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Social capital, health and community action: implications for health promotion
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0003-0108-4237
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background; The overwhelming increase in studies about social capital and health occurring since 1995 indicates a renewed interest in the social determinants of health and a call for a more explicit use of theory in public health and epidemiology. The links between social capital and health are still not clear and the meanings of different forms of individual and collective social capital and their implications for health promotion needs further exploration. The overall aims of this thesis are to explore the relationship between social capital and health and to contribute to the theoretical framework of the role of social capital for health and health promotion.

Methods; Data from a social capital survey were used to investigate the associations between individual social capital and self-rated health for men and women and different educational groups. Survey data were also analyzed to determine the association between collective social capital and self-rated health for men and women. A qualitative case study in a small community with observed high levels of civic engagement formed the basis for exploring the role of social capital for community action. Data from the same study were utilized for a grounded theory situational analysis of the social mechanisms leading to social capital mobilization.

Main findings; Access to individual social capital increases the odds for good self-rated health equally for men and women and different educational groups. However, the likelihood of having access to social capital differs between groups. The results indicate a positive association between collective social capital and self-rated health for women but not for men. Results from the qualitative case study illustrate how social capital in local communities can facilitate collective actions for public good but may also increase social inequality. Mobilizing social capital in local communities requires identification of community issues that call for action, a fighting spirit from trusted local leaders, “know-how” from creative entrepreneurs, and broad legitimacy and support in the community.

Conclusions; This thesis supports the idea that individual social capital is health-enhancing and that strengthening individual social capital can be considered one important health promotion strategy. Collective social capital may have a positive effect on self-rated health for women but not for men and therefore mobilizing collective social capital might be more health-enhancing for women. Collective social capital may have indirect positive effects on health for all by facilitating the ability of communities to solve collective health problems. However, mobilizing social capital in local communities requires an awareness of the risk for increased social inequality.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2010. , 105 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1355
Keyword [en]
social capital, self-rated health, health promotion, community action
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
URN: urn:nbn:se:umu:diva-34198ISBN: 978-91-7459-021-0 (print)OAI: oai:DiVA.org:umu-34198DiVA: diva2:319847
Public defence
2010-06-12, Betula, Norrlands Universitetssjukhus, Umeå, 10:00 (English)
Opponent
Supervisors
Available from: 2010-05-24 Created: 2010-05-20 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Social capital, gender and educational level: impact on self-rated health
Open this publication in new window or tab >>Social capital, gender and educational level: impact on self-rated health
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2010 (English)In: The Open Public Health Journal, ISSN 1874-9445, Vol. 3, 1-12 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: Social capital has been recognized as one important social determinant for health, but we still have limited knowledge about how it can be used to explain inequality in health. This study investigated the links between individual social capital and self-rated health by gender and educational level, and analyzed if access to social capital might explain the observed disparities in self-rated health between men and women and different educational groups. Study design: A cross-sectional survey in Northern Sweden. Methods: A social capital questionnaire was constructed and mailed to 15 000 randomly selected individuals. Different forms of structural and cognitive social capital were measured. Self-rated health was used as the outcome measure. Crude and adjusted OR and 95% CI were calculated for good selfrated health and access to each form of social capital. Multivariate regression was used to analyze how sociodemographic factors and access to social capital might influence differences in self-rated health by gender and educational level. Results: Access to almost each form of social capital significantly increased the odds for good self-rated health for all groups. A higher education significantly increased the odds for access to each form of social capital, and being a man significantly increased the odds for having access to some forms of social capital. The health advantage for higher educated and men partly decreased when controlling for access to social capital. Conclusions: Access to social capital can partly explain the observed health inequality between men and women and different educational groups. Strengthening social capital might be one way of tackling health inequality. It is important to consider the structural conditions that create unequal opportunities for different groups to access social capital.

