Social inequality and health: the role of social capital

A global perspective on risk factors for social isolation in community-dwelling older adults: A systematic review and meta-analysis

PURPOSE

Older people's physical and mental health are now significantly impacted by social isolation, a major threat to public health. Our goal was to identify the connections between risk factors and social isolation among this population across various geographic areas.

METHODS

Seven databases were thoroughly searched, from their inception until April 2023. Inclusion and exclusion criteria were used to choose the studies. For the included cross-sectional studies, we used the Agency for Healthcare Research and Quality (AHRQ) to assess the probability of bias, and the Newcastle-Ottawa scale for the cohort studies. The statistical analysis was performed using STATA 15 to calculate pooled odds ratios (OR) and 95% CI.

RESULTS

All 3043 papers were carefully examined, and 42 satisfied the criteria for inclusion. The results indicated that multi-domain risk factors and social isolation among older persons worldwide are significantly correlated. These multi-domain risk factors included biological factors, socioeconomic factors, and psychological and behavioral factors. It is also important to note that these factors may vary from region to region.

CONCLUSION

Many domain factors were linked to social isolation in older individuals living in communities throughout the world. To develop effective strategies for controlling social isolation, it is crucial to conduct assessments of social isolation risk factors in local communities.

A systematic review and meta-analysis of the relationship between economic inequality and prosocial behaviour

How does economic inequality relate to prosocial behaviour? Existing theories and empirical studies from multiple disciplines have produced mixed results. Here we conduct a systematic review and meta-analysis to systematically synthesize empirical studies. Results from 192 effect sizes and over 2.5 million observations in 100 studies show that the relationship varies from being negative to positive depending upon the study (95% prediction interval -0.450 to 0.343). However, on average, there is a small, negative relationship between economic inequality and prosocial behaviour (r = -0.064, P = 0.004, 95% confidence interval -0.106 to -0.021). There is generally no evidence that results depend upon characteristics of the studies, participants, the way prosocial behaviour and inequality were assessed, and the publication discipline. Given the prevalence of economic inequality and the importance of prosocial behaviour, this systematic review and meta-analysis provides a timely study on the relationship between economic inequality and prosocial behaviour.

Social isolation, socioeconomic status, and development of functional impairments in Chinese older adults aged 70 years and over: a cohort study

BACKGROUND

Social isolation in older people has been increasingly regarded as a public health issue in the face of rapid population ageing. It is not clear whether social isolation mediates the relationship between socioeconomic status and functional impairment.

METHODS

We used data from a cohort of Chinese older people aged 70 or older living in community (n = 1590). Socioeconomic status (SES) was operationalised as highest education attainment, monthly income at baseline and longest held occupation in lifetime. Functional abilities were measured using Barthel's Index for activities of daily living (ADL) measured at 18 and 36 months of follow-up, from which impairment was defined as score ≤ 19. Social isolation was measured by six attributes, such as marital status, living alone, and social contact with others. A score of ≥ 3 was defined as being in social isolation. Causal mediation analysis using natural effect models was used to assess mediation by social isolation.

RESULTS

We found that lower monthly income at baseline was related to higher risk of social isolation [relative risk comparing lowest to highest income (RR) = 1.52, 95% confidence interval (95% CI) 1.01-2.28]. Social gradient of ADL impairment was not clearly present. The evidence for the mediating role of social isolation was not clear.

CONCLUSIONS

Older people with low SES, particularly those with lower income, were at greater risk of social isolation. Policymakers should strive to improve the current community services and pension scheme to mitigate the situation of social isolation in older people in Hong Kong.

The role of neighborhood social capital on health and health inequality in rural and urban China

Given the "community lost" vs. "community saved" debate on how neighborhood solidarity changes with urbanization, we compared the rural-urban difference in the association of individuals' neighborhood social capital with health and the interaction effect between neighborhood social capital and income-poverty on health in China, where huge rural-urban disparities existed. Participants were 5014 Chinese adults (≥ 18 years) (rural: 2034; urban: 2980) from the 2012 cross-sectional Chinese General Social Survey. Health outcome was a factor score constructed by three items. Neighborhood social capital was divided into structural (neighborhood network size, frequency of socializing with neighbors, voting in neighborhood committee election, and participation in neighborhood voluntary activities) and cognitive (perceived neighborhood social cohesion) dimensions. Multivariable linear regression models showed positive associations between perceived neighborhood social cohesion and health in rural (β = 0.08, 95% CI: 0.03,0.14) and urban (β = 0.09, 95% CI: 0.05,0.12) areas. Only in rural but not urban areas was a neighborhood network of 10 or more persons (ref.: none) associated with better health (β = 0.25, 95% CI: 0.05,0.46). Interaction analysis showed that only in rural but not urban areas, with the increase of neighborhood network size, the health gap between the income-poor and the non-income-poor decreased generally. Our study suggested that cohesive neighborhoods benefit both rural and urban residents' health. Health interventions to improve neighborhood social cohesion should be designed to cope with the challenge of urbanization. Policymakers should avoid damaging neighborhood social capital when implementing other public policies, especially in rural areas where neighborhood network seems to matter more for health.

