The espousal of social capital in Oral health care Author: Dr. Shoeb Ahmed Ilyas BDS, MPH, EMSRHS, M.Phil. (HHSM), MHRM, MS (PSY), MS

(BIOTECH), PGDMLE, FHTA.

Health Care Quality Management Consultant

Ruby Med Plus, Telangana State, India.

Oral health is projected to be affected by the environment; to provide an understanding to this,

the concept of social capital can be used. Social networking appears to be the rational in social

capital in which there is ‘connections’ among individuals, a social network guided by a set of

values and norms of trustworthiness and reciprocity among peoples’, groups, communities etc of

the network. Putnami (1995) defines social capital as “coordination and co- operation for mutual

benefit”. Hence it is not only a way of describing social relationships within a group or society,

but also adds a social dimension to traditional structural explanations of disease by viewing

communities not just as contextual environments, but also as connected groups of

individuals.ii

The theory of social capital emphasizes multiple dimensions inside the concept. For example,

social capital can be divided into a behavioral/activity component (for example, participation)

and a cognitive/perceptual component (for example, trust). These are respectively being referred

to as structural and cognitive social capital.iii

. Structural and cognitive social capital can therefore

refer to linkages and perceptions in relation to people who are akin to each other; such as people

in one’s own community or people of alike socioeconomic status (referred to as bonding social

capital), or to people who are poles apart; such as people outside one’s community or with a

different social identity (known as bridging social capital). Social capital relations can also occur

in ceremonial institutions such as between community and local government structures (termed

linking social capital)iv

.

Social capital is not a magic pill for improving society’s oral health but, it is a useful concept

which focuses our attention on an important set of resources, inhering in relationships, networks

and associations, which have previously been given insufficient attention in the social sciences

and Dental literature. This is probably partly because they are not easy to categories, study and

measure their effects quickly. The social capital perspective therefore broadcast us that if we

normatively approve of the goal of enhancing population oral health, we cannot achieve this

through material inputs alone, or simply through “technological fixes”, whether “forced” or

magnanimously “approved” by those with superior resources. Social capital can contribute

towards health promotion, in the extent to which it can be used for its strategic value; the concept

can be carefully employed within wider health promotion practices which explicitly draw upon

social justice, equity and empowerment principlesv. Social capital draws on solidarity within

groups, communities, societies as well.

Building or sustaining healthy communities is an important weapon to prevent Dental Problems.

There is emerging evidences that the environment, place where people live is an important factor

in determining and sustaining inequalities in health outcome between individuals. Although there

is substantial geographical variation and inequality in Oral health status, understanding the role of

the social environment in the etiology of poor Oral health status is important for prevention of

Oral Health ailment in the community. There is good evidence in the Medical literature, that

health behavior and health care delivery are influenced by a broad range of systemic and social

factors, like social capital, and not only biomedical factors. Hence there is need to understand

how social capital may translate into better Oral health outcomes and health equity in Indian

Populations. In the Opinion of social scientists, policy makers, and international institutions like

World Health Organization and the World Bank, social capital contributes to health inequalities

within and between populations.

Oral Health-related Behaviors and Social Capital -

Social capital may influence community members’ oral health related behavior by promoting a

more rapid diffusion of health information, activity, and healthy behavior norms, health seeking

behavior (like brushing our teeths twice a day) and by exerting social control over deviant health-

related behavior, such as tobacco chewing. Another pathway is that privileged levels of

community cohesion result in higher degrees of social organization that enhances access to oral

health services that influence people oral health. Individual functioning and well-being is affected

by diverse social experience and conditions, which includes an individual’s social capital

environment. The theory of the diffusion of innovations suggests that the innovative behaviors

(e.g. use of preventive services) diffuse much more rapidly in communities that are cohesive and

that have higher levels of trustvi

.

Research in the 1970s on social support suggested a health-enhancing role for social relationships

in buffering the ill effects of stressvii

. People in societies with higher levels of social capital live

longer, have lower premature mortality rates, are less violent, and have lower levels of self-

perception of poor healthviii

. Social capital and social networks could improve community health

by alleviating stress levels caused by emotional and behavior problemsix

. Kawachi et al. 2004

note that ‘the growing gaps between the rich and the poor affect the social organization of

communities and that the resulting damage to the social fabric may have profound implications

for the public’s health.’

