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Social Capital, Social Cohesion and Health

Social Capital, Social Cohesion and Health. Ichiro Kawachi Professor of Social Epidemiology Harvard School of Public Health Sulzberger Colloquium April 6, 2011. Conceptual approaches to defining “social capital”.

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Social Capital, Social Cohesion and Health

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  1. Social Capital, Social Cohesion and Health Ichiro Kawachi Professor of Social Epidemiology Harvard School of Public Health Sulzberger Colloquium April 6, 2011

  2. Conceptual approaches to defining “social capital” Source: Kawachi, “Social Capital and Health”, In: Handbook of Medical Sociology, 6th edition (2010), chapter 2.

  3. Conceptual approaches to defining “social capital” Source: Kawachi, “Social Capital and Health”, In: Handbook of Medical Sociology, 6th edition (2010), chapter 2.

  4. Conceptual approaches to defining “social capital” Source: Kawachi, “Social Capital and Health”, In: Handbook of Medical Sociology, 6th edition (2010), chapter 2.

  5. State of Empirical Evidence • Most studies cross-sectional. • Majority of studies have focused on individual-level social capital (trust perceptions, associational membership). • Most studies used self-rated health as endpoint. • Demonstration of contextual effects remain elusive. Springer, 2008

  6. Systematic Review of Studies, 1996-November 1, 2006 Source: Kim, Subramanian & Kawachi, 2008. Chapter 8

  7. Source: Kim, Subramanian & Kawachi, 2008. Chapter 8

  8. Source: Kim, Subramanian & Kawachi, 2008. Chapter 8

  9. Problems in Causal Inference • Common method variance • Omitted variable bias (e.g. early childhood environment resulting in poor attachment and poor health). • Reverse causation (e.g. people participate because they are healthy).

  10. What can twin studies accomplish? • Control for inherited characteristics (e.g. temperament, personality, ability). • Control for early rearing environment (e.g. poor attachment → poor social relations & poor health in adulthood)

  11. Exclude unknown zygosity and separated before 14 (N=54 pairs) The National Survey of Midlife Development in the US (MIDUS) Twin Study,1995-1996 Twin screening for ~50,000 national representative sample 14.8% presence of twin 60% gave permission to access twin 26% Completed interview (N=998 pairs) Final study sample (N=944 pairs)

  12. Fixed effects coefficients for self-rated physical health *p<0.05 *p<0.05

  13. Fixed effects coefficients for depressive symptoms *p<0.05 *p<0.05

  14. Does living in a cohesive community influence health?

  15. Indicators of community social cohesion • Presence of active community organizations - neighborhood watch group. • Informal socializing. - do you have block parties? • Neighbors constantly helping each other. - will they pick up your kids from the bus stop? • Trust between neighbors.- do you leave your door unlocked when you go out?

  16. Mechanisms linking social cohesion to health outcomes • Collective action & collective efficacy e.g. mobilizing to protest the closure of emergency services; passage of local smoke-free ordnances…

  17. Mechanisms linking social cohesion to health outcomes • Informal social control the role of community adults (as opposed to the police) in intervening to stop smoking, drinking, drug use by children.

  18. Network closure Johnny’s mom Mrs. Casey (Johnny’s neighbor) Johnny

  19. Mechanisms linking social cohesion to health outcomes • Exchange of favors / diffusion of information. • More cohesive communities = more network closure (all your friends know each other). = less likelihood of free- riding (i.e. receiving favors without reciprocating) because of risk to one’s reputation.

  20. New Directions for Social Capital Research • Bonding / Bridging • Determinants of community social cohesion • Causal inference

  21. Bonding vs. Bridging Social Capital • Bonding social capital – social connections between people who are similar to each other in terms of status (race, social class, gender…).

  22. Bonding vs. Bridging Social Capital • Bonding social capital – social connections between people who are similar to each other in terms of status (race, social class, etc). • e.g. the Ku Klux Klan.