Place, publisher, year, edition, pages
Bentham Science Publishers, 2010
National Category
Medical and Health Sciences
Research subject
Social Medicine
Identifiers
urn:nbn:se:umu:diva-34195 (URN)10.2174/1874944501003010001 (DOI)
Available from: 2010-05-19 Created: 2010-05-19 Last updated: 2016-10-04Bibliographically approved
2. The importance of gender and conceptualization for understanding the association between collective social capital and health: a multilevel analysis from northern Sweden
Open this publication in new window or tab >>The importance of gender and conceptualization for understanding the association between collective social capital and health: a multilevel analysis from northern Sweden
2011 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 73, no 2, 264-273 p.Article in journal (Refereed) Published
Abstract [en]

Growing research on social capital and health has fuelled the debate on whether there is a place effect on health. A central question is whether health inequality between places is due to differences in the composition of people living in these places (compositional effect) or differences in the local social and physical environments (contextual effects). Despite extensive use of multilevel approaches that allows controlling for whether the effects of collective social capital are confounded by access to social capital at the individual level, the picture remains unclear. Recent studies indicate that contextual effects on health may vary for different population subgroups and measuring "average" contextual effects on health for a whole population might therefore be inappropriate. In this study from northern Sweden, we investigated the associations between collective social capital and self-rated health for men and women separately, to understand if health effects of collective social capital are gendered. Two measures of collective social capital were used: one conventional measure (aggregated measures of trust, participation and voting) and one specific place-related (neighbourhood) measure. The results show a positive association between collective social capital and self-rated health for women but not for men. Regardless of the measure used, women who live in very high social capital neighbourhoods are more likely to rate their health as good-fair, compared to women who live in very low social capital neighbourhoods. The health effects of collective social capital might thus be gendered in favour for women. However, a more equal involvement of men and women in the domestic sphere would potentially benefit men in this matter. When controlling for socioeconomic, sociodemographic and social capital attributes at the individual level, the relationship between women's health and collective social capital remained statistically significant when using the neighbourhood-related measure but not when using the conventional measure. Our results support the view that a neighbourhood-related measure provides a clearer picture of the health effects of collective social capital, at least for women.

Keyword
Northern Sweden, collective social capital, gender, self-rated health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-47251 (URN)10.1016/j.socscimed.2011.05.013 (DOI)21689877 (PubMedID)
Available from: 2011-10-18 Created: 2011-09-19 Last updated: 2017-05-23Bibliographically approved
3. Understanding the role of social capital for health promotion beyond Putnam: a qualitative case study from northern Sweden
Open this publication in new window or tab >>Understanding the role of social capital for health promotion beyond Putnam: a qualitative case study from northern Sweden
2009 (English)In: Social theory and health, ISSN 1477-8211, Vol. 7, no 4, 318-338 p.Article in journal (Refereed) Published
Abstract [en]

Social capital is believed to improve the capacity of communities to work together for solving collective health problems. The present study was conducted in a community in northern Sweden where citizens through collective actions managed to build an association-driven health center. The aims were to describe the community's existing social capital in order to explore how Putnam's theories could contribute to an understanding of the observed high civic engagement and to discuss how other theoretical perspectives might add to an understanding of the role of social capital for health promotion. A qualitative case study was performed and the analysis followed a grounded theory approach. In accordance with Putnam, inherited social capital and high participation in existing associations were found to be important for uniting people. Beyond these, other aspects such as effective information channels, strong leaders and high social control were also significant and better understood by adding Coleman's and Bourdieu's views of social capital. If social capital is to be used for the purposes of health promotion the risk of increased social inequality as an unintended consequence needs to be considered. An awareness of how specific contextual conditions affect the building and mobilizing of social capital is also crucial.

Keyword
social capital, community health promotion, qualitative case study, grounded theory
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:umu:diva-34196 (URN)10.1057/sth.2009.6 (DOI)
Available from: 2010-05-19 Created: 2010-05-19 Last updated: 2015-04-29Bibliographically approved
4. Collective actors as driving forces for mobilizing social capital in a local community: what can be learned for health promotion?
Open this publication in new window or tab >>Collective actors as driving forces for mobilizing social capital in a local community: what can be learned for health promotion?
2010 (English)In: Social capital and rural development / [ed] H Westlund & K Kobayashi, ? , 2010Chapter in book (Other academic)
Place, publisher, year, edition, pages
?, 2010
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:umu:diva-34190 (URN)
Note
Not yet publishedAvailable from: 2010-05-19 Created: 2010-05-19 Last updated: 2015-04-29Bibliographically approved

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