Diverging death risks: Mortality as a corollary of economic, social, cultural and person capital

Introduction

Diverging death risks are associated with a wide range of social factors, including not only education and income but also other economic and non-economic resources. The aim of this study was to assess the association of mortality risks with four types of resources: economic, social, cultural and person capital.

Methods

We used data of 2,952 participants from the Disparities in the Netherlands survey and annual mortality data from Statistics Netherlands for the period 2014 to 2021. Economic capital was measured through education, income, occupation, home equity, and liquid assets. Social capital was measured by the strength of social ties, the size of the core discussion network, and access to people in resourceful positions; cultural capital by lifestyle, digital skills, and mastery of English, and person capital by self-rated health, impediments to climbing stairs, self-confidence, self-image, people's appearance, and body mass index. To accommodate the fact that each capital was derived from several indicators, we used Partial Least Squares (PLS) Cox Regression.

Results

In multiple regression, higher economic, cultural, and person capital were associated with lower mortality (hazard ratio, 0.77; 95% confidence interval [CI, 0.65 to 0.90], 0.77 [0.64-0.93] and 0.80; [0.70-0.92]), adjusted for all capital measures and sex.

Conclusion

The finding that more economic, cultural and person capital is associated with lower mortality provides empirical support for an approach that uses a broad spectrum of capital measures - hitherto rarely included simultaneously in epidemiological research - in order to understand diverging death risks. By integrating sociological concepts, cohort data, and epidemiological research methods, our study highlights the need for further research on the interplay between different forms of resources in shaping health inequalities. In designing public health interventions, we advocate the adoption of a multidimensional capital-based framework for tackling social disparities in mortality.

Testing conditionality with Bourdieu's capital theory: How economic, social, and embodied cultural capital are associated with diet and physical activity in the Netherlands

Although Bourdieu's capital theory emphasized that economic, social, and embodied cultural capital interact to shape health behavior, existing empirical research mainly considered separate associations of the three forms of capital. Our aim was to investigate if and how economic, social, and embodied cultural capital are conditional on each other in their associations with adults' diet and physical activity. Cross-sectional, self-reported data from the 2014 GLOBE survey of 2812 adults aged between 25 and 75 years residing in Eindhoven, the Netherlands were used. Step-wise multiple logistic regression models included economic, social, and embodied cultural capital and adjustment for potential confounders. The models estimated odds ratios of main effects and two-way interactions of the forms of capital with fruit consumption, vegetable consumption, sports participation, and leisure time walking or cycling. In the main effects models, embodied cultural capital was consistently positively associated with all outcomes. Social capital was positively associated with sports participation, fruit consumption, and vegetable consumption, and economic capital was positively associated with sports participation and vegetable consumption. In the two-way interaction models, having specific higher levels of both economic and social capital strengthened their positive association with sports participation. No other combinations of capital were conditional on each other. Economic and social capital were conditional on each other in their association with sports participation, so interventions that provide both economic and social support may be especially effective for increasing this type of physical activity. As its association was strong with all outcomes but not conditional on other forms of capital, embodied cultural capital may operate distinctly from economic and social resources. Policy that takes differences in embodied cultural capital into account or changes to the environment that dampen the importance of embodied cultural resources for health behavior may help improve both diet and physical activity.

Unequal neurorehabilitation trajectories - a longitudinal case study combining field structures with social Class-Based Capital Conversion

Inequalities in illness, service provision, and outcomes are well documented in the Nordic universal welfare state. The ways in which inequalities are produced during illness recovery trajectories remain largely unknown. Long-term brain injury rehabilitation in this context provides a window into veiled aspects of inequality and the underlying mechanisms. We examine inequality empirically by combing framing field structures with the classed abilities of families to mobilise capital after a severe acquired brain injury (severe ABI). Using a Bourdieuan theoretical framework, informed by the concepts of field, doxa, cultural health capital (CHC), and rehabilitation capital (RC), we designed a longitudinal case study encompassing professional records, observations, and interviews that tracked and analysed subjects' trajectories. We found that families' consistent accumulation and conversion of capital was crucial after a severe ABI because of the multifaceted rehabilitation process involving many different field specific agendas and doxas. This study supplements previous concepts (CHC and RC) developed in a health care context by including other rehabilitation contexts. These disparities in forms of capital amongst social classes result in winners and losers and were reflected in the rehabilitation trajectories of the young adults, characterised by continuity on one extreme and broken trajectories on the other.

