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The editorial debate between several of the most prominent researchers of inequalities in the health field in this issue draws attention to two critical issues arising from different approaches to the conceptualisation of social capital. Firstly, the neglect of questions of power—its distribution and maintenance—in research on the relation between social capital and health. Secondly and more broadly the need to move beyond either a neo-Marxist or neo-Durkheimian explanation for inequalities in health so as to understand the economic imperatives that shape the distribution of all forms of capital. There are, however, two further imperatives for future work on the conceptualisation of social capital and the study of the relation between social capital and health. Firstly, social capital must be conceptualised as a dynamic process involving people living in places. As such it is a process with a past as well as a present and future. Secondly, existing research fails to consider the subjective, experiential dimension of social capital. Basically, future research on inequalities in health needs to move beyond the seemingly endless debates about macro statistical relations evident in these fascinating editorials. There are two developments urgently needed. Firstly, to link two somewhat separate domains of research—on area effects and social capital—and secondly, to link different “ways of knowing” about inequalities in health—provided by survey data, subjective narratives and historical documentary data.
Much of the work on area and health to date has tended to focus on aspects of the physical and material environment but increasingly people are attempting to include in measures of the “area effect” aspects of what is variously termed “social capital” and/or “social cohesion”. There are, however, several problems with this research. Firstly, it is generally based on administratively defined areas, which may bear little if any relation to the areas in which people perceive themselves to live. Secondly, the measures of “area effects” too often depend on the summation of individual and/or household data—for example deprivation indices—rather than being higher level measures of characteristics of the area that are “independent of the individuals who live there”. (The Glasgow group's work is an exception here.) Thirdly, it is difficult to decide whether aspects of social capital and/or social cohesion are best treated as compositional or contextual or something different from either of these two. Fourthly, and linked to this, there is a lack of clarity regarding the theoretical basis for, and therefore the measurement and analysis of dimensions of social capital.
In research I am undertaking with colleagues at the Universities of Salford, Lancaster and Cardiff we have attempted to construct a measure of social capital that incorporates aspects of social activism separately from social involvement and social support. From this we conclude that while more traditional measures of area effect have little if any power, our indicators of social capital—arguably richer measures of “context”—do have an impact over and above that of composition. But what of the subjective experiences of these areas—what do they add to this picture—and what if anything are we able to say about the historical dimension.
We are identifying a number of themes in the narratives of place and identify those that are relevant to the debate about the relation between social capital and health inequalities. This research involves in depth interviews with people living in four areas with contrasting material circumstances—two relatively disadvantaged and two relatively advantaged. Access to good quality and/or convenient facilities and services are important criteria for people in all four areas when making judgements about the quality of the place they live. However, a positive judgement about physical aspects of areas and convenience for services and transport routes can be rapidly swamped by what is perceived to be the “social decline” of an area. People in declining/disadvantaged areas clearly feel that they have little if any choice about where they live, but there are different narratives here. Some describe the decline of an area, which they previously perceived to be a good place to live. These narratives tell a story of powerlessness in the face of what is frequently described as major and rapid “social disintegration” as areas they value are “going down the pan”. A second type of narrative is about being “placed” in an area, which is perceived in a negative light by the respondent, and, they believe, by others outside the area. There is no sense in these accounts of areas with positive pasts although these too are stories of lack of control and choice. In both types of narratives, however, people describe how they struggle to distance themselves from those they live amongst—in both accounts normative notions of the importance of living in a “proper place” amongst “proper people” are evident.
These narratives “challenge” the research endeavour that concerns itself with the arguably “artificial” pursuit of separation between the composition and context of an area. Rather than seeking to disentangle the characteristics of the people who live in places from the characteristics of the places—including at least some material characteristics—these narratives tell a story of close and compelling linkages between people and the places they live in. To the extent that these relations are the “stuff” of social capital, they suggest that social capital is neither contextual nor compositional but rather generated, accessed and/or used at the interface between people and places. Our historical work is very preliminary but it does provide some fascinating glimmers of the potential salience of historical research. At the end of the 19th century and the early part of the 20th century, one of our four disadvantaged areas was known within the region for its active civic life. It was a place where, for example, according to one councillor, local politicians were well advised to keep clear of because “they'll organise public meetings at the drop of a hat”. Today, in contrast, it epitomises the supposed “collapse” of local democracy and political indifference and inertia frequently reported on in popular and academic medium. Much has happened between these two points in time and only fine grained historical research will help us understand the processes involved. In particular, we need to understand the extent to which experience of previous waves of urban renewal and regeneration might “cast long shadows forward” in terms of individual and collective action today.