'Ingredients' of a supportive web of caring relationships at the end of life: findings from a community research project in Austria

In accordance with the pluralisation of life plans in late modernity, the societal organisation of care at the end of life is diverse. Although the public discourse in western societies is dominated by questions about optimising specialised palliative care services, public health approaches, which take into account the social determinants and inequalities in end-of-life care, have gained in importance over the last decade. Conceptual aspects, dimensions of impact and benefit for the dying and their communities are well discussed in the public health end-of-life care research literature. Our research focuses on the preconditions of a supportive caring web in order to understand how communities can build on their social capital to deal with existential uncertainty. As part of a large-scale community research project, we carried out focus groups and interviews with community members. Through dispositive analysis, we generated a set of care-web 'ingredients', which constitute and foster a caring community. These 'ingredients' need to be cultivated through an ongoing process of co-creation. This requires: (i) a focus on relationships and social systems; (ii) the creation of reflective spaces; and (iii) the strengthening of social capital, and d) the addressing of inequalities in care.

Vulnerability in health and social capital: a qualitative analysis by levels of marginalization in Mexico

Background

Social capital is employed as an asset when there is a lack of an efficient health-care system. However, this relationship is not homogeneous and can differ according to the characteristics of individuals and their context. In this paper, we aim to analyze the role of social capital in the solution of healthcare problems among individuals with different levels of marginalization and unequal access to health services.

Methods

This qualitative study examines the role of social capital in the demand for healthcare among Mexican individuals with different levels of marginalization. The research draws data from semi-structured interviews (N = 247) that were collected in four Mexican states with different social welfare benefits: Mexico City, Tamaulipas, the State of Mexico, and Oaxaca. The interviewees were selected using the snowball method and other eligibility criteria such as education, age, and gender.

Results

Findings suggest that social capital is a relevant factor in solving healthcare problems, depending on the level of marginalization. The role of social capital can be explained by the precariousness of medical service delivery, the poor health infrastructure, and the difficult access to health care in Mexico. Networks are the main resource to deal with health related issues, food, medicine, and out-of-the-pocket medical expenses in contexts of high levels of marginalization. In the middle level of marginalization, networks also help in raising funds for more-specialized medical services and higher quality hospitals. In the least-marginalized levels, social capital is used as companionship for sick individuals, while support networks act as emotional relief. At this level, most individuals have private health insurance, and many of them have major medical healthcare coverage.

Conclusions

Participants reported low levels of trust in the health care system because of the poor infrastructure and quality of medical service delivery. Although the main criticism is focused on public healthcare institutions, there is a lack of trust in private medical services as well. These facts are related to the access and quality of medical service delivery and turn social capital into a significant asset. Despite that social bonds or links are valuable resources that individuals can use to solve healthcare related issues, the use of social capital is not homogenous. Indeed, it can be influenced by several factors that were represented in this study through the municipal marginalization index.

Social Mechanisms in Epidemiological Publications on Small-Area Health Inequalities-A Scoping Review

Background: Small-area social mechanisms—social processes involving the social environment around the place of residence—may be playing a role in the production of health inequalities. Understanding how small-area health inequalities (social environment affects health and consequently contribute to inequalities between areas) are generated and the role of social mechanisms in this process may help defining interventions to reduce inequalities. In mediation and pathway analyses, social mechanisms need to be treated as processes or factors. We aimed to identify which types of social mechanisms explaining the process leading from small-area characteristics to health inequalities have been considered and investigated in epidemiological publications and to establish how they have been operationalized.

Methods: We performed a scoping review for social mechanisms in the context of small-area health inequalities in the database PubMed. Epidemiological publications identified were categorized according to the typology proposed by Galster (social networks, social contagion, collective socialization, social cohesion, competition, relative deprivation, and parental mediation). Furthermore, we assessed whether the mechanisms were operationalized at the micro or macro level and whether mechanisms were considered as processes or merely as exposure factors.