Sick of social status: A Bourdieusian perspective on morbidity and health inequalities

Self-reported health (SRH) is one of the most frequently used measures for examining socioeconomic inequalities in health. Studies find that when faced with 'identical objective health', individuals in lower socioeconomic groups consistently report worse SRH than those in higher socioeconomic groups. Such findings are often dismissed as being the result of reporting bias, and existing literature dominated by the biomedical conception of SRH has not investigated the underlying social mechanisms at work. To address this limitation, drawing on the work of Bourdieu we employ a relational thinking between health and social position. By way of multiple correspondence analysis, we construct social space of health determinants for three European countries from different welfare states and map the trajectories of educational groups experiencing similar levels of morbidity and their relation to SRH. Differences in SRH observed among social groups for the same level of morbidity are understood in relation to the position and the relative power of individuals in different educational groups to maintain or improve their social conditions, especially with increasing levels of health loss. Our analysis indicates that reporting differences in SRH among educational groups emerges from objectively healthy individuals and follows differences in accumulation of social advantages and disadvantages.

Food insecurity among immigrants and refugees of diverse origins living in metropolitan Atlanta: the roles of acculturation and social connectedness

Little is known about the prevalence and correlates of food insecurity among immigrants and refugees. Acculturation and social connectedness may influence food insecurity (lack of access at all times to enough food for an active, healthy life) by affecting a person's ability to access and use governmental and charitable food assistance programs, as well as other community-based or informal food-related resources. We explored associations of acculturation and social connectedness with food insecurity among diverse immigrants and refugees living in metropolitan Atlanta, a major destination for these populations in recent years. From 2017 to 2018, we surveyed 162 adults attending health fairs or programs hosted by two community-based organizations serving immigrants and refugees. Food insecurity within the past year was assessed using the American Academy of Pediatrics' two-item questionnaire. Acculturation indicators included heritage culture and American acculturation scores (Vancouver Acculturation Index), English fluency, heritage language fluency, and percentage of lifetime in the USA. Social connectedness was operationalized using measures of religious attendance and social isolation. We conducted a multivariable logistic regression controlling for age, sex, education, household income, employment status, and household size. In the sample, 51.9% identified as Vietnamese, 16.0% Hispanic, 15.4% Burmese, 14.8% Bhutanese or Nepali, and 1.8% other. The average age was 39.10 (standard deviation [SD] =13.83), 34.0% were male, 73.8% had below a Bachelor's degree, and 49.7% were unemployed. Average scores for American acculturation (mean [M] = 3.26, SD = 1.05, range 1-5) were lower than heritage acculturation (M = 4.34, SD = 0.68, range 1-5). Additionally, 43.4% were fluent in English. Average percentage of life in the USA was 40.59% (SD = 33.48). Regarding social connectedness, 55.9% regularly attended religious services. Average social isolation scores were 3.93 (SD = 1.34, range 3-9). Overall, past-year food insecurity was reported by 17.3% (34.6% in Hispanics, 24.0% in Burmese, 13.1% in Vietnamese, and 8.3% in Bhutanese or Nepali). In adjusted models, food insecurity was associated with English fluency (adjusted odds ratio [aOR] = 0.36, p = .03) and social isolation (aOR = 2.29, p < .001) but not other measures of acculturation or religious attendance. Limited English proficiency may make it more difficult to navigate or use governmental and charitable food assistance programs. Social isolation may hinder individuals from obtaining information about food assistance programs, receiving aid for services navigation, and sharing or borrowing food from family, friends, and neighbors. Interventions should seek to improve access to English language and literacy services, enhance the linguistic and cultural competency of service providers, and build social connectedness among immigrants and refugees.

The role of workplace social capital on the relationship between perceived stress and professional identity among clinical nurses during the COVID-19 outbreak

AIM

Workplace social capital refers to relationship networks formed by individuals in an organization through long-term mutually beneficial interactions and cooperation with members. These relationship networks can create value and resources for organizations and individuals. This current study aimed to explore the potential impact of workplace social capital on the association between perceived stress and professional identity in clinical nurses during the COVID-19 outbreak.