A recent ecological study in Brazil has assessed the relationship between income inequality,

social cohesion and dental caries levels in 12-year-old schoolchildren, findings show that income

inequality expressed by the GINI coefficient was significantly associated with percentage of

children free of caries and mean DMFx. Social cohesion was significantly inversely associated

with percentage of caries free childrenxi

. At a local level oral health input into initiatives such as

the Health Promoting School network can produce sustainable improvements in oral health

outcomesxii

.

Oral health professionals working in isolation are unlikely to achieve sustained long-term

improvements in oral health,xiii

Hence Dentist working in collaborative partnerships with other

relevant professionals and agencies are more likely to produce desired results. Successful

collaborative working requires a shared agenda for action in which common risks/ health factors

are identified.xiv

Conclusion

Common Dental disorders like dental caries and Periodontitis can lead to substantial disabilities;

there is possibility that neighborhoods, residents’, characteristics can affect oral health of people

(which is of increasing interest to social researchers and epidemiologist). Income deprivation

and social capital measured at community level are potentially important joint determinants

of oral health. Poor oral health can be significantly associated with area-level income

deprivation, low social capital and state-society relations in which they are inherently embedded

and it also relies on the distinction between bonding, bridging and linking forms of social capital.

A “healthy society”, capable of consistently promoting the health of its citizens health, will be

characterized by a balanced distribution of a relatively rich endowment of all three of these forms

of social capital. Whether or not the resources of social capital which exist in any society will

take on health-promoting or health-degrading net effects is still not clear with diversified view of

pioneers in social capital.

References-

i Putnam, Robert 1995. “Bowling Alone: America’s Declining Social Capital.” Journal of

Democracy, 6 (1): 65-78.

ii Cullen, M and Whiteford, H (2001). The Interrelations of Social Capital with Health and Mental

Health. Canberra, National Mental Health Strategy, Canberra, Australia: Commonwealth

Department of Health and Aged Care.

iii Bain, K and Hicks, N. Building social capital and reaching out to excluded groups: the

Challenge of partnerships. Paper presented at CELAM meeting on The Struggle against Poverty

towards the turn of the Millennium, Washington D.C., 1998.

iv Szreter S, Woolcock M. Health by association? Social capital, social theory, and the political

economy of public health. Int J Epidemiol. 2004;33:650–667

v Wakefield, S. E. L., & Poland, B. (2005). Family, friend or foe? Critical reflections on the

relevance and role of social capital in health promotion and community development. Social

Science & Medicine, 60(12), 2819-2832.

vi Rogers, E. 1983. Diffusion of innovations. New York: Free Press

vii Cassel, J. 1976. ‘‘The Contribution of the Social Environment to Host Resistance.’’ American

Journal of Epidemiology 104 (2): 107–23.

viii Kawachi I, Kennedy B, Lochner K, Prothrow-Stith D. Social capital, income inequality and

mortality. Am J Public Health 1997; 87:1491–8?

ix Berkman LF, Glass TA, Brissette I, Seeman TE From social integration to health: Durkheim in

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x Marcos Pascoal Pattussi, Rebecca Hardy, and Aubrey Sheiham, “Neighborhood Social Capital

and Dental Injuries in Brazilian Adolescents” Am J Public Health.96:1462–1468; 2006

xi Pattussi M, Marcenes W, Croucher R, Sheiham A in press The relationship between dental

caries in 6–12 year-old Brazilian school children and social deprivation, income inequality and

social cohesion. Soc Sci Med;in press

xii Moyses S. The impact of health promotion policies in schools on oral health in Curitiba, Brasil.

PhD Thesis. University College London;2000.

xiii Sprod A, Anderson R, Treasure E. Effective oral health promotion. Literature Review. Cardiff:

Health Promotion Wales;1996

xiv

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health. Community Dent Oral Epidemiol 2000; 28:399–406.

1) Author-

Dr.Shoeb Ahmed

B.Sc.,BDS, M.Sc.(Biotech),M.Sc.(Psy), MHRM,

M.PHIL (HHSM), EMSRHS, PGDMLE, PGDHM, PGDHA,

DEM & ISO14000/14001.

E-Mail- drshoeb_2k@yahoo.com

2) CO-Author

Dr.Irfana Sultana

BDS.

e-mail- irfana.anwar@gmail.com