Self-rated health and social capital in transitional countries: Multilevel analysis of comparative surveys in Armenia, Azerbaijan, and Georgia

The role of health and health systems in promoting social capital, political participation and peace: A narrative review

High levels of violence and insecurity are highly detrimental for societies. United Nations Sustainable Development Goal 16 is advocating for peaceful, accountable and inclusive institutions as one powerful channel to foster global development. Investing in health and health policies can potentially contribute achieving these objectives. After providing a conceptual framework, this article reviews the existing literature on the evidence of the role of health and health systems in promoting social capital and trust, political engagement and participation, and peace that closely relate to the objectives of Sustainable Development Goal 16. We provide evidence of a systematically positive impact of better physical and mental health on social capital, and on political participation, both contributing to the sustainability of inclusive democratic institutions. We also document that health and health systems can help supporting peace, both via the reduction of social inequality and grievances, and by reducing the disruptive effects of epidemic shocks. Overall, the study provides evidence that health and health systems can generate co-benefits outside the health domain by promoting social capital, political participation and peace.

Quantifying the Influence of Informal Payments on Self-Rated Health: Evidence from 26 Post-Communist Countries

In contrast to previous studies that have focused on proximal outcomes such as access to and the utilization of healthcare, this study establishes and quantifies the influence of informal payments (IP) directly on population self-rated health, which can be considered the ultimate outcome. More specifically, we examine how making informal payments influences self-rated health by testing several theoretically-grounded explanations of the influence of making IP. Using the quasi-experimental instrumental variable technique increases the likelihood that our findings are not the result of reverse causality, omitted variable problem, and measurement error. Our main finding is that overall, making informal payments have a negative influence on self-rated health. However, this influence is higher for men, those who are poorer, live in rural areas, have a university education, and have lower social capital. Theoretical approaches that have stood out in explanations regarding the effects of making IP on self-rated health are Public Choice Theory, Institutional Theory, and Sociological Theories of Differences in Life Opportunities, Social Determinants of Health, and Social Capital.

Underlying Differences in Health Spending Within the World Health Organisation Europe Region-Comparing EU15, EU Post-2004, CIS, EU Candidate, and CARINFONET Countries

This study examined the differences in health spending within the World Health Organization (WHO) Europe region by comparing the EU15, the EU post-2004, CIS, EU Candidate and CARINFONET countries. The WHO European Region (53 countries) has been divided into the following sub-groups: EU15, EU post-2004, CIS, EU Candidate countries and CARINFONET countries. The study period, based on the availability of WHO Global Health expenditure data, was 1995 to 2014. EU15 countries have exhibited the strongest growth in total health spending both in nominal and purchasing power parity terms. The dynamics of CIS members' private sector expenditure growth as a percentage of GDP change has exceeded that of other groups. Private sector expenditure on health as a percentage of total government expenditure, has steadily the highest percentage point share among CARINFONET countries. Furthermore, private households' out-of-pocket payments on health as a percentage of total health expenditure, has been dominated by Central Asian republics for most of the period, although, for the period 2010 to 2014, the latter have tended to converge with those of CIS countries. Western EU15 nations have shown a serious growth of health expenditure far exceeding their pace of real economic growth in the long run. There is concerning growth of private health spending among the CIS and CARINFONET nations. It reflects growing citizen vulnerability in terms of questionable affordability of healthcare. Health care investment capability has grown most substantially in the Russian Federation, Turkey and Poland being the classical examples of emerging markets.

Social capital and physical health: An updated review of the literature for 2007-2018

PURPOSE

Social capital is frequently indicated as a determinant of population health. Despite an increase in the frequency of public health studies including such measures, our understanding of social capital's effects on health remains unclear. In 2008, a systematic review of the "first decade" of research on social capital and health was published in the textbook Social Capital and Health. Our study intends to update and expand upon this original review to account for developments in the literature over the second decade of research on social capital and health.

METHODS

We employed a systematic review of empirical studies investigating the relationship between measures of social capital and physical health outcomes published between January 1, 2007 and December 31, 2018. To identify potential studies, we conducted searches of PubMed, Embase, and PsychINFO databases in January 2019 using combinations of "social capital" and "physical health" search terms.

RESULTS

We identified 1,608 unique articles and reviewed 145 studies meeting our inclusion criteria. The most frequently examined health condition was self-reported health (57%), followed by mortality (12%), cardiovascular diseases (10%), obesity (7%), diabetes (6%), infectious diseases (5%), and cancers (3%). Of these studies, 127 (88%) reported at least partial support for a protective association between social capital and health. However, only 41 (28%) reported exclusively positive findings. The majority (59%) of results were mixed, suggesting a nuanced relationship between social capital and health. This finding could also be indicative of differences in study design, which showed substantial variation.

