social capital, social cohesion and health
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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”. - PowerPoint PPT PresentationTRANSCRIPT
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”
Level of Analysis Individual Group
SC as Cohesion
SC as Networks
Source: Kawachi, “Social Capital and Health”, In: Handbook of Medical Sociology, 6th edition (2010), chapter 2.
Conceptual approaches to defining “social capital”
Level of Analysis Individual Group
SC as Cohesion • Perceptions of trust
• Civic participation
• Volunteering.
• Survey responses aggregated to the group level.
SC as Networks
Source: Kawachi, “Social Capital and Health”, In: Handbook of Medical Sociology, 6th edition (2010), chapter 2.
Conceptual approaches to defining “social capital”
Level of Analysis Individual Group
SC as Cohesion • Perceptions of trust
• Civic participation
• Volunteering.
• Survey responses aggregated to the group level.
SC as Networks • Position Generator
• Resource Generator
• Whole social network analysis
Source: Kawachi, “Social Capital and Health”, In: Handbook of Medical Sociology, 6th edition (2010), chapter 2.
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
Hyppaa & Maki (men), 2001
Hyppaa & Maki (women), 2001
Subramanian et al., 2002
Pollack & Knesebeck, 2004
Veenstra, 2005a
Kim et al., 2006a
Kim et al., 2006b
Poortinga, 2006a
Poortinga, 2006b
Poortinga, 2006c
Poortinga, 2006d
Yip et al., in press
Stu
dy
Au
thor
s an
d Y
ear
of P
ublic
atio
n
.3 .4 .5 .6 .7 .8 .9 11 1.5 2Odds Ratio and 95% Confidence Interval
Figure 1: Studies of Individual-Level Trust and Fair/Poor Self-Rated Health (Dichotomous)
Source: Kim, Subramanian & Kawachi, 2008. Chapter 8
Systematic Review of Studies, 1996-November 1, 2006
Subramanian et al., 2002
Poortinga, 2006a
Poortinga, 2006c
Yip et al., in press
Stu
dy
Au
thor
s an
d Y
ear
of P
ublic
atio
n
.3 .4 .5 .6 .7 .8 .9 11 1.5 2Odds Ratio and 95% Confidence Interval
With Adjustment for Individual-Level Social CapitalFigure 2A: Studies of Area-Level Trust and Fair/Poor Self-Rated Health (Dichotomous)
Source: Kim, Subramanian & Kawachi, 2008. Chapter 8
Hyppaa et al. (men), 2001
Hyppaa et al. (women), 2001
Hyppaa et al., 2003
Lindstrom, 2004
Pollack & Kneseback, 2004
Veenstra, 2005a
Kim et al., 2006b
Poortinga, 2006a
Poortinga, 2006b
Poortinga, 2006c
Poortinga, 2006d
Yip et al., in press
Stu
dy A
utho
rs a
nd Y
ear
of P
ublic
atio
n
.3 .4 .5 .6 .7 .8 .9 11 1.5 2Odds Ratio and 95% Confidence Interval
Figure 3: Studies of Individual-Level Associational Memberships and Fair/Poor Self-Rated Health (Dichotomous)
Source: Kim, Subramanian & Kawachi, 2008. Chapter 8
Poortinga, 2006a
Poortinga, 2006c
Yip et al., in press
Stu
dy
Au
thor
s an
d Y
ear
of P
ublic
atio
n
.3 .4 .5 .6 .7 .8.911 1.5 2Odds Ratio and 95% Confidence Interval
With Adjustment for Individual-Level Social CapitalFigure 4A: Studies of Area-Level Associational Memberships and Fair/Poor Self-Rated Health (Dichotomous)
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).
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)
The National Survey of Midlife Development in the US (MIDUS) Twin Study,1995-1996
Twin screening for ~50,000 national representative sample
Final study sample (N=944 pairs)
14.8% presence of twin
60% gave permission to access twin
26% Completed interview (N=998 pairs)
Exclude unknown zygosity and separated before 14 (N=54 pairs)
Fixed effects coefficients for self-rated physical health
*p<0.05*p<0.05
Fixed effects coefficients for depressive symptoms
*p<0.05
*p<0.05
Does living in a cohesive community influence health?
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?
