, neighbourhood, state and even national level. Kawachi, Kennedy, Lochner, and Prothrow-Stith (1997), using General Social Survey data from 39 states in the USA, found that states with higher proportions of residents who believed that people could be trusted had lower age-adjusted rate of death from all causes. They also found that higher per capita density of membership in voluntary groups was related to lower mortality. Subramanian, Kawachi, and Kennedy (2001), also in the USA, using a single trust measure, found that the probability of self-reported poor health increased significantly from high to low ‘social capital’ states. Ellaway and Macintyre (1999) in Scotland reported that local association membership aggregated to neighbourhood area level was associated with health. In a qualitative study in the UK, Campbell and Wood (1999) found that areas with broader networks and higher civic engagement were those with better health outcomes.

Research has linked a number of individual-level social capital indicators with measures of health and wellbeing. For example, stronger social ties have been linked to lower levels of mortality (Berkman & Syme, 1979) and higher participation in social activities associated with better mental and physical health (Baum et al., 2000). Other research has linked civic participation and voluntary group membership to health (Joshi et al., 2000; Rietschlin, 1998). Larger network size has also been linked to positive health outcomes (see Taylor & Seeman, 1999 for a review). Other research has linked a mix of indicators of social capital to health outcomes. For example, connections with family and friends and participation in the local community (Gatrell et al., 2000) and number of friends willing to help, levels of trust and membership in a religious association (Hyyppä & Mäki, 2001) have been positively associated with self-reported general health. However, there are inconsistencies. For example, Ellaway and Macintyre (1999) found no relationship between involvement in a local association and self-rated individual health and Veenstra (2000) found few relationships between participation in voluntary associations and self-rated health. Baum et al. (2000) found no association between civic participation and mental or physical health.

There are a range of explanations for the positive influence that social capital can have on health; for example, that the presence of social capital can boost self esteem, provide social support, help people to access better resources, and act as a buffer against stressful life events (Campbell & Wood, 1999; Woolcock & Narayan, 2000).

Research and commentary on social capital supports the need to use complex measures and to examine it within a consideration of the impact of socio-economic factors such as educational level and income.

Characteristics of neighbourhoods or locations, including social capital, have been linked to health outcomes (Curtis & Jones, 1998; Mohan & Mohan, 2002). A qualitative study by Cattell (2001) in the UK found that the history and culture of place affects the way in which people respond to their community and that areas with similar socio-economic status differed in levels of social capital. The focus of much of this work has been on community-level social capital where it is argued that neighbourhoods themselves have differing amounts of social capital. For example, areas have been found to differ in measures of social capital such as social networks that were in turn related to health (Gatrell et al., 2000). Neighbourhood-level measures of social capital have generally been constructed by aggregating individual responses to questionnaires to area-level measures of social capital.

We report on a study undertaken in the Western suburbs of Adelaide designed to contribute to the literature on the impact of neighbourhood on health and social capital. We asked people about their perceptions of neighbourhood, including elements of neighbourhood-based social capital (such as neighbourhood connections and trust, reciprocity and feelings of safety) and self-reported health. We consider the relationship between these perceptions of neighbourhood life, measures of social capital, and individual health. Qualitative and quantitative methods were used to provide a comprehensive analysis of complex relationships. We focus on residents’ perceptions of their neighbourhood and the relationship with their health and as such do not compare areas on ‘objective’ measures. We draw on Bourdieu's conceptualisation of social capital and measure neighbourhood-based social capital at the individual level and explore the impact of both material factors and social capital on health.