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IJE vol.33 no.4 © International Epidemiological Association 2004; all rights reserved.
Editor's Choice |
Social capital: everything or nothing?
Social capital forms our point-counterpoint in this issue. The major contribution of Szreter and Woolcock's opening piece1—which deserves to become a citation classic—is to develop our understanding of the links between social capital and health outcomes through an improved theory of social capital. This improvement expands the idea of linking social capital—that is, the mechanisms that produce links between individuals operating at different levels of power or authority in a society. This form of social capital is distinguished from bonding social capital (of individuals with similar characteristics) and bridging social capital (of individuals with different characteristics, but usually similar status) previously defined by Putnam, who states he is agnostic on whether this distinction will be useful.2
Our commentators have their say: Navarro is incensed that his trenchant critique of social capital did not engage Szreter and Woolcock.3 Kawachi and colleagues go for a more empirical approach providing an analysis of the studies relating social capital to health.4 Ellaway is commendably brief, noting that politicians such as Bill Clinton, George Bush, Tony Blair, and Bertie Ahern have all found merit in social capital to pedal their own agendas.5 For Muntaner, the bottom line is whether social capital brings new ideas and findings; he argues for less ideology and more-specific models integrating social structure and psychosocial exposures into better understanding of the determinants of morbidity and mortality.6 Elsewhere,7 Pearce and Davey Smith make the point that in his seminal work, Making Democracy Work,8 Putnam explicitly states that health should not be considered an outcome of social capital, but by the publication of Bowling Alone,9 his view is that social capital is as important a cause of ill-health as smoking!
Readers might do well to pull out the June 2002 issue of International Journal of Epidemiology in which the role of income inequalities and health were discussed, centred on Rodgers original paper,10 with thoughtful pieces by Richard Wilkinson,11 Miguel Porta and colleagues,12 Angus Deaton,13 and Lynch and Davey Smith.14 Income inequality is but one dimension of social inequality, but usefully, there is less disagreement about how to measure it and a growing understanding of how to interpret associations (and lack of associations) with health outcomes. Meanwhile, if you like quizzes, try measuring your own ‘social capital’ using the questions employed in a massive US Social Capital Community Bench Mark Survey (Box).15
Social capital survey instrument
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References
1 Szreter S, Woolcock M. Health by association? Social capital, social theory and the political economy of public health. Int J Epidemiol 2004;33:650–67.
2 Putnam RD. Health by association: some comments. Int J Epidemiol 2004;33:667–71.
3 Navarro V. Is capital the solution or the problem? Int J Epidemiol 2004;33:672–74.
4 Kawachi I, Kim D, Coutts A, Subramanian SV. Reconciling the three accounts of social capital. Int J Epidemiol 2004;33:682–90.
5 Ellaway A. Can subtle refinements of popular concepts be put into practice? Int J Epidemiol 2004;33:681–82.
6 Muntaner C. Social capital, social class and the slow progress of psychosocial epidemiology. Int J Epidemiol 2004;33:674–80.
7 Pearce N, Davey Smith G. Is social capital the key to inequalities in health? Am Public Health 2003;93:122–29.
8 Putnam RD. Making Democracy Work. Princeton, NJ: Princeton University Press, 1993.
9 Putnam RD. Bowling Alone. New York, NY: Simon & Schuster, 2000.
10 Rodgers GB. Income and inequality as determinants of mortality: an international cross-section analysis. Int J Epidemiol 2002;31:533–38.
11 Wilkinson R. Liberty, fraternity, equality. Int J Epidemiol 2002;31:538–43.
12 Porta M, Borrell C, Copete JL. Theory in the fabric of evidence on the health effects of inequalities in income distribution. Int J Epidemiol 2002;31:543–46.
13 Deaton A. The convoluted story of international studies of inequality and health. Int J Epidemiol 2002;31:546–49.
14 Lynch J, Davey Smith G. Income inequality and health: the end of the story? Int J Epidemiol 2002;31:549–51.
15 http://www.cfsv.org/communitysurvey/ (accessed 11 May 2004).
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