Elsevier

Social Science & Medicine

Volume 66, Issue 5, March 2008, Pages 1174-1184
Social Science & Medicine

Social capital in its place: Using social theory to understand social capital and inequalities in health

https://doi.org/10.1016/j.socscimed.2007.11.026Get rights and content

Abstract

Social capital has been controversially linked to public health benefits, particularly as an explanation for the relationship between economic inequalities and health. This paper focuses on social capital in this context, particularly a recent emphasis on social capital in neighbourhoods and growing use of Bourdieu's social theory in empirical investigations. A review of some of this work is used to suggest the need for a more coherent theoretical approach to using Bourdieu and to introduce an ethnographic study of social connections in New Zealand. Forty-six residents of, a rural town, a deprived city suburb, or an affluent suburb, volunteered to be interviewed about their social connections. Their talk was transcribed and analysed in terms of everyday practice. The results of this study suggest that social connections are not necessarily located in neighbourhoods, and that social capital will be better understood in a broader social context which includes competition for resources between deprived and non-deprived groups, and the practices of all citizens across neighbourhoods. When considering social capital, an exclusive focus on deprived neighbourhoods as sites for research and intervention is not helpful.

Introduction

The social capital concept has been developed independently in areas such as sociology, education, and political economy and drawn on by public health researchers since the 1990s to consider social effects on inequalities in health. In their review, Moore, Haines, Hawe and Shiell (2006) argue that since the introduction of the concept, health related research has drawn most heavily upon Putnam's (1995) conceptualisation of social capital in terms of “features of social organisation, such as civic participation, norms of reciprocity, and trust in others” which are assumed to be beneficial. However, this use has been critiqued as ill-defined and innumerable commentators have called for better theories (e.g. Baum, 1999, Blakely et al., 2006, Campbell and Gillies, 2001, Fassin, 2003, Lochner et al., 1999, Muntaner and Lynch, 1999, Szreter and Woolcock, 2004). Hawe and Shiell (2000) and Macinko and Starfield (2001) have pointed to inconsistencies between the conceptualisations and measures used, and Portes (1998) and Woolcock (1998) noted the conceptual fragmentation of approaches. On political grounds there has been concern that the popularity of the concept allows social policy to ignore structural inequalities (Fassin, 2003, Muntaner et al., 2001) and to place responsibility for the effects of poverty on the poor (Pearce & Davey Smith, 2003).

Recently, Moore et al. (2006) have suggested that important aspects of the social capital concept have been “lost in translation” to the discourse of public health. In particular, understandings of social capital as resources accessed through membership in social networks (Lin, 1999) have been lost. This shift in conceptualisation has been reflected recently in moves toward including the social theory of Pierre Bourdieu who originally defined social capital as “the aggregate of actual or potential resources linked to possession of a durable network…” (Bourdieu, 1986). For example, both Carpiano (2006) and Ziersch (2005) have drawn on Bourdieu to contribute considerations of the differences between the antecedents, actual resources, and outcomes of social capital. Ziersch (2005) surveyed members of two Australian suburbs to assess the implications of access to social capital for health. She drew on both Putnam and Bourdieu to conceptualise and measure social capital in terms of networks and values that facilitate access to resources and resources available through this infrastructure. Her findings show that some elements and pathways were related to mental health but none to physical health. Ziersch suggests that this complex and fragmented approach to measurement is the key to understanding social capital components that health promoters may target, although she also warns against a prescriptive and potentially “victim-blaming” approach to local social capital promoting activities. Carpiano (2006) draws more fully on Bourdieu's sociological theorising to construct a detailed conceptual model of neighbourhood based social capital which focuses on social networks and the importance for the individual of being connected to networks that possess beneficial resources. Carpiano separates the measurement of resources from that of their antecedents or consequences. However, to develop an empirical model for the assessment of social capital in neighbourhoods, he departs from Bourdieu. Like Ziersch, he uses existing empirical work to itemise elements for measurement: social support, social leverage, informal social control, and neighbourhood organisation participation. Carpiano (2007) tested this model in a study comparing neighbourhoods in Los Angeles and found little support for hypotheses about the relationship between these elements of social capital at neighbourhood level with health behaviours or perceived health. These shifts, from Putnam's empirically based account of social capital in terms of norms that are universally beneficial, to more clearly defined conceptualisations of networks and resources as the basis for empirical enquiry, are appealing given past problems and critiques. However, there are three major issues to be addressed in this present application of network theories: the focus on geographical location, the interpretation of social theory, and methodological problems.