Results: We retrieved 1,019 studies, 15 thereof were included in our analysis. Eight forms of operationalization were found in the category social networks and another nine in the category social cohesion. Other categories were hardly represented. Furthermore, all studies were cross sectional and did not consider mechanisms as processes. Except for one, all studies treated mechanisms merely as factors whose respective association to health outcomes was tested.

Conclusion: In epidemiological publications, social mechanisms in studies on small-area effects on health inequalities are not operationalized as processes in which these mechanisms would play a role. Rather, the focus is on studying associations. To understand the production of health inequalities and the causal effect of social mechanisms on health, it is necessary to analyze mechanisms as processes. For this purpose, methods such as complex system modeling should be considered.

Educational inequalities in self-rated health and social relationships - analyses based on the European Social Survey 2002-2016

BACKGROUND

While there is evidence for educational health inequalities in Europe, studies on time trends and on the explanatory contribution of social relations are less consistent. It has been shown that the use of welfare state typologies can be helpful to examine health inequalities in a comparative perspective. Against this background, analyses are focused on three research questions: (1) How did educational inequalities in self-rated health (SRH) develop between 2002 and 2016 in different European countries? (2) In how far can structural and functional aspects of social relations help to explain these inequalities? (3) Do these explanatory contributions vary between different types of welfare states?

METHODS

Data stem from the European Social Survey. Data from 20 countries across 8 waves (2002-2016) was included in the sample (allocated to 5 types of welfare states). Structural aspects of social relations were measured by living with a partner, frequency of social contacts and social participation. Availability of emotional support was used as functional dimension. Educational level was assessed based on the International Standard Classification of Education. SRH was measured in all waves on a five-point scale by one question: "How is your health in general? Would you say it is very good, good, fair, bad or very bad?"

RESULTS

Across all countries, educational inequalities were increasing between 2002 and 2016. Explanatory contribution of emotional support, living with a partner, and social contacts was small (5% or less across the eight waves). Social participation explained 11% of the educational inequalities in SRH in the European countries. There were small variations in the explanatory contribution of social participation between welfare states.

CONCLUSIONS

Promoting social participation, especially of people with low education is a possible intervention to reduce inequalities in SRH in Europe.

Capital interplays and social inequalities in health

We explore the ramifications of applying Pierre Bourdieu's theory of capitals to epidemiological research on socioeconomic health inequalities. Capitals are resources used by individuals and groups to maintain and enhance their positions in the social order. The notion of capital interplay refers to the interconnectedness of multiple forms of capital in the production of good health. We provide definitions of economic, cultural and social capitals and describe a variety of causally distal processes-namely, capital acquisition, multiplier and transmission interplays-from which new hypotheses can be developed to guide future study of socioeconomic health inequalities in modern societies.

Social capital as a mediator of the influence of socioeconomic position on health: Findings from a population-based cross-sectional study in Chandigarh, India

Background

Social capital has been recognized as part of the WHO's Social Determinants of Health model given that social connections and relationships may serve as resources of information and tangible support. While the association between socioeconomic position and health is relatively well established, scant empirical research has been conducted in developing countries on the association between social capital and health.

Objective

Based on the WHO's Social Determinants of Health framework, we tested whether social capital mediates the effect of socioeconomic position on mental and physical health.

Methods

A population-based study was conducted among a representative sample (n = 1563) of men and women in Chandigarh, India. We used standardized scales for measuring social capital (mediator variable) and self-rated mental and physical health (outcome variable).

Results

A socioeconomic position index (independent variable) was computed from education, occupation, and caste categories. Mediation model was tested using path analysis in IBM SPSS-Amos. Participants' mean age was 40.1 years. About half of the participants were women (49.3%), and most were relatively well educated. The results showed that socioeconomic position was a significant predictor of physical and mental health. Social capital was a significant mediator of the effect of socioeconomic position on mental health but not physical health.

Conclusion

Besides removing socioeconomic barriers through poverty alleviation programs, interventions to improve social capital, especially in economically disadvantaged communities, may help in improving population health.