CONCLUSIONS

Despite limitations in the literature, our review chronicles an evolution in the field of social capital and health in terms of size and sophistication. Overall, these studies suggest that social capital may be an important protective factor for some physical health outcomes, but further research is needed to confirm and clarify these findings.

Poverty Does Make Us Sick

This study evaluates the direct causal effects of household wealth on health. We discuss several specific mechanisms that that could relate poverty with worse health and hypothesize that poverty will undermine population health. This hypothesis was tested based on data drawn from a recent cross-country survey in 12 post-Soviet countries and Mongolia using classic regression (OLS) and instrumental variable 2SLS regressions. The results indicate that poverty does indeed lead to worsening health. This negative effect of poverty on health remains unchanged after controlling for a wide range of individual characteristics, healthcare performance indicators, trust in individuals, government, parliament, and political parties, as well as country-level unobserved characteristics. Using an instrumental variable increases our confidence in being able to isolate the effects of poverty on health status and confirms that our results are not due to endogeneity. In addition, the strong negative effect of poverty on health remains robust to the use of a set of country-level aggregated indicators (e.g. GDP and Gini) instead of country dummies, the employment of a subjective self-assessment indicator of poverty instead of an objective one, and an alternative conceptualization of health status as a binomial variable (for bad and very bad health) instead of a continuous one.

Social Capital and Mental Health in Rural and Urban China: A Composite Hypothesis Approach

The objective of this study is to follow the composite theory approach to analyze the effect of social capital on self-rated mental health in rural and urban China. Our nationally representative sample includes 10,968 respondents from 130 county-level communities. Two-level random-coefficient linear regressions, which model individual and community variations in subjective mental health, were estimated by taking the hierarchical structure of the dataset into account. We found that a significant proportion of the total variations in self-rated mental health were explained at the community level. We also found an association between low contextual civic trust and poor self-rated mental health after adjusting for individual social capital and individual socioeconomic-demographic variables. The study also revealed that: (1) in rural areas a positive relationship between civic and political trust and mental health existed both at the individual and the community level, respectively; and (2) in urban areas, only political trust at the individual level contributed to better mental health. In addition, the individual and community level political participation exhibited a positive impact on mental health measures in both rural and urban China. The individual level civic participation was positively associated to the outcome variable. However, the community-level civic participation seemed to negatively impact mental health in urban area. Our findings emphasize the importance of both individual and community-level healthcare interventions in China. Finally, this study also found that human capital covariates remained important predictors of self-rated mental health status even after controlling social capital both at individual and community levels. This study suggested that the composite thesis could provide a more convincing narrative than other theories in explaining the effects of both human and social capital on health.

Effects of the 2008 global financial crisis on population health

We compare the transmission channels through which the 2008 global financial crisis affected health. We find that postponing or skipping visits to the doctor after falling ill and stopping buying regular medication had the strongest negative effects on health, followed by a reduced consumption of staple foods, utilities being cut, being forced to move, and having to sell assets. In comparison, experiencing cuts in TV, phone, and internet services, as well as delaying payments for utilities had relatively weaker negative impacts. In contrast, having a household head or household member lose a job also had negative effects on health status, although this effect was relatively lower. Finally, a reduced flow of remittances had the weakest negative effect.

Who wants to pay more taxes to improve public health care?

We study the factors that influence willingness to pay to improve public health care in 29 post-communist countries, Eastern and Southern Europe, and Eurasia using 2 up-to-date cross-sectional surveys conducted in 2010 and 2016 (N = 34 768). Three hypotheses received full degree of support through empirical analysis: increase in satisfaction with health care, university education, and higher level of wealth positively associated with willingness to pay in all regions. In comparison, having a higher level social trust and adhering to left-leaning ideological position strengthens support for public health care in Southern Europe and Eurasia only, while having a higher level of institutional trust strengthens support for public health care in Eastern Europe and Eurasia only.

Particularized trust, generalized trust, and immigrant self-rated health: cross-national analysis of World Values Survey

OBJECTIVES

This research examined the associations between two types of trust, generalized and particularized, and self-rated health among immigrants.

STUDY DESIGN

Data were drawn from the World Values Survey (WVS6), the latest wave of cross-sectional surveys based on face-to-face interviews.

