Social Capital and Poor Communities

7: Social Capital, Poverty, and Community Health: An Exploration of Linkages

Chapter 7 Social Capital, Poverty, and Community Health: An Exploration of Linkages Sherman A. James, Amy J. Schulz, and Juliana van Olphen This chapter explores the degree to which the overall health of communities depends, at least in part, on reliable access to social capital among their residents . As discussed in chapter 1 by Mark Warren, Phillip Thompson, and Susan Saegert, social theorists (for example, Bourdieu 1987; Coleman 1988, 1990; Putnam 1993) have generally defined social capital as resources that inhere in social relationships. These resources include mutual trust, a sense of reciprocal obligation, and civic participation aimed at benefiting the group or community as a whole. As such, social capital is construed to be a property of groups or communities, not of individuals. Thus defined, social capital bears a strong resemblance to a number of other theoretical constructs (such as social integration, social support, and community capacity) that have been used with great success by public health researchers for many years. We examine the overlap between social capital and these analogous constructs in setting the stage for our review of the emerging literature on the relationship between social capital and the public's health. Following the review, we present a conceptual model outlining our own perspective on the pathways through which social capital may influence, directly and indirectly, the health of poor, innercity U.S. communities. We illustrate several key points of our model through a case study of an ongoing, community-based, public health intervention in Detroit, Michigan. The chapter concludes with several policy recommendations designed to foster sustainable progress in building the capacity of poor communities to solve public health problems. SOCIAL CAPITAL AS A CONSTRUCT IN PUBLIC HEALTH The field of public health has a long-standing interest in the impact of socioenvironmental factors on health (Yen and Syme 1999). Research dating back to 1854 has examined patterns of social behavior and social organization and their implications for understanding the differential distribution of diseases across communities (Snow 1936). Despite the fact that scientific paradigms and research methods emphasizing the individual as the unit of analysis have come to dominate public I 165 Social Capital and Poor Communities health in recent decades (Pearce 1996), a subset of researchers and practitioners continues to focus on the impact of community structures, broadly conceived, on the public's health. The latter emphasis includes the location and quality of housing (saegert and Winkel 1998); patterns of residential segregation by race (Polednak 1996; Wallace 1990; Collins and Williams 1999; Fullilove 1998); membership in social networks and related perceptions of social support (House, Umberson, and Landis 1988; Heaney and Israel 1997); community and political participation (Wandersman et al. 1987; LaVeist 1992; Israel et al. 1994; Eng and Parker 1994; Goodman et al. 1998); and relative equity in gaining access to community-level economic resources (Wilkinson 1996; Kennedy, Kawachi, and Prothrow-Stith 1996; Kaplan et al. 1996; Lynch et al. 1998). These aspects of the social environment are interconnected in complex ways. For example, the physical structure of communities shapes, and is shaped by, patterns of social interaction among residents. Those patterns, in turn, are strongly influenced by the economic resources of residents (Wallace 1990; Fullilove 1998) and by cultural values linked to race or ethnicity (James 1993; Lomas 1998). Over the years a substantial body of evidence has emerged attesting to the impact of these features of the social environment on the health of both individuals and communities (Cassel 1976; House et al. 1988; Wolf and Bruhn 1993; Aday 1994; Cohen et al. 1997; Israel et al. 1998). Importantly, this impact does not appear to be disease-specific; rather, the evidence suggests that it shapes a community's overall risk for being at risk (Link and Phelan 1995). The growing interest in the relationship between access to social capital and community health (for example, Wilkinson 1997; Kawachi et al. 1997; Kennedy et al. 1996; Lomas 1998) is a potentially important elaboration on the ancient public health thesis that the manner in which social relationships are structured in a given society is a powerful determinant of the health status of all members in that society (Cassel 1976; Link and Phelan 1995). To paraphrase Bob Edwards and Michael Foley (1997), however, the question is, to what extent does the concept of social capital yield a distinctive analytic payoff above and beyond the analogous constructs used in public health for many years? Despite unresolved theoretical and measurement challenges, the construct of social capital appeals to many...