Do health behaviors mediate the association between social capital and health?
Introduction
There is a growing body of evidence that the social environment plays an important role in shaping people's health. Research efforts in this area have mainly focused on the concepts of social support and social capital. Social capital is generally defined as the features of social organization – such as civic participation, norms of reciprocity, and trust in others – that help facilitate cooperation for mutual benefit (see e.g., Putnam, 2000). As such, social capital can be considered a collective resource that benefits communities and can be distinguished from the individual health effects of social networks and support (see e.g., Lochner et al., 1999). Social capital has been linked to various health outcomes, among which self-rated health (Kawachi et al., 1999, Hyyppä and Mäki, 2001, Subramanian et al., 2002, Helliwell, 2003, Poortinga, 2006a, Poortinga, 2006b), cardiovascular and cancer mortality rates (Kawachi et al., 1997), suicide rates (Helliwell, 2003), and child mental health (Caughy et al., 2003). With the recognition that social capital is important for people's health comes the need to identify the specific mechanisms that link social capital to health. It has been hypothesized that social capital provides a buffer against the adverse effects of stress (Wilkinson, 1996); that social capital helps to disseminate health information and knowledge more quickly across communities (Kawachi and Berkman, 2000); that socially cohesive communities have better access to local services and amenities because they are more likely to be successful at fighting potential cuts in services (Sampson et al., 1997, Kawachi et al., 1999); and that communities with high levels of social capital are more effective at exercising social control over different health behaviors (Kawachi and Berkman, 2000, Subramanian et al., 2002). There is some empirical support for the latter hypothesis. Social capital has been found to be associated with various health behaviors, such as physical activity (e.g., Lindström et al., 2001; Stahl et al., 2001; Addy et al., 2004), fruit and vegetable consumption (Lindström et al., 2001), smoking (Lindström, 2003), and alcohol consumption (Weitzman and Chen, 2005). Mohan et al. (2005) provide further support for the idea that health behaviors form part of a possible mediating pathway between social capital and health. They found that the mortality effects of social capital were attenuated when controlling for differences in health-related behaviors.
The aim of this study is to investigate if health behaviors mediate the association between social capital and health. More specifically, the study examines (1) whether social capital is associated with health, (2) whether social capital is associated with a number of health-related behaviors (i.e., smoking, alcohol intake, and fruit and vegetable consumption), and (3) whether controlling for the health-related behaviors attenuates the association between social capital and health.
Section snippets
Study population
Data from the 2002 Health Survey for England were used. The Health Survey for England (HSE) is a series of annual studies covering the English adult population aged 16 and over living in private households. The data were collected from January 2002 to March 2003. In total, 7394 individual interviews were conducted within 4332 households that were selected from 720 postcode sectors.1
Results
Table 2 shows that self-rated health can be predicted from a wide range of individual, household, and community variables. Older age groups and economically inactive individuals were more likely to report poor health. A social class gradient was found for self-rated health, with ‘skilled manual’ and ‘partly and unskilled manual’ households being more likely to report poor health than ‘professional and intermediate’ households. In addition, house ownership substantially reduced the risk of
Discussion
The main aim of the current study was to investigate whether health behaviors mediate the association between social capital and health. A series of multilevel analyses shows that the social capital and support variables are significantly associated with self-rated health. This confirms earlier findings that these concepts play an important role in shaping people's health (see, e.g., Subramanian et al., 2002, Kawachi et al., 2004, Poortinga, 2006b). Some interesting associations with different
References (34)
- et al.
When being alone might be better: neighbourhood poverty, social capital, and child mental health
Soc. Sci. Med.
(2003) - et al.
Individual-level relationships between social capital and self-rated health in a bilingual community
Prev. Med.
(2001) Social capital and the miniaturization of community among daily and intermittent smokers: a population-based study
Prev. Med.
(2003)- et al.
Socioeconomic differences in leisure time physical activity: the role of shaping participation and social capital in shaping health related behaviour
Soc. Sci. Med.
(2001) - et al.
Social capital: a guide to its measurement
Health Place
(1999) - et al.
Social capital, geography and health: a small area analysis for England
Soc. Sci. Med.
(2005) - et al.
A longitudinal study of the effects of tobacco smoking and other modifiable risk factors on ill health in middle-aged and old americans: results from the health and retirement study and asset and health dynamics among the oldest old survey
Prev. Med.
(2002) Social capital: an individual or collective resource for health?
Soc. Sci. Med.
(2006)Social relations or social capital? Individual and community health effects of bonding social capital
Soc. Sci. Med.
(2006)- et al.
The importance of the social environment for physically active lifestyle-results from an international study
Soc. Sci. Med.
(2001)