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PubMed2004

Local services and amenities, neighborhood social capital, and health.

Recent work on health and place has examined the impact of the environment on health. At the local level, research has followed several strands, such as contextual effects of neighborhoods, the impact of differential access to services and amenities, effects of a neighborhood's collective efficacy, and the relationship between social capital and health. Of these four approaches, social capital has generated the most debate; some scholars discuss social capital as a key epidemiological variable, while others discount or dismiss its utility. We undertook this research to assess whether the concept of social capital could increase our understanding of the impact of neighborhoods on residents' health. We utilized key informant interviews and focus groups to understand ways in which residents of diverse neighborhoods in one large California city perceived that their local communities were affecting health. We argue in this paper that using the term "social capital" to discuss social resources and their mobilization in a particular neighborhood highlights the ways in which social resources can vary in relation to economic resources, and that residents of neighborhoods with differing levels of services and amenities face different issues when mobilizing to improve their neighborhoods. Additionally, the projects that people invest in vary by neighborhood socioeconomic status. We draw on the paired concepts of "bridging" and "bonding" social capital, and discuss that while stores of bonding social capital may be more uniform across neighborhoods of varying SES, bridging social capital tends to be found in greater amounts in neighborhoods of higher SES which allows them greater success when mobilizing to improve their neighborhoods.

Adult↗
PubMed2005

Toward a neighborhood resource-based theory of social capital for health: can Bourdieu and sociology help?

Within the past several years, a considerable body of research on social capital has emerged in public health. Although offering the potential for new insights into how community factors impact health and well being, this research has received criticism for being undertheorized and methodologically flawed. In an effort to address some of these limitations, this paper applies Pierre Bourdieu's (1986) [Bourdieu, P. (1986). Handbook of theory and research for the sociology of education (pp. 241-258). New York: Greenwood] social capital theory to create a conceptual model of neighborhood socioeconomic processes, social capital (resources inhered within social networks), and health. After briefly reviewing the social capital conceptualizations of Bourdieu and Putnam, I attempt to integrate these authors' theories to better understand how social capital might operate within neighborhoods or local areas. Next, I describe a conceptual model that incorporates this theoretical integration of social capital into a framework of neighborhood social processes as health determinants. Discussion focuses on the utility of this Bourdieu-based neighborhood social capital theory and model for examining several under-addressed issues of social capital in the neighborhood effects literature and generating specific, empirically testable hypotheses for future research.

Behavioral Research↗
PubMed2006

US state- and county-level social capital in relation to obesity and physical inactivity: a multilevel, multivariable analysis.

Although social capital has been linked to a variety of health outcomes, its association with obesity has yet to be elucidated. This study explored the relations between social capital measured at the US state and county levels and individual obesity and leisure-time physical inactivity. Individual-level data were drawn from the 2001 Behavioral Risk Factor Surveillance System survey, while data from other surveys and administrative sources were used to construct contextual measures. Two state-level social capital scales were derived from 10 indicators and two county-level scales from five indicators. In 2-level analyses of over 167,000 adults nested within 48 states plus the District of Columbia, residence in a state above the median on one or both state social capital scales (vs. neither scale) was associated with lower relative odds of obesity and physical inactivity, controlling for individual-level covariables and state-level estimates of mean household income, the Gini coefficient, and the percentage of Black residents. In 3-level analyses, the adjusted odds ratio (OR) for physical inactivity associated with residence in a county above the median on one or both county social capital scales was significantly below 1, while the association with obesity was not significant. Significantly weaker inverse ORs for the relations between state- and county-level social capital and obesity were observed among American Indians/Alaska Natives compared to Whites. Meanwhile, little support was found for mediation by social capital of the associations of urban sprawl and income inequality with obesity or physical inactivity. Overall, this study provides some evidence for the promotion of social capital as a potential strategy for addressing the burgeoning obesity epidemic.

Adult↗
PubMed2006

Do health behaviors mediate the association between social capital and health?

INTRODUCTION: There is increasing evidence that social capital is important for people's health. However, there is still considerable disagreement about the specific pathways that links social capital to health. This study investigates the hypothesis that the association between social capital and health is mediated by people's health behaviors. METHOD: Data from the 2002 Health Survey for England (n = 7394) were used and analyzed from a multilevel perspective. The association between social capital and self-rated health were examined before and after controlling for smoking, alcohol intake, and fruit/vegetable consumption. RESULTS: Social capital was found to be associated with self-rated health, as well as with the different health behaviors. In addition, the health behaviors were significantly related to self-rated health. However, controlling for smoking, alcohol intake, and fruit/vegetable consumption did not substantially affect the association between social capital and self-rated health. CONCLUSIONS: The results demonstrate that social capital and support are important determinants of self-rated health and health behaviors. But only limited support was found for the hypothesis that health behaviors mediate the association between social capital and health.

