Social Capital & Health

Excerpts from the Executive Summary follow:

What is a 'healthy community?

Within health promotion there is currently an emphasis on community action - with health promoters aiming not only for individual behaviour change, but also for the development of community contexts which enable and support healthy behaviours.

It is important that those seeking to promote health-enabling communities have a realistic understanding of the types of community networks, resources and relationships that exist in their local communities of interest, and that their understandings of community resonate with the experiences and perceptions of ordinary people at the grassroots levels. However, our understandings of what constitutes a 'health-enabling community' are still in their infancy.

This report examines the possibility that Putnam's (1993) concept of 'social capital' might serve as a framework for the design and evaluation of community-level health promotional interventions and policies and for research into the health-community interface.

Social capital

Putnam defines social capital in terms of four characteristics:

• the existence of community networks
• civic engagement (participation in these community networks)
• local identity and a sense of solidarity and equality with other community members
• norms of trust and reciprocal help and support

A great deal of research has pointed to links between social capital and a range of positive political and economic outcomes. More recently it has been argued that social capital might also be associated with positive health outcomes.

Structure of the report

Literature review

The first section of the report discusses existing methods of health promotion (including information-based approaches, peer education, community-led participatory approaches and public health movements), as well as current theoretical debates about factors that influence health at the individual, community and macro-social levels of analysis. It illustrates ways in which the concept of social capital has the potential to fill gaps in our understandings of the determinants of health-related behaviours, and of the mechanisms underlying the success or failure of health promotional interventions.

The empirical study

Using in-depth interviews and focus groups, the empirical study examines community networks and relationships in ward-level local communities in England. It focuses on two less affluent wards in the city of Luton - one characterised by relatively low levels of health and the second by relatively high levels of health, in the interests of exploring whether levels of social capital might be higher in the 'high health' ward.

Two aspects of social capital (trust and civic engagement/perceived citizen power) appeared to be higher in the 'high health' community, and two aspects (local identity and local community facilities) higher in the 'low health' community. The implications of these findings are discussed. It is argued that certain aspects of social capital might be more health-enhancing than others, and that much research remains to be done in following up this exploratory finding.

This report provides a micro-qualitative account of people's involvement in a range of social networks: informal face-to-face networks of friends, neighbours and relatives; voluntary associations related to leisure, hobbies and personal development; and formal and informal community activist groups and initiatives. Those relationships of trust and reciprocity that did exist in our communities of interest were located overwhelmingly within informal face-to-face networks of friends, neighbours and relatives, and the report highlights the relatively minimal role played by other network types in our informants' lives. Attention is given to those aspects of contemporary working and living conditions that limit the development of the more generalised forms of community-level trust and local identity and reciprocal help and support pre-supposed by Putnam's characterisation of social capital

There was evidence for strong within-community differences in the way in which social capital is created, sustained and accessed, and the report emphasises the need for more attention to the interaction of social capital, gender, age socio-economic status and ethnicity. It is concluded that the notion of social capital has the potential to make a valuable contribution to our understandings of what constitutes a 'health-enabling community', and seven recommendations for further development of the concept are put forward.

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