Is social capital good for health?
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Jean Guo, Setti Raïs Ali and Lise Rochaix
Social capital is a concept that came to us from sociology and has since been taken up by various disciplines including political sciences, epidemiology and economics, and whose definition is still the subject of numerous debates. In this article, the authors use Putnam’s definition of social capital (1), as “features of social organization, such as trust, norms, and networks, that can improve the efficiency of society by facilitating coordinated actions.” In other words, social capital, like other forms of capital, is productive: it allows us to achieve goals that would be unattainable without it, by relying on interpersonal relations such as trust, reciprocity and norms. A great deal of the literature on the economics of health has documented the link between perceived levels of health and social capital, measuring the latter by participation in collective activities (such as political parties, leisure activities), and by the capacity of the individual to call on others in times of need. These studies show conclusively that social capital is good for health, even taking into account the possibility of reverse causality, that is, that those in the best health might also have a higher rate of social capital.
From the point of view of public decision makers, the perspectives for applying this kind of work are rich as soon as we can show that interventions leading to an increase in social capital have a beneficial effect on individual health. To document this, Jean Guo, Setti Raïs Ali and Lise Rochaix undertook a narrative literature review in health economics, selecting articles dealing with health interventions as defined by the World Health Organisation, that is: “activities designed to modify a process, a course of action, or a sequence of events with a view to changing one or more of its characteristics such as its performance in order to improve a health indicator or to attain health promotion goals.” In particular, they are interested in health interventions leading to a change in social capital. Having collected articles of interest, the authors present a selection of interventions that aim to generate a health benefit through an improvement in social capital, illustrative of their diversity and chosen for their degree of innovation. They construct a typology of these interventions in five parts. First, they present the interventions that aim to increase the degree of interaction of individuals at the community level by changing their environment. This part includes evidence of the effect on perceived health of a reduction in insecurity, and the creation of shared gardens. In the second and third parts, they discuss interventions leading to changes in behaviour beneficial to health, particularly among specific patient populations. Network effects and peer influence on individual health behaviour is evidenced in interventions intended to improve the compliance of patients with HIV and to encourage participation in screening for breast cancer among disadvantaged and isolated patients. Finally, the last two parts of the typology specifically deal with mental health by presenting a range of interventions that can ameliorate the management of a pathology and reduce anxiety linked to illness, such as the creation of a discussion space for group activities, or the introduction of a help line. Not dedicated exclusively to the management of the psychological distress of patients, this last part touches on issues of care for health professionals and caretakers, for whom social capital interventions show promising results on levels of reported stress, reducing the risk of burn-out. Social capital thus seems to be a multidimensional lever for promoting health, applicable to a wide variety of contexts and challenges in public health.
(1) Putnam, R. D. (1993). “The prosperous community”. The American prospect, 4(13), 35-42.
Original title of the article: “Social capital and health interventions: enhancing social capital to improve health.”
Published in: Elgar Companion to Social Capital and Health, Edward Elgar Publishing.