Adolescent↗
PubMed2001

Poor people, poor places, and poor health: the mediating role of social networks and social capital.

This paper explores the dynamics between poverty and exclusion; neighbourhood, and health and well being by considering the role of social networks and social capital in the social processes involved. It is based on qualitative research taking two deprived areas as exemplary case studies, and involving depth interviews with residents. Neighbourhood influences on networks and social capital were explored, network typologies developed reflecting structural and cultural aspects of individual's networks, and pathways implicated in health effects considered. The complexity of social capital is addressed. The role of three factors in influencing social networks and social capital are demonstrated: neighbourhood characteristics and perceptions; poverty and social exclusion, and social consciousness. Perceptions of inequality could be a source of social capital as well as demoralisation. Different network structures-dense and weak, homogeneous and heterogeneous- were involved in the creation of social capital and had implications for well being. Coping, enjoyment of life and hope are identified as benefits. Although participation in organisations was confirmed as beneficial, it is suggested that today's heterogeneous neighbourhoods also require regenerated local work opportunities to develop bridging ties necessary for the genesis of inclusive social capital and better health. Despite the capacity of social capital to buffer its harsher effects, the concept is not wholly adequate for explaining the deleterious effects of poverty on health and well being.

Adaptation, Psychological↗
PubMed2001

People, partnerships and human progress: building community capital.

The Victorian-era journal The Sanitarian used on its masthead the slogan 'A nation's health is a nation's wealth'. Today, we are re-discovering that wisdom, recognizing that health is indeed a form of wealth. Moreover, we are beginning to understand that wealth is not merely our economic capital, but includes three other forms of capital--social, natural and human capital. Health is one key element of human capital. A healthy community is one that has high levels of social, ecological, human and economic 'capital', the combination of which may be thought of as 'community capital'. The challenge for communities in the 21st century will be to increase all four forms of capital simultaneously. This means working with suitable partners in the private sector, making human development the central purpose of governance, and more closely integrating social, environmental and economic policy. Community gardens, sustainable transportation systems and energy conservation programmes in community housing projects are some of the ways in which we can build community capital.

Canada↗
PubMed2004

Operative technique of a new decompression procedure for Kienböck disease: partial capitate shortening.

A new decompression procedure for Kienböck disease, namely "partial capitate shortening," was developed. Patients in Lichtman stages 2 and 3A, independent of the ulnar variance, are candidates for this procedure. This procedure can dramatically reduce compressive forces on the lunate almost as much as a traditional decompression procedure of the capitate (capitate shortening combined with capitate-hamate fusion) and much more than the decompression procedure of the forearm bone such as radial shortening. We surmise that our procedure will allow better lunate revascularization. Although the scaphoid progressively adopts an abnormal palmarflexed position after capitate shortening combined with capitate-hamate fusion, partial capitate shortening can maintain normal carpal alignment, resulting in better joint congruency around the scaphoid and range of motion of the wrist. Moreover, partial capitate shortening allows minimal invasion and is an easy technique without bone grafting. Both operating and immobilizing time are shortened, and there are no secondary problems in the distal radioulnar and/or ulnocarpal joint often seen after radial osteotomy procedures.

Journal Article↗
PubMed2006

Searching for social capital: historical perspectives on health, poverty and culture.

Social capital has been seen as having a positive effect on health, and the concept of social capital has been viewed as of central importance to debates about healthy, sustainable communities. More generally, behaviour and its relationship with health has become much more central to policy-making, as illustrated in the Choosing Health White Paper (2005), and the concept of social capital has been one influence on the concept of social exclusion. Robert Putnam's arguments, both those expressed in Making Democracy Work (1993) and the revised version seen in Bowling Alone (2000) have been taken up by numerous social scientists and policy-makers. But despite the explicitly historical perspective that Putnam employs in Bowling Alone in particular, the history of social capital remains rather neglected in the available literature. This article is concerned with providing a historical perspective on social capital, especially the ways in which social investigators have viewed the relationships between health, poverty and behaviour. The article puts social capital alongside that of 'underclass' concepts such as the culture of poverty thesis, and examines how the latter has been invented and reinvented in the U.K. and the U.S.A. over the last 120 years. It argues that there are important similarities between the culture of poverty and social capital, but also significant differences, and these have implications for current policy initiatives. One way of analysing concepts like social capital and social exclusion more rigorously is by locating them within this longer-term history of social investigation, in which debates about health, poverty, and culture have been of

Community Health Planning↗
PubMed2005

Social capital and risk for chronic illnesses.

