Social Capital and Health - Findings from the Scottish Health Survey and Scottish Social Attitudes Survey

1 Introduction

1.1 Recent years have seen growing interest in understanding how an 'assets-based' approach might help address some of the long-standing problems and inequalities associated with health in Scotland. In his foreword to a paper launching the Assets Alliance Scotland (Assets Alliance Scotland, 2010), the Chief Medical Officer referred to research by the Glasgow Centre for Population Health, which has compared Glasgow with Manchester and Liverpool and found that income inequalities alone cannot explain Glasgow's relatively poor health. There appears to be a 'Glasgow effect' and indeed a 'Scotland effect' in relation to health that cannot be reduced simply to differences in socio-economic structures. Instead, it is suggested that this difference is psychosocial, relating to cultural forces, particularly in the most deprived communities, that go beyond differences of economic position. As the Chief Medical Officer puts it, 'there is something within the spirit of individuals living within deprived communities that needs healed'. An assets-based approach seeks to rectify this situation, by focusing on supporting and utilising the innate capacities and coping mechanisms that individuals and communities possess. In doing so, it is hoped that health will improve, because people will be equipped to take control of their social circumstances and sustain their own wellbeing.

1.2 In its focus on psychosocial factors and on the associations and informal linkages that exist within the community and between the community and external institutions, the assets-based approach has clear links with research on the relationship between ‘social capital’ and health. The Office of National Statistics (ONS) has adopted the Organisation for Economic Co-operation and Development (OECD) definition for their work on social capital, which highlights the role of networks as well as the importance of shared values and understandings: “Networks together with shared norms, values and understandings that facilitate co-operation within or among groups” (Cote and Healy, 2001:41). This link is explicitly referred to in the Chief Medical Officer’s most recent annual report (2011), which highlights the ‘recognition of social capital (the connections within and between social networks) and its importance as an asset’ in discussing Area Based Community Development as an assets-based approach that could be applied to improve health and wellbeing. Conversely, in perhaps the best known account of social capital, Bowling Alone, Putnam (2000) links declining social capital with a range of negative outcomes for health and wellbeing. He argued that people in America have become disconnected from their family, friends, neighbours and social structures and that this shrinking access to social capital was associated with health outcomes ranging from more teenage pregnancies to higher mortality rates. He points to studies that indicate that stroke victims with strong support networks recover more physical capacities than stroke victims with weak social networks, and that older people who are involved with clubs, volunteering or local politics consider themselves in better general health than uninvolved people, even after accounting for socio-economic status and other demographic factors.

1.3 This paper explores the Scottish evidence for a link between social capital and health outcomes in order to inform the ongoing development of an assets-based approach to addressing health problems and inequalities. It uses data from two sources - the 2009 Scottish Health Survey (SHeS 2009^[1]) and the 2009 Scottish Social Attitudes survey (SSA 2009^[2]), although the majority of the paper focuses on the former due to the inclusion of self-assessed health plus WEMWBS variables. The Scottish Health Survey is commissioned by the Scottish Government and aims to monitor health in Scotland, while the Scottish Social Attitudes survey is an annual survey exploring social and political attitudes. In 2009, both surveys included a number of measures of social capital, alongside a wide range of demographic measures and relevant health outcomes.