First, the focus on neighbourhood as the site of access to social capital does not accord with recent recognition that neighbourhood is not necessarily community (Szreter, 2002) and that the value of social capital is in broader social connections (Szreter & Woolcock, 2004). There has been a focus on “community” since the new public health developments in the 1970s. Shiell and Hawe (1996) pointed to acceptance that “sense of community” and “community competence” in neighbourhoods contribute directly to health, and research and policy focus for reducing health inequalities in the UK has been on “poor places” (Cattell, 2004). The communitarian approach to health has associated neighbourhoods with communities (Moore et al., 2006) and hence with social networks. Here, neighbourhoods are understood as residential areas which are typically measured either objectively (as in classifications of deprivation, affluence, or crime rates in clusters of residences; e.g. Virtanen et al., 2007) or subjectively (e.g. by asking respondents to consider their local area within a 15 or 20 min walk or drive from their home; see Bowling & Stafford, 2007). However, Veenstra (2005) and Veenstra et al. (2005) are among those who have used empirical work to question whether neighbourhood is clearly related to measures of social capital or health. Edmondson's (2003) ethnographic research makes the point that the importance of location as the focus of social life is contextual across time and place, and we can observe today that many people do not base their social life in their neighbourhood of residence. Another way of describing this is to draw on Bourdieu, as Gatrell, Popay and Thomas (2004) have done, to show empirically that neighbourhood is not the same as ‘social space’. They found that social space, described using Bourdieu's relational approach and delineated by economic capital and social capital, is related to health but dispersed across different geographical spaces. Carpiano (2006) and Ziersch's (2005) models neglect this recognition of the importance of the wider social and political environment, although Putnam (2000) had already noted that close connections within groups (bonding) may seem helpful, but it is the connections between different groups (bridging) that allow sharing of resources and are accordingly more beneficial. In relation to neighbourhood groups, qualitative studies in the UK (Campbell et al., 1999, Cattell, 2001) and in the USA (Altschuler, Somkin, & Adler, 2004) have found that these external links or bridging networks are potentially more important in regards to well-being than social connections within neighbourhoods, and Portes (1998) has reviewed evidence for the damaging effects of neighbourhood networks. Bourdieu's theorising provides an explanation of the advantages of social networks that is not in terms of exclusive neighbourhood bonds, but across different fields of practice in a broader conception of social relations.

This brings us to the second problematic issue which is the way that some health researchers have drawn upon Bourdieu's theorising and forced a fragment of his social theory into models based in an existing communitarian approach. Focussing on neighbourhood communities as units within which social capital has its effects omits the broader social issues which are the very basis of Bourdieu's (1977) theory of practice. Bourdieu uses capital as a metaphor for power (Fine, 2001), in which the notion of capital includes not only economic resources but also the benefits of access to cultural, symbolic, and social capitals. Thus, social capital is only one form of capital within a political economy in which all capitals are resources (Bourdieu, 1986). Competition for access to these interconnected resources is constantly enacted across different fields of practice, such as education, sport, or commerce, in everyday life (Bourdieu, 1984). Social capital may be understood as a good in these terms, but it is not available for the taking: one very important aspect of the social reality of competition for resources (Bourdieu & Wacquant, 1992) is the exclusion of members of other groups from access. In “Distinction” Bourdieu (1984) describes the social mechanisms of exclusion through which dominant groups accord status to preferences for, and ownership of, objects like art, music or food. He has also pointed out (Bourdieu, 1986) that, while economic capital is the basis of wealth, social and cultural capitals are mechanisms that ensure transmission of capital within wealthy groups. Thus, Bourdieu explains the interrelationship of material, social and cultural capitals, and at the same time shifts our attention from the deprived in society (or people who live in poor places) to the role of the wealthy in perpetuating inequalities. The understanding that possession of capital is about unequal social relations between groups, and about exclusion of others from beneficial resources, maps well onto current observations of health inequalities. Campbell, Cornish, and Mclean (2004) note the perpetuation of inequalities figured by this conceptualisation of power: possession of economic, social, and cultural capitals facilitates the accumulation of more, and those with the least remain powerless. Veenstra (2007) has drawn on Bourdieu's theory and methods to describe how Canadians from 25 communities were located in social spaces delineated by economic, cultural, and social capitals. Occupation of positions across the social spaces (and not geographical spaces) was related to differences in self-rated health and depression; those with the lowest income, lowest status occupations, and fewest social connections reported poorer health. Thus, attention to this broader notion of social space, as described by Bourdieu, provides a basis for empirical enquiry in relation to health; the workings of social capital may be observed in the connections of everyday social life across geographical spaces, and between wealthy as well as poor people. This will be the basis of the study described in this paper, however, there are some methodological considerations to be made in undertaking such a shift.