OBJECTIVES: This study used an ecological model of social capital to examine the relationship between social capital and chronic illness. The model hypothesizes that personal social support and collective social capital are related to risk for chronic illnesses. METHODS: Data were taken from the American Changing Lives public use database. Seven hundred and sixty-nine persons meeting inclusion criteria were included. Dependent variables were the reported presence of hypertension and diabetes. Logistic regression analysis was used to identify correlates of these chronic illnesses, including demographic variables, and social capital and social support variables measured at both the personal and collective levels. RESULTS: Significant results were usually consistent with model hypotheses; that is, measures of social capital and social support were related to the presence of diabetes and hypertension in expected ways. However, in other cases, the hypothesized relationships were not statistically significant, due to limitations in the model or data. DISCUSSION: Social support and social capital both serve as protective factors against chronic illness. Development of social capital may proceed from the personal family and social environment to collective measures of trust and engagement, and this suggests that family relationships are the foundation on which to base efforts to build social capital.

Adult↗
PubMed2006

Psychometric evaluation of a short measure of social capital at work.

BACKGROUND: Prior studies on social capital and health have assessed social capital in residential neighbourhoods and communities, but the question whether the concept should also be applicable in workplaces has been raised. The present study reports on the psychometric properties of an 8-item measure of social capital at work. METHODS: Data were derived from the Finnish Public Sector Study (N = 48,592) collected in 2000-2002. Based on face validity, an expert unfamiliar with the data selected 8 questionnaire items from the available items for a scale of social capital. Reliability analysis included tests of internal consistency, item-total correlations, and within-unit (interrater) agreement by rwg index. The associations with theoretically related and unrelated constructs were examined to assess convergent and divergent validity (construct validity). Criterion-related validity was explored with respect to self-rated health using multilevel logistic regression models. The effects of individual level and work unit level social capital were modelled on self-rated health. RESULTS: The internal consistency of the scale was good (Cronbach's alpha = 0.88). The rwg index was 0.88, which indicates a significant within-unit agreement. The scale was associated with, but not redundant to, conceptually close constructs such as procedural justice, job control, and effort-reward imbalance. Its associations with conceptually more distant concepts, such as trait anxiety and magnitude of change in work, were weaker. In multilevel models, significantly elevated age adjusted odds ratios (ORs) of poor self-rated health (OR = 2.42, 95% confidence interval (CI): 2.24-2.61 for the women and OR = 2.99, 95% CI: 2.56-3.50 for the men) were observed for the employees in the lowest vs. highest quartile of individual level social capital. In addition, low social capital at the work unit level was associated with a higher likelihood of poor self-rated health. CONCLUSION: Psychometric techniques show our 8-item measure of social capital to be a valid tool reflecting the construct and displaying the postulated links with other variables.

Adolescent↗
PubMed2004

The social capital:health relationship in two disadvantaged neighbourhoods.

OBJECTIVES: Research into the social determinants of health inequalities is increasingly focusing on macro-level forces affecting individuals and communities. The concept of social capital has been at the centre of this research as a potential explanatory framework for understanding these inequalities. The aim of this study was to identify the components that define social capital and its relationship to self-reported health in two neighbourhoods known to be disadvantaged in south-western Sydney. METHODS: This study uses data from cross-sectional household (door-knock) surveys originally developed as evaluation tools for neighbourhood based interventions. Secondary analyses including factor analysis and multiple regression analysis were used to provide empirical evidence of the components defining social capital and how these, as a concept, were associated with self-reported health. RESULTS: The study revealed six common social capital components in each sample and an additional component in one neighbourhood. These included neighbourhood attachment, support networks, feelings of trust and reciprocity, local engagement, personal attachment to the area, feelings about safety and proactivity in the social context. The social capital model incorporating demographic and socio-economic characteristics explained 23.4% of health variance in one neighbourhood, and 19.3% in the other. Examining the social capital:health relationship revealed that with the exception of feelings of trust and reciprocity, no other social capital component made significant contributions to explaining health variance and that macro-level factors such as housing conditions and employment opportunities emerged as key explanatory factors. CONCLUSION: If interventions are to use social capital as a way of addressing health inequalities, these need to look closely at the role of trust for improving health outcomes of deprived populations as well as ensuring access to resources and infrastructure.

