Children's health-related quality of life, neighbourhood socio-economic deprivation and social capital. A contextual analysis
Introduction
There is accumulating evidence on both sides of the Atlantic that the shared social environment at the neighbourhood level exerts significant effects on the health and quality of life of the persons living there, independent of their individual-level risk profile (Coleman (1988), Coleman (1990b); Diez Roux et al., 2001; Driessen, Gunther, & Van Os, 1998; Kalff et al., 2001; Sampson, Raudenbush, & Earls, 1997; Van Os, Driessen, Gunther, & Delespaul, 2000). Since the publication of Robert Park's seminal paper in 1915 “The City: Suggestions for the Investigation of Human Behaviour in the City Environment” (Park, 1967), generations of “Chicago School” sociologists and their students have been documenting how neighbourhood-level ecological factors have affected social disorganisation and social cohesion, both in adults and children (Janowitz, 1952; Kurtz, 1984; Shaw & McKay, 1969; Smith, 1988; Wirth, 1957). Specifically related to medically relevant outcomes, neighbourhood measures that have been reported to contribute to an increased risk of poor general and mental health outcomes include measures of socio-economic deprivation (Diez Roux et al., 2001; Driessen et al., 1998; Kalff et al., 2001) and, more recently, measures of “social capital” (Coleman (1988), Coleman (1990b); Kawachi, Kennedy, & Wilkinson, 1999b; Sampson, Morenoff, & Earls, 1999; Sampson et al., 1997).
Adolescence is an age of increasing independence and autonomy, with more time being spent in neighbourhood settings, away from the family and the formal social control institution of the school (Allison et al., 1999). Neighbourhood characteristics differ because of residential segregation and these differences influence child development and health (Garcia Coll et al., 1996). Neighbourhood poverty and socio-economic deprivation have been reported to have negative effects on children's mental health (Kalff et al., 2001), internalising behaviour and school achievement (Duncan, Brooks Gunn, & Klebanov, 1994). Local community forms of deprivation have been defined by an array of social indicators that characterize a so-called “underclass” (Kasarda, 1993; Wilson, 1987). Studies have shown that these indicators mark the specific pathways where adolescents living in these communities are led to negative behavioural outcomes. For example, James Quane and Bruce Rankin have developed a causal model of the direct and mediated effects of neighbourhood disadvantage and family structure on youth employment expectations (Quane & Rankin, 1998). The authors show that the employment expectations of adolescents are significantly lower in both broken family and welfare homes in poor neighbourhoods compared to adolescents in households in middle-class neighbourhoods. Neighbourhood deprivation was also indirectly associated with reduced expectation through the pathway of exposure of the adolescents in these areas to peers who identify with deviant norms. Related to the nonnormative social environment found in deprived neighbourhoods, chronic exposure to community violence has been argued to be associated with a wide variety of mental health problems in children, ranging from posttraumatic stress disorder to anxiety (Osofsky, 1995; Richters & Martinez, 1993). Therefore, neighbourhood contextual effects may be especially important from a developmental perspective, their cumulative effect impacting most on children and adolescents who grow up in these environments (Furstenberg, 2001; Kalff et al., 2001).
More recent work has demonstrated that neighbourhood measures of “social capital” are also associated with the health of both adults (Kawachi et al., 1999b) and children (Aneshensel & Sucoff, 1996). The objective of the present paper, therefore, is to study not only socio-economic factors but also social capital and their association with child outcomes.