METHODS

In this cross-sectional study, 308 Chinese clinical nurses filled out the Chinese Workplace Social Capital Scale, the Chinese Perceived Stress Scale, and the Chinese Nurse's Professional Identity Scale. Descriptive analysis, independent samples t test, analysis of variance, Pearson correlation analyses, and bootstrap method were performed to analyze the data.

RESULTS

Perceived stress was negatively correlated with professional identity (r = -0.455, p < .001). Workplace social capital was not found to moderate the relationship between perceived stress and professional identity (95% CI -0.03 to- 0.06, p = .47 > .05). Instead, it mediated that relationship (95% CI -0.61 to -0.19, p < .05), and its mediating effect was -0.37.

CONCLUSIONS

In the early stages of the COVID-19 outbreak, workplace social capital among the investigated clinical nurses failed to buffer the negative impact of perceived stress on professional identity, but it did play a part in mediating perceived stress and professional identity. A healthy workplace should be provided to clinical nurses to improve their professional identity, while lowering perceived stress.

A Bourdieusian approach to class-related inequalities: the role of capitals and capital structure in the utilisation of healthcare services in later life

This paper draws on Bourdieu's theory of economic, social and cultural capital to understand the relative effect of the volume and the composition of these capitals on healthcare service use in later life. Based on data from the fifth wave of the Survey of Health, Aging, and Retirement in Europe (n = 64,840), we first look at the contribution of each capital in the use of three healthcare services (general practitioner, dentist and hospital). Using cluster analysis, we then mobilise Bourdieu's concept of habitus to explain how the unequal distribution of material and non-material capitals acquired in childhood lead to different levels of health and hospital care utilisation in later life. After controlling for demographic and health insurance variables, our results show that economic capital has the strongest individual association among the three capitals. However, the results of a cluster analysis used to distinguish between capital structures show that those with high non-material capital and low material capital have higher levels of primary healthcare utilisation, and in turn lower levels of hospital use. Bourdieu's approach sheds light on the importance of capitals in all forms and structures to understand the class-related mechanisms that contribute to different levels of healthcare use.

Family Leisure, Self-Management, and Satisfaction in Spanish Youth

Youth values leisure as a right, a source of growth and integral development, and a context for experimentation. It has been shown that organized leisure leads to more benefits than unorganized leisure; when undertaken (Throughout the document, an attempt will be made to use inclusive language, although “under Law 3/2007 of 22 March, for the effective equality of women and men, any reference to positions, persons or groups included in this document in masculine, are to be understood as including both women and men.”) by the young people themselves, these benefits lead to the development of prosocial skills, self-efficacy, autonomy, and increased independence, personal motivation, and responsibility, as well as acting as a protective factor against risky behaviors. When organized leisure activities are also shared with the family, the benefits influence a positive family environment. This study focused on analyzing the relationship between family-shared leisure practices that are managed by Spanish youth in post-compulsory secondary education and the importance and satisfaction granted to these experiences. The sample consisted of 1,764 post-compulsory secondary education students from all over Spain. Youths responsibility for the organization of their leisure activities, the perception of the relationship between enjoyment of the activity and involvement in its management, the organization of the spaces in which leisure activities are carried out, their satisfaction with them, and the importance attached to shared practice and family experiences were recorded. The results showed a shortage of self-managed youth leisure practices, but increased responsibility, spatial organization, and satisfaction were confirmed when leisure experiences are shared with the family. The need to encourage opportunities for children to self-organize their leisure practices from an early age is commented on.

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.

The influence of participation on mortality in very old age among community-living people in Sweden

BACKGROUND

Participation in everyday life and society is generally seen as essential for health-related outcomes and acknowledged to affect older people's well-being.

AIMS

To investigate if aspects of performance- and togetherness-related participation influence on mortality among very old single living people in Sweden.

METHODS

ENABLE-AGE Survey Study data involving single-living participants in Sweden (N = 314, aged 81-91 years), followed over 10 years were used. Multivariate Cox regression models adjusted for demographic and health-related variables were used to analyse specific items influencing mortality.