Adolescent↗
PubMed2006

Social capital, family violence, and neglect.

BACKGROUND: Social capital includes collective efficacy, psychological sense of community, neighborhood cohesion, and parental investment in the child. It has been shown to be associated with a variety of health and welfare outcomes and may be useful in understanding and preventing parenting behaviors on the continuum of child abuse and neglect. OBJECTIVE: The purpose of this research was to evaluate low social capital as a risk factor for harsh physical punishment, neglectful parenting, psychologically harsh parenting, and domestic violence. METHODS: This study is an analysis of cross-sectional telephone survey data of mothers in North and South Carolina (n = 1435). We constructed a 4-point social capital index reflecting survey responses to items ascertaining neighborhood characteristics, willingness to take personal action, the presence of 2 adults in the household, and regular religious service participation. We assessed the relationship of social capital to inventories of self-reported parenting behaviors and in-home violence. RESULTS: In adjusted analysis, we found that each 1 point increase in a 4-point social capital index was associated with a 30% reduction in the odds of neglectful parenting, psychologically harsh parenting, and domestic violence. There was no relationship between social capital and harsh physical punishment. CONCLUSIONS: This study demonstrates that increasing social capital decreases the odds of neglectful parenting, psychologically harsh parenting, and domestic violence but not harsh physical punishment. This supports further investigation into developing social capital as a resource for families.

Child↗
PubMed1975

Capital expenditures and the availability of funds.

Data on capital expenditures and the availability of funds assembled from the annual financial and service records of 42 short-term voluntary hospitals in New York City over two decades were used to analyze the behavior of annual capital expenditures on building and equipment assets. Desired expenditures on capital as a factor of production are viewed as being the result of changes in anticipated output and of the substitution of capital for labor. Actual capital expenditures in each year also reflect the availability of flows of nonoperating revenues and the completion of capital programs initiated in previous years. Nonoperating revenues include philanthropy and earnings on financial assets as principal sources. A monetary revenue series, adjusted for changes in hospital charges, was used to measure output and thus to seperate the effects of demand for hospital services and supply of funds on investment behavior. The data were approached as annual aggregates for 42 hospitals over the years 1946-1966 and as annual hospital averages for teaching and nonteaching hospitals over the same period. In both approaches four causal factors-output, substitution, the flow of nonoperating revenues, and a distributed lag-explained about 95 per cent of the sample variance of capital expenditures. Allowing for available funds reduced the average time required for 95 per cent completion of a capital adjustment from 7 to 3 years. Responsiveness of hospitals to these economic variables suggests that socially desired investment can be attained by (a) "monetizing" needs of groups now underserved; (b) improving availability of funds if used for acceptable public purposes; and (c) including consumers in determining institutional and regional priorities.

Charities↗
PubMed1978

The crisis of the western system of medicine in contemporary capitalism.

This article makes a critique of current interpretations of the crises of the western system of medicine and presents alternative explanations for those crises. It indicates that the crises of medicine--reflected in its ubiquitous problems of costs and ineffectiveness--are due to and reflect the crises of legitimation and capital accumulation of contemporary capitalism. The article is divided into six parts: the first two define the characteristics of the crises of western contemporary capitalism and of its system of medicine, with a critique of current theories which try to explain them. Parts three and four contrapose to these theories a Marxist interpretation of the crises, tracing their causes to the needs created by the process of capital accumulation and to the demands expressed by the working population. The needs and demands generated by Capital and Labor are intrinsically in conflict, and are realized in the daily practice of class struggle. The characteristics and consequences of that struggle for health and for the organization, content, and ideology of medicine are analyzed in the fifth part. This class struggle takes place within a political context in which Capital and its social expression, the bouregeoisie or corporate class, have the dominant influence on the organs of the State. The sixth part of the article shows how that dominance determines the nature of the State responses to the crises of medicine. A primary thesis of this paper is that social class, class struggle, capitalism, and imperialism are not passé categories, as most ideologists of capitalism postulate, but rather they are the most important paradigms for understanding the crises of the western system of power and its medicine.

Democracy↗
PubMed2001

Social capital, disorganized communities, and the third way: understanding the retreat from structural inequalities in epidemiology and public health.