  23. Bonding vs. Bridging Social Capital • Bridging social capital – social connections that bridge different SES and race/ethnic groups. • e.g. integrated Hindu/Muslim associations in India. Yale University Press, 2002

  24. “Do bonding and bridging social capital have differential effects on self-rated health? A community based study in Japan.”T.Iwase,E. Suzuki, T. Fujiwara, S. Takao, Doi H, Kawachi I.JECH, December 16 (2010). • Community sample of 2,260 Okayama City residents, 20-80 years old. • Inquired about participation in a variety of civic associations (PTA, sports clubs, alumni associations, political campaign clubs, citizen’s groups, and community associations). • Distinguished bonding vs. bridging social capital (diversity by occupation, age group, gender).

  25. Multivariable-adjusted* odds ratios of poor self-rated health. *adjusted for sex, age, living arrangement, education, smoking, overweight, and other type of social capital.

  26. Multivariable-adjusted* odds ratios of poor self-rated health. *adjusted for sex, age, living arrangement, education, smoking, overweight, and other type of social capital.

  27. New Directions for Social Capital Research • Bonding / Bridging • Determinants of community social cohesion • Causal inference

  28. Methods(slide courtesy of Dr. Tomoya Hanibuchi) • Using GIS and topographical maps • 5 cross sections: t1 (pre-1890) t2 (1890-1920) t3 (1920-1960) t4 (1960-1980) t5 (post-1980) Settlements t1 t2 t3 t4 t5 Individual samples

  29. OR (95% CI) by periods (t1 ~ t5) for SC indicators,estimated by logistic regression models Courtesy of Dr. Tomoya Hanibuchi

  30. New Directions for Social Capital Research • Bonding / Bridging • Determinants of community social cohesion • Causal inference

  31. Nagoya ←Taketoyo town Taketoyo town population 42,000 45 min from Nagoya

  32. Taketoyo Town Intervention • In 2007, municipal officials launched campaign to promote healthy aging among citizens. • Intervention: Opening of community centers for seniors, called “salons”. • Managed by volunteers. • Some of the town residents were also participants of an ongoing cohort study (Aichi Gerontological Evaluation Study, AGES). Source: Prof. Katsunori Kondo, personal communication

  33. ←Ping-Pong Salon Social Programs Bingo→ Source: Prof. Katsunori Kondo, personal communication

  34. But Does X really cause Y? β Y X Participation in salons Good health

  35. Alternative Hypothesis #1: Reverse causation.(Good health allows you to participate.) β Salon participation Good Health β reverse

  36. Alternative Hypothesis #2: ConfoundingAssociation may reflect the influence of omitted variables. β Salon participation Good health Congeniality, temperament.

  37. Can we find an instrument? Z Participation in salons Good health Congeniality, etc.

  38. Can we find an instrument? Distance to nearest salon Participation in salons Good health Congeniality, etc.

  39. 3 sites in 2007 & participants □site Circleshows500m most participants come from neighborhood ●participants 20073 sites 20082 sites 20092sites By 2012: total 10 sites Source: Prof. Katsunori Kondo, personal communication

  40. Distance from salons as an instrumental variable % of participants per older persons living in the distance bracket N →（414）　　（860）　　（607）　　（477）　（264）　　（206）　　（281）　　（209）　（630） Distance from salon

  41. 2 Stage Least Squares (2SLS)

  42. Distance to the salons showed significant linkage to participation to the salons. The estimated participation in the salons had a marginally significant (10%) effect on trust in 2008 independent of age, sex and trust in 2006. Participation in the salons & Trust P-values are in parentheses. Test for regressor endogeneity In Likelihood Ratio test, H0:ρ(the error correlation)=0 was not rejected (p=0.25), ”participation” is not necessarily an endogenous variable.

  43. Participation in the salons & SRH P-values are in parentheses. • Distance to the salons showed significant linkage to participation in the salons. • The estimated participation in the salons had a significant (5%) effect on SRH in 2008 independent of age, sex and SRH in 2006. Test for regressorendogeneity In Likelihood Ratio test, H0:ρ(the error correlation)=0 was not rejected (p=0.33), ”participation” is not necessarily an endogenous variable.

  44. Findings • ↓distance from salon = ↑participation. • ↑participation (instrumented) = ↑trust of others over 2-year follow-up period, adjusting for baseline trust. • ↑participation (instrumented) = ↑self-rated health over 2-year follow-up period, adjusting for baseline health. Professor Katsunori Kondo, Nihon Fukushi University

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