IJE Advance Access originally published online on July 28, 2004
International Journal of Epidemiology 2004 33(4):650-667; doi:10.1093/ije/dyh013
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IJE vol.33 no.4 © International Epidemiological Association 2004; all rights reserved.
Point-Counterpoint |
Health by association? Social capital, social theory, and the political economy of public health
1 Faculty of History and Fellow of St John's College, University of Cambridge, Cambridge, UK
2 Development Research Group, The World Bank, and Kennedy School of Government, Harvard University, USA
Correspondence: Simon Szreter, St John's College, University of Cambridge, Cambridge CB2 1TP, UK. E-mail: srss{at}cam.ac.uk
Three perspectives on the efficacy of social capital have been explored in the public health literature. A ‘social support’ perspective argues that informal networks are central to objective and subjective welfare; an ‘inequality’ thesis posits that widening economic disparities have eroded citizens' sense of social justice and inclusion, which in turn has led to heightened anxiety and compromised rising life expectancies; a ‘political economy’ approach sees the primary determinant of poor health outcomes as the socially and politically mediated exclusion from material resources. A more comprehensive but grounded theory of social capital is presented that develops a distinction between bonding, bridging, and linking social capital. It is argued that this framework helps to reconcile these three perspectives, incorporating a broader reading of history, politics, and the empirical evidence regarding the mechanisms connecting types of network structure and state—society relations to public health outcomes.
Keywords Social capital, social support, public health, political economy, inequality, the state, British 19th century history
Accepted 6 August 2003
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