The construct of social capital has recently captured the interest of researchers in social epidemiology and public health. The authors review current hypotheses on the social capital and health link, and examine the empirical evidence and its implications for health policy. The construct of social capital employed in the public health literature lacks depth compared with its uses in social science. It presents itself as an alternative to materialist structural inequalities (class, gender, and race) and invokes a romanticized view of communities without social conflict that favors an idealist psychology over a psychology connected to material resources and social structure. The evidence on social capital as a determinant of better health is scant or ambiguous. Even if confirmed, such hypotheses call for attention to social determinants beyond the proximal realm of individualized sociopsychological infrastructure. Social capital is used in public health as an alternative to both state-centered economic redistribution and party politics, and represents a potential privatization of both economics and politics. Such uses of social capital mirror recent "third way" policies in Germany, the United Kingdom, and United States. If third way policies lose support in Europe, the prominence of social capital there might be short lived. In the United States, where the working class is less likely to influence social policy, interest in social capital could be longer lived or could drift into academic limbo like other psychosocial constructs once heralded as the next big idea.

Community Health Planning↗
PubMed2003

Capitate transposition to replace necrotic lunate bone with a pedicle for Kienbock's disease: review of 30 cases.

OBJECTIVE: To investigate the clinical application of capitate transposition with a pedicle in 30 cases of Kienbock's disease. METHODS: The external diameter and curvature of the capitate head and proximal facet of the lunate were observed and measured in 100 specimens. The vascularity of the capitate was also investigated. Capitate transposition with a vascular pedicle was designed to treat 30 patients with advanced Kienbock's disease who were followed up for 2 to 16 years and then analyzed according to Evans's scoring system. RESULTS: Aseptic necrosis did not occur in the transposed capitate because the pedicle fascia including the dorsal branch of the anterior interosseous artery ensured the vascularity of proximal two thirds of the capitate. The transposed capitate reestablished a relatively pain-free radiocarpal joint. Follow-up results showed that grip strength and motion arc were up to 70% of contralateral side. CONCLUSIONS: Capitate transposition with a pedicle is a reliable treatment method for advanced Kienbock's disease, with favorable prognosis for at least five years postoperatively.

Adolescent↗
PubMed2000

Needs-based primary medical care capitation: development and evaluation of alternative approaches.

OBJECTIVE: To develop and evaluate alternative methods of adjusting primary medical care capitation payments for variations in relative need for health care among enrolled practice populations. METHODS: We developed alternative needs-based capitation formulae and applied them to a sample of capitation-funded primary care practices to assess each formula's performance against a reference standard of capitation payments based on age, sex and self-assessed health status of the enrolled populations. The alternative formulae were based on: (1) age and sex; (2) age, sex and individually-measured socioeconomic characteristics; (3) age, sex and socioeconomic characteristics imputed from census data for enrollees' neighbourhood of residence; (4) age, sex and standardized mortality ratio for enrollees' neighbourhood of residence. RESULTS: Age/sex-adjusted capitation payments for the six practices studied ranged from 10% higher to 18% lower than the reference standard payments. Capitation formulae based on socioeconomic and mortality data did not perform consistently better than the current age/sex-based formula. CONCLUSIONS: Primary medical care capitation payments adjusted only for age and sex do not reflect the relative health care needs of enrolled practice populations. Our alternative formulae based on socioeconomic and mortality data also failed to reflect relative needs. Methods that use other approaches to adjusting for differences in relative need among enrolled populations should be investigated.

Adolescent↗
PubMed2002

Mental health costs and access under alternative capitation systems in Colorado.

OBJECTIVE: To examine service cost and access for persons with severe mental illness under Medicaid mental health capitation payment in Colorado. Capitation contracts were made with two organizational models: community mental health centers (CMHCs) that manage and deliver services (direct capitation [DC]) and joint ventures between CMHCs and a for-profit managed care firm (managed behavioral health organization, [MBHO]) and compared to fee for service (F.F.S.). DATA SOURCES/STUDY SETTING: Both primary and secondary data were collected for the year prior to the new financing policy and the following two years (1995-1998). STUDY DESIGN: A stratified random sample of 522 severely mentally ill subjects was selected from comparable geographic areas within the capitated and FFS regions of Colorado. Major variables include service cost, utilization, and access (probability of service use) derived from secondary claims data, subject reported access collected at six-month intervals, and baseline outcomes (symptoms, functioning, and quality of life). PRINCIPAL FINDINGS: In comparison to the FFS area, cost per person was reduced in the capitated areas in each of the two years following implementation. By the end of year two, cost per person was reduced by two-thirds in the MBHO areas and by one-fifth in the DC areas. Reductions in access were found for both capitated areas, although reductions in utilization for those receiving service were found only in the MBHO model. CONCLUSIONS: Medicaid mental health capitation in Colorado resulted in cost reducing service changes for persons with severe mental illness. Assessment of outcome change is necessary to identify cost effectiveness.

Adolescent↗