METHODS

The immigrant subsample analyzed herein contains 3108 foreign-born individuals clustered from 51 countries. Given the hierarchically nested data, two-level logistic regressions models were estimated using HLM (Hierarchical Linear Modeling) 7.1.

RESULTS

At the individual level, net of socio-economic and demographic factors (age, gender, marital status, education, income, neighborhood security, and subjective well-being), particularized trust was positively related to physical health (odds ratio [OR] = 1.11, P < .001). Generalized trust, however, was not a significant predictor. At the country level, based on alternative models, the aggregate measure of particularized trust was negatively associated with subjective health. The odds of being healthy were on average about 30% lower.

CONCLUSION

The interdisciplinary literature on social determinants of health has largely focused on the salubrious impact of trust and other forms of social capital on physical well-being. Many previous studies based on general, not immigrant, populations also did not differentiate between generalized and particularized types of trust. Results from this study suggest that this conceptual distinction is critical in understanding how and to what extent the two are differentially related to immigrant well-being across multiple levels of analysis.

Do employers reward physical attractiveness in transition countries?

This paper studies the labour market returns to physical attractiveness using data from three transition countries of the Caucasus: Armenia, Azerbaijan and Georgia. I estimate a large positive effect of attractive looks on males' probability of employment. Results from the most comprehensive model suggest a marginal effect of 11.1 percentage points. Using a partial identification approach, I show that this relationship is likely to be causal. After accounting for covariates, particularly measures of human capital, there is no evidence for a statistically significant link between females' attractiveness and employment.

How does social capital matter to the health status of older adults? Evidence from the China Health and Retirement Longitudinal Survey

This paper uses longitudinal data from China to examine the causal relationship between structural social capital and health among Chinese older adults. We employ various econometric strategies to control for the potential endogeneity of social capital and account for the possible contextual confounding effects by including community-level social capital. We use three indicators to measure individuals' general, physical, and mental health. Results indicate that social capital has a significant and positive effect on general and physical health. Based on our primary IV findings, a one standard-deviation increase in social capital leads to a 4.9 standard-deviation decrease in the probability of having bad health and a 2.2 standard-deviation decrease in physical activity limitations. Our results are robust to a series of sensitivity checks. Further analysis suggests heterogeneous effects by age but not by gender or area of residence.

Gender differences in the association between cognitive social capital, self-rated health, and depressive symptoms: a comparative analysis of Sweden and Ukraine

Background

Social capital is one of the social determinants of health, but there is still a lack of studies comparing its significance for health in different cultural settings. This study investigates and compares the relations between individual cognitive social capital and depressive symptoms and self-rated health in Sweden and Ukraine for men and women separately.

Study design

Two cross-sectional nationally representative surveys of adult populations were used for the analysis. Data from the Ukraine’s World Health Survey and the Sweden’s National Public Health Survey were analyzed in this comparative study.

Methods

The independent variable, cognitive social capital, was operationalized as institutional trust and feelings of safety. Depressive symptoms and self-rated health were used as the outcome variables. Crude and adjusted odds ratios and the 95 % confidence intervals were calculated using logistic regression. The model also adjusted for socio-demographic and lifestyle variables.

Results

Institutional trust is higher in Sweden compared to Ukraine (31 % of the Swedes vs. 12 % of the Ukrainians reported high trust to their national government/parliament). There is a strong association between self-rated health and institutional trust for both sexes in Sweden (odds ratio/OR = 1.99; 95 % CI = 1.58–2.50 for women and OR = 1.82, CI = 1.48–2.24 for men who reported low institutional trust compared with those with high institutional trust) but only for women (OR = 1.88, CI = 1.12–3.15) in Ukraine. Trust thus seems to be more important for self-rated health of women and men in Sweden compared to their counterparts in Ukraine. Significant associations between depressive symptoms and institutional trust were not observed in either country after adjusting for socio-demographic and lifestyle factors. A lack of feeling of safety increased the odds of having depressive symptoms among women (OR = 1.97, CI = 1.41–2.76) and men (OR = 3.91, CI = 2.19–6.97) in Sweden. The same association was observed for poor self-rated health among Swedish women (OR = 2.15, CI = 1.55–2.99) and men (OR = 2.75, CI = 1.58–4.80). In Ukraine, a lack of feeling of safety did not show any significant association with self-rated health or depressive symptoms for men, but it increased the odds of depressive symptoms among women (OR = 1.72, CI = 1.13–2.62).

Conclusions

In general, individual cognitive social capital is higher in Sweden than in Ukraine, and there is a stronger association between cognitive social capital and self-rated health in Sweden than in Ukraine. Interventions aiming to increase cognitive social capital for health promoting purposes might be favorable in Sweden, but this is not evidently the case in Ukraine.