A comparative study of social capital and hospital readmission in older adults

Numerous factors contribute to hospital readmissions of older adults. The role social capital may play in preventing hospital readmissions is unknown. The aim of this descriptive, cross-sectional study was to determine if levels of personal social capital differ in two groups of patients aged 65 and older, those readmitted to the hospital within 30 days of discharge and those not readmitted. Participants in this study (N = 106) were community-dwelling older adults discharged from 11 hospitals in the Midwestern United States. The Personal Social Capital Scale and a demographic questionnaire were mailed to eligible participants for completion. Multivariate Analysis of Variance (MANOVA) was computed to examine the differences in the dependent variables of bonding and bridging social capital between those patients readmitted within 30 days and those not readmitted within 30 days. No significant differences between the two groups' mean levels of bonding or bridging social capital were identified.

Social relationships and physician utilization among older adults-A systematic review

Background

In older age health needs and demand for health services utilization increase. Individual’s social relationships can play a decisive role regarding the utilization of outpatient health care services. This systematic review examines the associations of structural and functional dimensions of social relationships with outpatient health services use of older adults.

Methods

The databases PubMed, CINAHL, SocINDEX, PsycINFO, International Bibliography of the Social Sciences (IBSS), Sociological Abstracts, and Applied Social Sciences Index and Abstracts (ASSIA) were searched in February 2016. The methodological and reporting quality of the articles was assessed and the results were synthesized descriptively and systematically.

Results

Out of 1.392 hits, 36 articles (35 studies) were included in the systematic review. The methodological and reporting quality of the included articles was reasonable. Various structural and functional characteristics of social relationships were associated with the use (yes/no) and the frequency of using outpatient care among older adults. The majority of the associations between structural dimensions of social relationships and the use of physicians were positive and moderate in strength. The associations between functional dimensions of social relationships and the probability of using physician services were inconsistent and varied in strength. For the most part, social relationship variables assigned to the structural dimension were positively and weakly to moderately associated with the frequency of physician visits. Functional aspects of social relationships also tended to have positive associations with the frequency of physician utilization. The associations were weak to moderate in strength.

Conclusions

Measuring social relationships and their influence on health services use is a challenging methodological endeavor indicated by the inconclusive results. The results suggest that the outpatient care utilization behavior of older individuals being structurally and functionally integrated in social relationships is different to older adults being socially isolated or having no social support. All in all, the current status of quantitative data was insufficient. Future health services research should accentuate social ties in more detail, especially according to quality aspects of social relationships.

The role of social capital in explaining mental health inequalities between immigrants and Swedish-born: a population-based cross-sectional study

BACKGROUND

Social capital may theoretically explain health inequalities between social groups, but empirical evidence is lacking. Some studies indicate that social capital may be particularly important for immigrant health. Nearly 16% of Sweden's population are foreign-born immigrants and research has shown them to be susceptible to psychological distress, though significant variation has been found between groups. In this study, we investigate the following hypotheses: 1) if non-refugees have better mental health than Swedish-born, and refugees experience worse mental health than Swedish-born; 2) if mental health status converges with that of Swedish-born with longer duration of residence; and 3) if social capital mediates the effect of immigrant status on psychological distress for different immigrant groups as compared to Swedish-born.

METHODS

This cross-sectional study uses baseline data from the Stockholm Public Health Cohort and includes 50,498 randomly-selected individuals from Stockholm County in 2002, 2006, and 2010. Mental health was measured as psychological distress, using the 12-item General Health Questionnaire. Social capital was measured using indicators of bonding, bridging, and linking social capital. Both cognitive and structural aspects were measured for the latter two indicators. Mediation was tested using logistic regression and the Sobel test.

RESULTS

The results show that refugees generally had greater odds of psychological distress than non-refugees compared to their respective Swedish-born counterparts. Among immigrant men, both refugees and non-refugees had significantly greater odds of psychological distress than Swedish-born men. Only refugee women in Sweden 10 years or more had significantly greater odds of psychological distress compared to Swedish-born women. The mediation analysis demonstrated that indicators of social capital mediated the association for all immigrant men (except non-refugees in Sweden 3-9 years) and for refugee women in Sweden 10 years or more. While bonding social capital showed the greatest mediatory role among the three social capital types, adding them together had the strongest explanatory effect.

CONCLUSIONS

Social capital explains differences in mental health for some immigrant groups, highlighting its role as a potentially important post-migration factor. Increased investment from policy-makers regarding how social capital can be promoted among new arrivals may be important for preventing psychological distress.

The role of community social capital in the relationship between socioeconomic status and adolescent life satisfaction: mediating or moderating? Evidence from Czech data

BACKGROUND

The concept of social capital has been extensively used to explain the relationship between socioeconomic status (SES) and adolescent health and well-being. Much less is known about the specific mechanism through which social capital impacts the relationship. This paper investigates whether an individual's perception of community social capital moderates or mediates the association between SES and life satisfaction.

