Social Capital and Health: Maximizing the Benefits

What Is Social Capital and Why Is It Important to Health Research and Policy?

Sandra Franke, Policy Research Initiative, Government of Canada

Various definitions and approaches have emerged in the development of social capital theory. Establishing a common definition and approach to social capital has been part of a Government of Canada project conducted by the Policy Research Initiative (PRI). This article describes the "network approach" adopted by the PRI and explains how it provides a mechanism for understanding how public intervention and government services can take social ties into account to achieve their goals, particularly in the areas of disease prevention and health care.

A Collaborative Effort

In January 2003, a committee of Assistant Deputy Ministers from 12 federal departments requested that the PRI investigate the role and contribution of social capital in Canadian public policy research, development and evaluation. Through its project Social Capital as a Public Policy Tool, the PRI developed an operational definition of the concept,¹ proposing a framework for the analysis and measurement of social capital in a government context² and identifying key policy and program areas where social capital could play an important role.³ The PRI also put forward a number of major recommendations with respect to the utility of social capital as a concept in the public policy context.⁴

Perspectives on Social Capital

Literature on the subject distinguishes between different broad perspectives or approaches to social capital; while each has a different emphasis or focus, they have important aspects in common, such as the notions of participation, cooperation and solidarity. However, there are differences in how each one considers such ideas as social cohesion, engagement, trust, reciprocity and institutional efficacy. Of the main approaches, one focuses on the propensity for people or organizations to cooperate to attain certain objectives⁵--looking at what motivates them to form associations, the types of associations they form and their perception of collective issues (reflecting cultural beliefs and influences).⁶ Another focuses on the conditions, both favourable and unfavourable, for cooperation--placing emphasis on the social and political structures of a community that convey values and norms, such as trust and reciprocity, which in turn create conditions for social and civic engagement.⁷ A third, a "network approach" which the PRI has pursued, emphasizes the structures that may enable cooperation--the network structures that provide access to key resources.

While presenting interesting and varied views on social capital, the development and use of different approaches have contributed to skepticism about the value of social capital as a concept, and sometimes to its being underutilized as a research instrument. This is one reason that the PRI has worked extensively across the federal government to achieve consensus on the definition of social capital.

Using a Network Approach for Public Policy

Through the PRI 's collaborative project, the network approach has emerged as a common perspective to help understand social capital in a public policy context. Understanding how networks give individuals and groups a way of obtaining useful resources and studying how they access and mobilize these resources productively provides considerable useful material for public policy practitioners. Opting for this approach, the PRI recommended that the Government of Canada adopt the following definition: Social capital refers to the networks of social relations that may provide individuals and groups with access to resources and supports.⁴

The network approach is based on the notion that the structural and dynamic aspects of social relationships provide access to certain resources, including information, social support and material aid.^8,9,10 It considers both individual social capital (the social networks through which an individual finds the resources he or she needs), as well as collective social capital (the networks formed by social groups within a community to achieve the resources needed to attain their goals).

In order for the network approach to support social capital research as an effective tool, it must be considered within a much broader context. Rather than viewing social networks in isolation, they need to be considered in combination with other resources that operate in different ways, depending on their context. The PRI developed a framework that captures this broader context.

The PRI framework distinguishes what social capital is (i.e., structure and operation of networks) from what it does (i.e., has direct effects and results), while identifying its sources (i.e., its determinants). It positions social capital as an independent variable--and not as an end in itself--so that its contribution to attaining results can be studied in any field of research, making it a very useful tool for public policy.

Figure 1: PRI Framework for the Analysis of Social Capital

Source: Adapted with permission from Policy Research Initiative, 2005.⁴

Social Networks: A Form of Capital

Most people do not think of the ties they create as an investment like their savings or their education. However, from a public policy perspective, it may be an appropriate way to look at how people rely on their social networks to resolve difficult situations or to get ahead. The term "capital" is merely an expression of the idea that, in certain situations, relationships can be a resource and viewed in a similar way as financial, human or physical resources. A better understanding of the synergy between the various forms of capital throughout a person's life (i.e., the complementarity, substitution or leverage of one form of capital relative to another) supports the design of policies and programs that are tailored to people's needs.

In essence, the network approach looks at social ties as a vehicle for delivering needed resources and supports. These include: tangible resources (material goods, financial assistance, services, information or advice); social support (emotional support, presence, friendship); influence (reinforcement of positive behaviours); capacity building (ability to deal with adversity, self-control, self-determination); and service brokerage (effective access to services for those who are unable or unwilling to access services by themselves).

Stocks and Flows

It is also useful to use the concept of capital stocks and flows to look at the way social capital operates to produce results.¹¹ Social capital stocks refer to the presence and different types of an individual's social relationships in their various forms and combinations. One useful typology distinguishes between bonding, bridging and linking, but other typologies may be more appropriate, depending on the field under study. Each type of relationship gives access to a different range of resources.