RESULTS

Participation in performance- or togetherness-oriented activities was found to significantly influence mortality [HR 0.62 (0.44-0.88), P value 0.006, and HR 0.72 (0.53-0.97), P value 0.031, respectively]. Talking to neighbours and following local politics had a protective effect on mortality, speaking to relatives on the phone (CI 1.10-2.02) and performing leisure activities together with others (CI 1.10-2.00) had the opposite influence. That is, those performing the latter activities were significantly more likely to die earlier.

DISCUSSION

The main contribution of this study is the facet of the results showing that aspects of performance- and togetherness-related participation have a protective effect on mortality in very old age. This is important knowledge for designing health promotion and preventive efforts for the ageing population. Moreover, it constitutes a contribution to the development of instruments capturing aspects of participation influencing on mortality.

CONCLUSION

In the development of health promotion and preventive efforts the inclusion of participation facets could be considered in favour of potential positive influences on longevity.

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.

Two theoretical strands of social capital, and total, cardiovascular, cancer and other mortality: A population-based prospective cohort study

The aim is to prospectively investigate both the “cohesion” and “network” perspectives of social capital in relation to total, cardiovascular (CVD), cancer and all other causes mortality. The 2008 public health survey in Scania was a postal questionnaire with three letters of reminder, and it was answered in the Autumn by 28,198 respondents (55% participation) aged 18–80 from a stratified random sample of the population register. This baseline was connected with the national causes of death registry (Dödsorsaksregistret) with a more than five-year follow-up August 27- November 14 (depending on individual response) to December 31, 2013 (946 deaths). The analyses were performed in multiple adjusted survival (Cox-) regression models. Results show that low social participation, common to both theoretical perspectives, had consistently high hazard rate ratios (HRRs) of total, CVD, cancer and other morality, and that HRRs of total and CVD mortality remained statistically significant even after adjustments for all covariates including health behaviors, BMI, unmet healthcare needs and self-rated health, HRR 1.28 (1.08–1.52) and HRR 1.79 (1.28–2.50), respectively. In contrast, low social support, specific to the “network” perspective, showed no significant associations with mortality, except for low emotional and instrumental support and other causes mortality for which HRRs remained significant adjusted for demographics and socioeconomic status (SES). Generalized trust in other people, specific to the “cohesion” perspective, showed statistically significant HRRs for total and other causes mortality until adjustments for health-related behaviours and BMI, although not after complete adjustments, and significant HRRs for CVD and cancer mortality before adjustment for health behaviours. In conclusion, low social participation is consistently associated with all forms of mortality, and particularly total and CVD mortality. Social participation represents a strong core of social capital theory, and items should measure both variety of social contact surfaces and intensity.

•

There is no consensus regarding the definition of social capital.

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The “network” and “cohesion” approaches are discussed in the public health literature.

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Generalized trust is specific to the cohesion approach also including social participation.

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Social support is sometimes defined as an aspect of network which also includes social participation.

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Social participation was the strongest predictor of total and cause-specific mortality.

Interplay between financial assets and social relations on decline in physical function and mortality among older people

It is well established that socioeconomic position (SEP) and social relations impact physical function and mortality in old age. Due to differential vulnerability, few social relations may lead to greater decline in physical function and mortality among older people with low compared to high SEP. The aim was to investigate whether older people with few social relations experience greater decline in physical function and mortality when also subject to low financial assets? The study population included 4060 older people aged 75 or 80 years at baseline in 1998-1999. Social relations at baseline and physical function at baseline and after 1.5, 3.0 and 4.5 years were obtained from questionnaires. Financial assets at baseline and mortality during 10 years of follow-up were obtained from registers. Analyses of the associations between financial assets combined with social relations and decline in physical function and mortality, respectively, were conducted. Among males, but not females, low financial assets and few social relations were associated with the greatest decline in physical function. Yet, interaction only reached significance between financial assets and visits. Among males and females, low financial assets and few social relations were associated with the highest mortality. Interactions only reached significance between financial assets and visits for females and social activity for males. In conclusion, few social relations implied greater decline in physical function among older males and higher mortality among older males and females with low financial assets; however, the study only supports the presence of differential vulnerability for visits and social activity.