METHODS

This study employs cross-sectional data from the 2009-2010 Czech Health Behaviour in School-Aged Children survey: a WHO Collaborative Cross-National Study (HBSC). A sample of 4425 adolescents from the 5^th, 7^th and 9^th grade (94.5% school response rate, 87% student response) was used to perform multilevel analysis.

RESULTS

We found that pupils' life satisfaction was positively related to both family affluence and perceived wealth. Moreover, we found the cognitive component of social capital to be positively associated with life satisfaction. Additionally, a significant interaction was found, such that the social gradient in life satisfaction was flattened when pupils reported high levels of perceived community social capital.

CONCLUSIONS

The present findings suggest that community social capital acts as an unequal health resource for adolescents, but could potentially represent opportunities for public health policy to close the gap in socioeconomic disparities.

Communicative social capital and collective efficacy as determinants of access to health-enhancing resources in residential communities

This article contributes to the burgeoning literature on the social determinants of health disparities. The authors investigate how communication resources and collective efficacy, independently and in combination, shape residents' access to health enhancing resources (including healthcare services, sources of healthier food options, and public recreation spaces) in their communities. Using random digit dial telephone survey data from 833 residents of South Los Angeles communities the authors show that communicative social capital-that is, an information and problem-solving resource that accrues to residents as they become more integrated into their local communication network of neighbors, community organizations, and local media-plays a significant role in access to health resources. This relationship is complicated by individuals' health insurance and health status, as communicative social capital magnifies the sense of absence of resources for those who are in worse health and lack insurance. Communicative social capital builds collective efficacy, which is positively related to access to health-enhancing resources, but it also mediates the negative relationship between communicative social capital and access to health resources. Residents with richer stores of communicative social capital and collective efficacy report better access to health resources. The authors conclude with a discussion of implications of these findings and suggestions for future research.

Social capital and self-rated health among older adults: a comparative analysis of Finland, Poland and Spain

The aim of this paper is to investigate the association between structural and cognitive aspects of social capital and self-rated health among adults aged 50 or more, living in three countries: Finland, Poland and Spain. The study, which was based on data from the European Social Survey (2008/09), was a part of the EU research project COURAGE in Europe. More specifically the paper assesses the association between social capital indicators – informal social network and general trust – and good self-rated health through single-level and joint effects analyses. The results showed that Finland was a country of high social capital, in terms of both social networks and general trust, while Spain showed low levels of general trust and Poland low levels of informal social networks. As to the association between social capital and self-rated health, high levels of general trust and high networks were found to be associated with good health among all countries' respondents. Older persons living in partnerships, with higher education, higher levels of engagement in informal networks and general trust, were found to be more likely to show good self-rated health. Our comparative analyses revealed different associations between social capital and health according to country.

The associations between resilience, social capital and self-rated health among HIV-positive South Africans

This study examined the relationship between resilience, social capital and self-rated health among 263 HIV-positive South Africans living in poverty, using questionnaires. Self-rated good health was predicted by younger age, trust in community-based organizations and having contacts of different religions. The findings highlight the importance of community-based networks and resources for care and support for persons living with HIV/AIDS in poor, rural areas. Furthermore, resilience, which also related positively to education and income, contributed positively to self-rated health, drawing attention to the interplay between resources at individual and community levels.

'If you feel that nobody wants you you'll withdraw into your own': Gypsies/Travellers, networks and healthcare utilisation

Gypsies and Travellers are the unhealthiest group in British society, suffering from higher levels of physical and mental illness, lower life expectancy and with low levels of healthcare utilisation. They also continue to experience the highest level of prejudice and discrimination in society. While studies indicate that social networks play an important role in shaping health beliefs and the response to symptoms, evidence on the influence of networks on health is unclear and contradictory. This article draws on social network theory and research into the relation between discrimination and health to critically examine how networks mediate between collective experiences of racism and health-related behavior. Qualitative interviews with 39 adult Gypsies and Travellers were conducted in the South-East of England to explore the wider structural and institutional context and the influence those contexts play in shaping health beliefs and decisions whether to access formal health services. The findings indicate that the influence networks play in shaping health behaviour is dependent on the particular social context of the group and its status in relation to wider social structures, making generalization problematic.