Social capital flows refer to the way social relationships come into play in a given situation. Social capital inflows involve investments (emotionally, in time, in effort, etc.) that allow an individual to accumulate a stock of social capital. These investments are the conditions or processes that create and maintain social ties. Social capital outflows are the conditions and processes that allow individuals to use that stock to achieve socioeconomic and health benefits.

How Is Social Capital Created and Used?

A network perspective of social capital that is considered in a broader analytical context, as discussed earlier, allows researchers to identify, describe and measure the entire set of variables that come into play in examining the instrumental role of social relationships. However, in specific situations, the determinants of social capital are not always easy to identify. Nor is it always easy to establish with certainty the direction of the relationship between social capital and the outcomes.

Take, for example, the creation of social capital at the individual level. Does social engagement help to create social capital for individuals? Considering the question in the context of the network model shows that the answer depends; in some circumstances, membership in a group may indeed contribute to the social capital of an individual--if it leads to concrete social relationships. Here, social engagement could be considered as a determinant of social capital. But this is not always the case--some forms of involvement, such as voting, do not necessarily create new ties.

Another example sheds light on the difficulty of determining causality--in this case, at the collective level. Is social cohesion in a community the result of thriving networks, or is it an input that creates the networks? In a particular community, cohesion may be the result of networks, but it is not necessarily because a community is rich in networks that it is cohesive. It all depends on the end purpose of the networks.

Such examples point to the importance of avoiding the use of social engagement or social cohesion (or other concepts, such as trust) as a proxy for social capital. They also reinforce the importance of carefully considering the research hypothesis and clearly grounding it in an analytical framework. Moreover, validating the hypothesis allows the researcher to better understand in which circumstances social capital is created, and in which circumstances it is used to produce specific results. Data from longitudinal or very detailed surveys provide the best evidence.

Health Policy and Social Capital

The question of whether or not governments should intervene or play a role in shaping social capital has been asked increasingly in recent years. In fact, to varying degrees, governments already influence the way social relationships unfold--the configuration of and access to public spaces, programs of mentoring and home care, support for community groups and natural caregivers, and partnerships with community organizations--to name a few. Adopting a perspective based on social capital simply means paying explicit attention to the role of social relationships in attaining policy objectives and, inversely, looking at the effects of policies on social relations. A social capital perspective is particularly relevant and useful in three social policy areas⁴-- helping populations at risk of social exclusion, supporting individuals in major life transitions, and encouraging and promoting community development.

Vulnerable Populations

We know that there is a close association between the existence and quality of interpersonal ties and mortality, morbidity, convalescence and adjustment to chronic disease or limitations on activity.^12,13 For example, the type of social environment into which a person is integrated has a direct relationship on health-related behaviours, for better or for worse (e.g., use of tobacco, drugs or alcohol, diet, physical activity, sleep, use of medications).¹⁴ Good social integration generally makes for good social support, or at least the feeling that it is accessible. On the other hand, social isolation is associated with a deterioration in health, particularly mental health, because of the negative effects associated with it, including alienation.¹² Health policies need to look at the extent to which those populations most at risk for suffering from social exclusion and isolation could make better use of social networks to achieve improved health. Such populations include people who have a disability or illness, older persons, recent immigrants and those living in poverty or in marginalized communities--in particular, some First Nations and Inuit communities.

Major Life Transitions

A better understanding of the evolution of an individual's social networks and the different roles they play at key points in life phases is equally important for the development of health policies. For example, family ties have implications for child development that affect lifelong habits; peers are influential during the transition to adult life; the passage into parenthood creates pressures (maternity, neonatal care); and social support comes into play in episodes of illness, sudden limitations on activities, as well as in the aging process. There is still much to be understood about the specific structure and dynamics of the social networks relating to these processes, as well as about which populations make the best use of their social capital under these circumstances.¹²

Health and Community Development

The role of social networks in community health is also an avenue of interest for health policy development. What is important here is the quality of cross-sectoral cooperation among community stakeholders, specifically those whose interventions are aimed at improving population health and reducing health inequalities.¹⁵ This approach calls for interventions that go beyond the health sector to include action on poverty, education, employment conditions, quality of the natural and built environments, safety, access to information and other dimensions--all of which have an impact on health at the community level.¹⁶ In this sense, the quality of cross-sectoral cooperation is essential. There are a number of strategies that can help to maximize the ability of stakeholder alliances to achieve health policy objectives. These include looking at the types of collective networks and at the relationships among organizations in a community, identifying and creating favourable conditions for them, and eliminating barriers that limit their reach.

Potential of the Network Approach

It is hoped that adoption of a single model--specifically the network approach--by the federal government will dispel confusion about the social capital concept, while maximizing its contribution to policy and program research, development and evaluation. The approach holds potential in a number of issue areas, including immigrant integration, the fight against poverty and social exclusion, professional development, public safety, civic participation, community development and health. The network approach can be tailored to a wide range of areas, and can be used more directly or less directly, depending on the issue and the desired results. Some articles in this issue delve into specific applications; others outline the approach's broader potential.