The third issue then is in methodological approaches to observing the function and effects of social capital conceptualised in this way. Williams (2003) has critiqued the generally positivist approach to research on inequalities and health. Following epidemiological observations of correlations between inequalities in socio-economic status and health, subsequent research (e.g. Wilkinson, 2005) has sought explanations based on conflation of ontological and epistemological levels of understanding. Variables, such as social capital, are hypothesized to mediate the relationships between inequalities and health in a causal linear flow and proposed for empirical testing as a series of quantifiable relationships. This leads to testing dubiously measured (Fassin, 2003) fragments of the constructs and any relationships that are apparent are seen as subject to the limitations of place and not generalisable (Ziersch, 2005). Edmondson (2003) describes how reducing social capital to single variables measured at the neighbourhood level, omits the broader social and historical view. Social capital is not a single ‘thing’ because the ways social relations are enacted is changing both culturally and historically (Morrow, 1999). However, this suggestion of complexity does not mean that repeatedly applying complex models with multiple parameters to different sorts of neighbourhoods will help understanding. Bourdieu (1984) has warned of the “…the mistake of inventing as many explanatory systems as there are fields, instead of seeing them as a transformed form of all the others; or worse, the error of setting up a particular combination of factors active in a particular field of practices as a universal explanatory principle” (p. 113).

Williams' (2003) recommends a critical realist approach in which the social reality of the flow of capitals may not be observed directly (although its effects on health are) and is not necessarily linear. The key assumption here is that there is a social reality that may not be directly observed but may be described; the criteria for testing social theories “…cannot be predictive, but must instead be exclusively explanatory” (Scambler, 2002, p. 43). Bourdieu (1984) sees capital as “a social relation…which only exists and only produces its effect in the field in which it is produced and reproduced” (p. 113). Veenstra (2007) has described the importance of this relational theory to his use of correspondence analysis to describe social spaces. However, Bourdieu (1984) also noted that this sort of survey produces a “snapshot” taken “after the battle” for a continually contested and negotiated set of social relations and values, in which the researcher's measures themselves are “weapons and prizes in the struggles between the classes” (pp. 245–246). Accordingly, he recommends a variety of methods to capture social space. Edmondson (2003) has demonstrated the usefulness of ethnographic research, and Altschuler et al. (2004) used interviews and focus groups to study “processes and actions of people's relationships…” (p. 1221), and to show how social resources vary according to economic resources. Thus, qualitative methods were also chosen for the present study that was designed to explore people's social connections. In regard to Bourdieu's theory of practice, we aimed to ask people about their social life in terms of everyday practice. These practices were also to be examined in relation to the differences in people's access to material resources (deprived and non-deprived groups) and to differences in their geographical situation (rural and urban).

Section snippets

Method

Interviews and small group interviews were conducted with residents in three different neighbourhoods in, or near, a New Zealand provincial city (population 100,000). The areas were chosen to include urban and rural localities, and both deprived and non-deprived areas. The small rural town (we named ‘Watersdown’) was selected because of its proximity to the city (30 km) and its mix of farming and town dwellers in a small area. Two urban neighbourhoods were selected according to levels of

Social connections

An immediate finding was that, although we had focussed on neighbourhood or local community in structuring the study, in explaining its purposes to participants, and in many interview questions, the primary daily connections reported were not related to neighbourhood. The important connections operated across several different fields of practice such as family, schooling, work, and recreational activities beyond the neighbourhood.

Discussion

In public health research there has been a shift toward applications of Bourdieu's network based theory of social capital to explanations of social inequalities and health. However, Bourdieu's use of the social capital metaphor must be understood as part of a broader social theory and not treated as an autonomous ‘variable’ to be shoe-horned into models based on other assumptions. This broader theory does not focus on local connections as a source of beneficial social capital and suggests

Acknowledgements

Thanks to Anne-Marie Gillies and Neil Pearce for their support for this project, and to three anonymous reviewers for their comments on an earlier draft of the paper.

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