A systematic review of the relationships between social capital and socioeconomic inequalities in health: a contribution to understanding the psychosocial pathway of health inequalities

Introduction

Recent research on health inequalities moves beyond illustrating the importance of psychosocial factors for health to a more in-depth study of the specific psychosocial pathways involved. Social capital is a concept that captures both a buffer function of the social environment on health, as well as potential negative effects arising from social inequality and exclusion. This systematic review assesses the current evidence, and identifies gaps in knowledge, on the associations and interactions between social capital and socioeconomic inequalities in health.

Methods

Through this systematic review we identified studies on the interactions between social capital and socioeconomic inequalities in health published before July 2012.

Results

The literature search resulted in 618 studies after removal of duplicates, of which 60 studies were eligible for analysis. Self-reported measures of health were most frequently used, together with different bonding, bridging and linking components of social capital. A large majority, 56 studies, confirmed a correlation between social capital and socioeconomic inequalities in health. Twelve studies reported that social capital might buffer negative health effects of low socioeconomic status and five studies concluded that social capital has a stronger positive effect on health for people with a lower socioeconomic status.

Conclusions

There is evidence for both a buffer effect and a dependency effect of social capital on socioeconomic inequalities in health, although the studies that assess these interactions are limited in number. More evidence is needed, as identified hypotheses have implications for community action and for action on the structural causes of social inequalities.

Does neighbourhood social capital aid in levelling the social gradient in the health and well-being of children and adolescents? A literature review

Background

Although most countries in the European Union are richer and healthier than ever, health inequalities remain an important public health challenge. Health-related problems and premature death have disproportionately been reported in disadvantaged neighbourhoods. Neighbourhood social capital is believed to influence the association between neighbourhood deprivation and health in children and adolescents, making it a potentially interesting concept for policymakers.

Methods

This study aims to review the role of social capital in health inequalities and the social gradient in health and well-being of children and adolescents. A systematic review of published quantitative literature was conducted, focussing on (1) the mediating role of neighbourhood social capital in the relationship between socio-economic status (SES) and health-related outcomes in children and adolescents and (2) the interaction between neighbourhood social capital and socio-economic characteristics in relation to health-related outcomes in children and adolescents. Three electronic databases were searched. Studies executed between 1 January 1990 and 1 September 2011 in Western countries (USA, New Zealand, Australia and Europe) that included a health-related outcome in children or adolescents and a variable that measured neighbourhood social capital were included.

Results

Eight studies met the inclusion criteria for the review. The findings are mixed. Only two of five studies confirmed that neighbourhood social capital mediates the association between neighbourhood deprivation and health and well-being in adolescents. Furthermore, two studies found a significant interaction between neighbourhood socio-economic factors and neighbourhood social capital, which indicates that neighbourhood social capital is especially beneficial for children who reside in deprived neighbourhoods. However, two other studies did not find a significant interaction between SES and neighbourhood social capital. Due to the broad range of studied health-related outcomes, the different operationalisations of neighbourhood social capital and the conceptual overlap between measures of SES and social capital in some studies, the factors that explain these differences in findings remain unclear.

Conclusions

Although the findings of this study should be interpreted with caution, the results suggest that neighbourhood social capital might play a role in the health gradient among children and adolescents. However, only two of the included studies were conducted in Europe. Furthermore, some studies focussed on specific populations and minority groups. To formulate relevant European policy recommendations, further European-focussed research on this issue is needed.

Capital Relations and Health: Mediating and Moderating Effects of Cultural, Economic, and Social Capitals on Mortality in Alameda County, California

Inspired by Bourdieu's theories on various forms of capital, conversions among them, and the fields (social spaces) delineated by possession of them, the authors investigate distinct and interconnected effects of cultural, economic, and social capitals on risk of mortality. Using 35 years of longitudinal data from the Alameda County Study (n = 6,157), they created discrete-time hazard models to predict all-cause mortality from educational attainment (institutionalized cultural capital), household income (economic capital), and different forms of personal ties (social capital). The results show that education, income, having three or more close friends, regularity of church attendance, and participation in social/recreational groups were all negatively and significantly associated with risk of mortality. Income mediated a significant portion of the education effect. None of the personal ties variables mediated the effects of education or income. Relative composition of the sum total of education and income did not have an effect. Lastly, examination of statistical interactions between capitals determined that protective effects of church attendance and participation in community betterment groups applied only to non-wealthy people. These findings speak to the structure of the U.S. social space within which health-delimiting relationally defined social classes may be made manifest.