IJE Advance Access originally published online on February 28, 2006
International Journal of Epidemiology 2006 35(3):607-613; doi:10.1093/ije/dyl010
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Does area-based social capital matter for the health of Australians? A multilevel analysis of self-rated health in Tasmania
1 Key Centre for Women's Health in Society, University of Melbourne, Melbourne, Australia
2 School of Public Health, Queensland University of Technology, Brisbane, Australia
3 Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
* Corresponding author. Key Centre for Women's Health in Society, School of Population Health, University of Melbourne 0310, Australia. E-mail: a.kavanagh{at}unimelb.edu.au
Background Material circumstances and collective psychosocial processes have been invoked as potential explanations for socioeconomic inequalities in health; and, linking social capital has been proposed as a way of reconciling these apparently opposing explanations.
Methods We conducted multilevel logistic regression of self-rated health (fair or poor vs excellent, very good, or good) on 14 495 individuals living within 41 statistical local areas who were respondents to the 1998 Tasmanian Healthy Communities Study. We modelled the effects of area-level socioeconomic disadvantage and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, social trust, trust in public/private institutions, and political participation), and adjusted for the effects of individual characteristics.
Results Area-level socioeconomic disadvantage was associated with poor self-rated health (ß = 0.0937, P < 0.001) an effect that was attenuated, but remained significant, after adjusting for individual characteristics (ß = 0.0419, P < 0.001). Social trust was associated with a reduction in poor self-rated health (ß = –0.0501, p = 0.008) and remained significant when individual characteristics (ß = –0.0398, P = 0.005) were included. Political participation was non-significant in the unadjusted model but became significant when adjusted for individual characteristics (ß = –0.2557, P = 0.045). The effects of social trust and political participation were attenuated and became non-significant when area-level socioeconomic disadvantage was included.
Conclusion Area-based socioeconomic disadvantage is a determinant of self-rated health in Tasmania, but we did not find an independent effect of area-level social capital. These findings suggest that in Tasmania investments in improving the material circumstances in which people live are likely to lead to greater improvements in population health than attempts to increase area-level social capital.
Keywords Social capital, socioeconomic disadvantage, multilevel analysis
Accepted 10 January 2006
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