In contrast to the objective socio-economic measures at the neighbourhood level, the concept of neighbourhood social capital has been advanced to emphasize the aspect of human agency in social life and its role in collective action (Emirbayer & Goodwin, 1994; Portes, 1998; Portes & Sensenbrenner, 1993). Coleman and Putnam are considered the architects of much of the contemporary discourse on social capital in the sociology literature (Coleman, 1990a; Putnam, 1993). Kawachi et al. have summarized their theories and have “defined” social capital as “those features of social organizations—such as networks of secondary associations, high levels of interpersonal trust and norms of mutual aid and reciprocity—which act as resources for individuals and facilitate collective action” (Kawachi, Kennedy, Lochner, & Prothrow-Stith, 1997b). The concept has had a widespread and popular reception as a way of denoting the many kinds of resources that can be appropriable from direct and indirect interpersonal relations and personal network structures (Sandefur & Laumann, 1998). Methodologically and empirically, it can be further conceptualised as social integration measured as a collective characteristic (Sampson et al., 1997) and the measurement relies largely on the subjective assessments of the residents of the neighbourhood social environment. For example, collective efficacy has been used to account for the process of social capital formation whereby the perceived level of cohesion and trust between neighbours is tied to their shared beliefs in their capability of collective action (Sampson et al., 1999). Collective efficacy is largely a matter of social integration that leads to the capacity to achieve common goals. This collective efficacy is analytically similar, but at a clearly different level, than the individual characteristic of self-efficacy of individuals to succeed in reaching personal goals (Sampson et al., 1997). In the case of children, collective efficacy involves specific spatial dynamics of intergenerational closure, social exchange and shared child control, which contribute to the deficits and disadvantages in the social environment (Sampson et al., 1999).
Five different plausible pathways by which social capital might influence individual health have been described, including promotion of a more rapid diffusion of health information, increased likelihood that healthy norms or behaviour are adopted, social control over deviant health-related behaviour (collective efficacy), increased access to local services and amenities and psychosocial processes such as affective support, self-esteem and mutual respect (Kawachi et al., 1999b).
Generally, more deprived neighbourhoods may also be lower in social capital. However, anecdotal evidence suggests that inhabitants of some socio-economically deprived neighbourhoods may help and trust each other, whereas conversely people in affluent neighbourhoods may not develop any ties with their neighbours. Therefore, it does not follow that social capital is per definition a function of deprivation and the first objective of the present paper is to examine whether and in what way socio-economic deprivation and social capital are associated.
The second objective is to study the associations between socio-economic factors and social capital on the one hand and different dimensions of quality of life and behaviour on the other in children at the beginning of the period of adolescence. Furthermore, the question whether the effects of socio-economic deprivation and social capital on child quality of life occur independently of each other was examined. It was hypothesised that both high socio-economic deprivation and low social capital would independently reduce children's health-related quality of life.
In addition, the sense of relative deprivation may be damaging to health (Fiscella & Franks, 1997; Kawachi, Kennedy, Lochner, & Prothrow-Stith, 1997a). Therefore, family SES may have different effects in neighbourhoods with lower or higher socio-economic deprivation. Statistically this can be expressed as an individual by area socio-economic status interaction.
Section snippets
Research design
The Maastricht population counts 122 000 inhabitants and is fairly homogeneous in ethnic terms (CBS (Dutch National Statistics Institute). 2001). Twenty percent have a non-Dutch nationality with six percent of these having a non-Western origin. These percentages of migrants are low compared to large Dutch cities like Amsterdam (44%, 31%, respectively) and Rotterdam (40%, 30%), but similar to the percentages in most other small cities in the Netherlands. Maastricht consists of 36 residential
Community survey
Forty-eight percent of the 7236 selected inhabitants responded. Of these, 48% were male, 34% were aged between 20 and 34 years, 46% were aged between 35 and 54 years and 20% were aged between 55 and 65 years. Thirty-two percent of the respondents required only elementary or lower level education for their profession. Women, persons aged between 55 and 65 years, and persons without a job (i.e. unemployed, housewife, etc.) were slightly over-represented in the group of respondents, whereas
Associations between neighbourhood socio-economic measures and neighbourhood social capital
The results showed that neighbourhoods with higher socio-economic deprivation, generally, had lower levels of informal social control (ISC) and social cohesion and trust in both children (SC&Tc) and adults (SC&T). Residential instability was specifically associated with SC&T and SC&Tc. The results of the present study in a small city in the Netherlands support research conducted in larger American cities. For example, both absolute and relative deprivation were found to be associated with
Conclusion
Both socio-economic deprivation and social capital were associated with various quality of life dimensions, whereas the mental health and behaviour dimensions were more specifically associated with one aspect of social capital: ISC. The wider social environment may impact on the emotional and physical development of young people through different pathways.
Acknowledgements
We gratefully acknowledge the financial support by the Maastricht local authorities. The authors are grateful to all the employees of the Youth Health Care Division, Municipal Health Centre for their assistance in the family sample data-collection; and to Frans van Kan, Sandra van Wijk and Nicole Peters for their assistance in the community survey data-collection.
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