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…
Informal social control
the role of community adults (as opposed to the police) in intervening to stop smoking, drinking, drug use by children.
Mechanisms linking social cohesion to health outcomes
Network closure
Johnny
Johnny’s mom
Mrs. Casey (Johnny’s neighbor)
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.
Mechanisms linking social cohesion to health outcomes
• Bonding / Bridging• Determinants of community social cohesion• Causal inference
New Directions for Social Capital Research
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…).
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.
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
“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).
Multivariable-adjusted* odds ratios of poor self-rated health.
Type of social capital OR (95% CI)
Bonding capital
None Low Middle High
1.000.82 (0.59-1.13)0.81 (0.49-1.34)0.68 (0.32-1.44)
*adjusted for sex, age, living arrangement, education, smoking, overweight, and other type of social capital.
Type of social capital OR (95% CI)
Bonding capital
None Low Middle High
1.000.82 (0.59-1.13)0.81 (0.49-1.34)0.68 (0.32-1.44)
Bridging capital
None Low Middle High
1.000.72 (0.53-0.98)0.61 (0.41-0.91)0.33 (0.19-0.58)
*adjusted for sex, age, living arrangement, education, smoking, overweight, and other type of social capital.
Multivariable-adjusted* odds ratios of poor self-rated health.
• Bonding / Bridging• Determinants of community social cohesion• Causal inference
New Directions for Social Capital Research
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)
t1t2
t3t4
t5
Settlements
Individual samples
31
OR (95% CI) by periods (t1 ~ t5) for SC indicators,estimated by logistic regression models
32
Courtesy of Dr. Tomoya Hanibuchi
• Bonding / Bridging• Determinants of community social cohesion• Causal inference
New Directions for Social Capital Research
study area
0 5 102.5km
N
Aichi PrefectureTokai Obu
Chita
Agui
Taketoyo
Mihama
Minamichita
Higashiura
Chita Peninsula
Nagoya
←Taketoyo town
Taketoyo town population 42,000 45 min from Nagoya
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
Salon Social Programs
←Ping-Pong
Bingo→
Source: Prof. Katsunori Kondo, personal communication
But Does X really cause Y?
X YParticipation in salons
Good health
β
Alternative Hypothesis #1: Reverse causation.
(Good health allows you to participate.)
Salon participation Good Health
β
β reverse
Alternative Hypothesis #2: ConfoundingAssociation may reflect the influence of
omitted variables.
Salon participation Good healthβ
Congeniality, temperament.
Can we find an instrument?
Participation in salons
Good health
Congeniality, etc.
Z
Can we find an instrument?
Participation in salons
Good health
Congeniality, etc.
Distance to nearest salon
3 sites in 2007 & participants
● participants
Circle shows 500m
□ site
2007 3 sites2008 2 sites2009 2sitesBy 2012: total 10 sites
most participants come from neighborhood
Source: Prof. Katsunori Kondo, personal communication
Distance from salons as an instrumental variable
Distance from salon
% of participants per older persons
living in the distance bracket
N → ( 414 ) ( 860 ) ( 607 ) ( 477 ) ( 264 ) ( 206 ) ( 281 ) ( 209 ) ( 630 )
2 Stage Least Squares (2SLS)
edictorsPrOther X̂ k
edictorsPrOther X̂Y k
45
Participation in the salons & Trust
• 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.
P-values are in parentheses.
(0.061) (0.598) (0.568) (0.000) (0.663)
ionparticipat0.39age06.00240 male.0260 Ztrust06.4800.15 Ztrust08
(0.000) (0.000)
distance0.690.68onarticipatip̂
iiiiii
iii
u
v
Test for regressor endogeneityIn Likelihood Ratio test, H0:ρ(the error correlation)=0 was not rejected (p=0.25), ”participation” is not necessarily an endogenous variable.
46
P-values are in parentheses.
(0.022) (0.000) (0.160) (0.000) (0.000)
ionparticipat0.43age06.0190 male0.060 Zsrh06.5001.45 Zsrh08
(0.000) (0.000)
distance0.690.68onarticipatip̂
iiiiii
iii
u
v
• 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 regressor endogeneityIn Likelihood Ratio test, H0:ρ(the error correlation)=0 was not rejected (p=0.33), ”participation” is not necessarily an endogenous variable.
Participation in the salons & SRH
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