Electronic supplementary material

The online version of this article (doi:10.1186/s13033-016-0068-4) contains supplementary material, which is available to authorized users.

Longitudinal association between social capital and self-esteem: a matter of context

The aim of this study is to investigate the longitudinal association between indicators of different components of social capital at the individual, household, and area levels and self-esteem while adjusting for various confounders at multiple levels. Respondents participating in Wave 1 (2009) and 2 (2010) of the Seoul Welfare Panel Study were used in the analysis. The final sample for the current study includes a total of 5127 participants in 2738 households within 25 administrative areas. This study shows that only a small amount of variance in self-esteem was attributed to the area level (7.6%). On the other hand, a relatively large amount of variance in self-esteem was attributed to the household level (52.5%). It has also shown that all individual-level social capital indicators including perceived helpfulness, organizational participation, and volunteer work were positively associated with self-esteem. Among household-level indicators of social capital, only organizational participation was associated with self-esteem. However, none of the area-level social capital indicators were associated with self-esteem. The main finding of the current study suggested that the association between social capital and self-esteem varied depending on both dimensions and levels of social capital indicators.

Measurement of social capital in relation to health in low and middle income countries (LMIC): a systematic review

Social capital is a neglected determinant of health in low and middle income countries. To date, majority of evidence syntheses on social capital and health are based upon high income countries. We conducted this systematic review to identify the methods used to measure social capital in low and middle-income countries and to evaluate their relative strengths and weaknesses. An electronic search was conducted using Pubmed, Science citation index expanded, Social science citation index expanded, Web of knowledge, Cochrane, Trip, Google scholar and selected grey literature sources. We aimed to include all studies conducted in low and middle-income countries, published in English that have measured any aspect of social capital in relation to health in the study, from 1980 to January 2013. We extracted data using a data extraction form and performed narrative synthesis as the measures were heterogeneous. Of the 472 articles retrieved, 46 articles were selected for the review. The review included 32 studies from middle income countries and seven studies from low income countries. Seven were cross national studies. Most studies were descriptive cross sectional in design (n = 39). Only two randomized controlled trials were included. Among the studies conducted using primary data (n = 32), we identified18 purposely built tools that measured various dimensions of social capital. Validity (n = 11) and reliability (n = 8) of the tools were assessed only in very few studies. Cognitive constructs of social capital, namely trust, social cohesion and sense of belonging had a positive association towards measured health outcome in majority of the studies. While most studies measured social capital at individual/micro level (n = 32), group level measurements were obtained by aggregation of individual measures. As many tools originate in high income contexts, cultural adaptation, validation and reliability assessment is mandatory in adapting the tool to the study setting. Evidence on causality and assessing predictive validity is a problem due to the scarcity of prospective study designs. We recommend Harpham et al. s' Adapted Social Capital Assessment Tool (A-SCAT), Hurtado et al. s' six item tool and Elgar et al. s' World Value Survey Social Capital Scale for assessment of social capital in low and middle income countries.

Epidemiological characteristics of human and animal rabies in Azerbaijan

The Caucasus is a region of geopolitical importance, in the gateway between Europe and Asia. This geographical location makes the region equally important in the epidemiology and control of transboundary infectious diseases such as rabies. Azerbaijan is the largest country in the Caucasus, and although rabies is notifiable and considered endemic, there is little information on the burden of human and animal rabies. Here, we describe a cross-disciplinary international collaboration aimed at improving rabies control in Azerbaijan. Partial nucleoprotein gene sequences were obtained from animal rabies cases for comparison with those from surrounding areas. Reported human and animal rabies cases between 2000 and 2010 were also reviewed and analysed by region and year. Comparison of rabies virus strains circulating in Azerbaijan demonstrates more than one lineage of rabies virus circulating concurrently in Azerbaijan and illustrates the need for further sample collection and characterization. Officially reported rabies data showed an increase in human and animal rabies cases, and an increase in animal bites requiring provision of post-exposure prophylaxis, since 2006. This is despite apparently consistent levels of dog vaccination and culling of stray dogs.

Individual, household and administrative area levels of social capital and their associations with mental health: a multi-level analysis of cross-sectional evidence

BACKGROUND

Research has seldom considered social capital at the individual, household and administrative area level simultaneously and examined its association with mental health.

AIM

The main purpose of this study was to examine the association between social capital and mental health while controlling for various confounders at multiple levels using multi-level analysis and operationalizing social capital at the individual, household and administrative area level.

METHODS

This study used cross-sectional data from the 2010 Seoul Welfare Panel Study conducted by the Seoul Welfare Foundation (participation rates for the household and household members were 87.6% and 87.5%, respectively).

RESULTS

and conclusions: The main finding of this study was that organizational participation (B = 0.132, p < .001) and perceived helpfulness (B = 0.129, p < .001) were positively associated with mental health. This study also found that perceived helpfulness was positively associated with mental health (B = 0.070, p < .001). However, it did not find a significant association between the contextual level of social capital and mental health. The results indicate that the different dimensions of social capital may act differently to mental health depending on the level.

Social capital and self-reported general and mental health in nine Former Soviet Union countries

Social capital has been proposed as a potentially important contributor to health, yet most of the existing research tends to ignore the challenge of assessing causality in this relationship. We deal with this issue by employing various instrumental variable estimation techniques. We apply the analysis to a set of nine former Soviet countries, using a unique multi-country household survey specifically designed for this region. Our results confirm that there appears to be a causal association running from several dimensions of individual social capital to general and mental health. Individual trust appears to be more strongly related to general health, while social isolation- to mental health. In addition, social support and trust seem to be more important determinants of health than the social capital dimensions that facilitate solidarity and collective action. Our findings are remarkably robust to a range of different specifications, including the use of instrumental variables. Certain interaction effects are also found: for instance, untrusting people who live in communities with higher aggregate level of trust are even less likely to experience good health than untrusting people living in the reference communities.

Compositional and contextual associations of social capital and self-rated health in Seoul, South Korea: a multilevel analysis of longitudinal evidence

This study aims to examine the association between social capital at the individual and administrative-area levels and individual self-rated health while adjusting for various confounders at multiple levels using a multilevel analysis with longitudinal data from Seoul, South Korea. Respondents participating in Wave 1 (2009) and 2 (2010) of the Seoul Welfare Panel Study who have full information on the independent and dependent variables were used in the final analysis. This yielded a total of 5482 participants in 2742 households, which were in turn found within 25 administrative areas in Seoul, South Korea. The results of a three level random intercept logistic regression analysis showed that an individual level perceived helpfulness and organizational participation were associated with a higher likelihood of reporting good health after controlling for individual, household, administrative-area level variables, and baseline self-rated health. However, neither administrative-area level social capital variables were associated with self-rated health. The results suggest that individual level social capital plays an important role in enhancing individual health. The results also suggest that the relatively large size of the administrative-area used in this study may be one reason which may hinder detecting any significant associations at this level. Further research is also needed to seek more relevant contexts where contextual social capital would be operating.

A multilevel analysis of social capital and self-reported health: evidence from Seoul, South Korea

Background

This study aims to resolve two limitations of previous studies. First, as only a few studies examining social capital have been conducted in non-western countries, it is inconclusive that the concept, which has been developed in Western societies, applies similarly to an Asian context. Second, this study considers social capital at the individual-level, area-level and cross-levels of interaction and examines its associations with health while simultaneously controlling for various confounders at both the individual-level and area-level, whereas previous studies only considered one of the two levels. The purpose of this study is therefore to examine the associations between social capital and health by using multilevel analysis after controlling for various confounders both at the individual and area-levels (i.e., concentrated disadvantage) in non-western countries.

Methods

We conducted a cross-sectional survey from December 2010 to April 2011 in Seoul, South Korea. The target population included respondents aged 25 years and older who have resided in the same administrative area since 2008. The final sample for this study consisted of 4,730 respondents within all 25 of Seoul's administrative areas.

Results

In our final model, individual-level social capital, including network sources (OR = 1.23; 95% CI = 1.11-1.37) and organizational participation (OR = 2.55; 95% CI = 2.11-3.08) was positively associated with good/very good health. Interestingly, the individual × area organizational participation cross-level interaction was negatively associated with good/very good health (OR = 0.40; 95% CI = 0.32-0.50), indicating that in areas with higher organizational participation, individuals with high organizational participation were less likely to report good/very good health when compared to low organizational participation individuals.

Conclusion

Our study provides evidence that individual-level social capital is associated with self-reported health, even after controlling for both individual and area-level confounders. Although this study did not find significant relationships between area-level organizational participation and self-reported health, this study found the cross-level interaction for social capital. Hence, in areas with lower organizational participation, the probability of reporting good/very good health is higher for individuals with high organizational participation than individuals with low organizational participation. This study, albeit tentatively, suggests that policy makers should focus upon social capital when making policies which aim to enhance one's health.