Association of social capital at the individual level with physical activity in communities with high mortality in Korea

The aim of this study was to investigate the association of various dimensions of social capital at the individual level with physical activity. We used data from community health interviews conducted in 40 sub-municipal-level administrative units with high mortality from August to October in 2010, 2011 or 2012 for health projects in South Korea. The 8800 study subjects included 220 adults from each administrative unit, who were sampled systematically using the resident registration database. The physical activity level was defined according to the intensity, duration and frequency of self-reported physical activity. Social capital indicators were assessed with measures used in other health surveys or studies. Adjusting for gender, age, marital status, educational level, occupation, food security (a proxy for socio-economic status), administrative unit and self-rated health, we calculated the adjusted odds ratio (AOR) with a 95% confidence interval (CI) of participating in physical activity based on various measures of social capital using multivariate logistic regression analysis. Social participation in both informal and formal organizations compared with no social participation, higher generalized trust compared with lower trust and higher perceived control at both the community and individual levels compared with lower perceived control at both levels increased the odds of being physically active [AOR = 1.25 (95% CI: 1.10-1.41), 1.36 (95% CI: 1.19-1.54) and 1.31 (95% CI: 1.17-1.48), respectively]. Various social capital measures at the individual level were found to be associated with physical activity independently of each other and of confounders in communities with high mortality in Korea.

Margins of freedom: a field-theoretic approach to class-based health dispositions and practices

Pierre Bourdieu's theory of practice situates social practices in the relational interplay between experiential mental phenomena (habitus), resources (capitals) and objective social structures (fields). When applied to class-based practices in particular, the overarching field of power within which social classes are potentially made manifest is the primary field of interest. Applying relational statistical techniques to original survey data from Toronto and Vancouver, Canada, we investigated whether smoking, engaging in physical activity and consuming fruit and vegetables are dispersed in a three-dimensional field of power shaped by economic and cultural capitals and cultural dispositions and practices. We find that aesthetic dispositions and flexibility of developing and established dispositions are associated with positioning in the Canadian field of power and embedded in the logics of the health practices dispersed in the field. From this field-theoretic perspective, behavioural change requires the disruption of existing relations of harmony between the habitus of agents, the fields within which the practices are enacted and the capitals that inform and enforce the mores and regularities of the fields. The three-dimensional model can be explored at: http://relational-health.ca/margins-freedom.

Determinants of dietary compliance among Italian children: disentangling the effect of social origins using Bourdieu's cultural capital theory

Making use of Bourdieu's threefold conceptualisation of cultural capital, this paper examines and disentangles the association between social origins and children's food consumption. The aim of the work is twofold. Using data from the Multipurpose survey on daily life conducted by Istat (2009-2012), we first show that children's compliance with dietary advice is indeed influenced by their social origins, but more so in terms of familial cultural resources than economic ones. All types of cultural capital enhance the quality of children's nutrition. Second, we concentrate on the role of the school canteen as a child-centred investment strategy intended to reduce health inequalities by providing a wholesome lunch for all children. Although the school meal effectively improves the degree of dietary compliance, the results indicate that this public service is less often used by children from lower social origins. Moreover, we do not find any equalising effect of the school meal on the diets of disadvantaged children. These findings are discussed in light of future research on sociology of health stratification and health promotion programmes.

Protocol for a randomized controlled trial testing the impact of feedback on familial risk of chronic diseases on family-level intentions to participate in preventive lifestyle behaviors

Background

Common disease risk clusters in families due to shared genetics, exposure to environmental risk factors, and because many health behaviours are established and maintained in family environments. This randomised controlled trial will test whether the provision of a family health history (FHH) risk assessment tool increases intentions and engagement in health behaviors. Message distribution and collective behavior change within family networks will be mapped using social network analysis. The relative intervention impact will be compared between families from different ethnic backgrounds.

Methods

One hundred and fifty mothers (50 Anglo-Australian, 50 Italian-Australian, 50 Vietnamese-Australian) will be recruited, with four or more other family members across three generations, including a child (aged 10–18 years). Each family is randomly assigned to intervention or control. At baseline and 6-month follow-up, all participants complete surveys to assess dietary and physical activity intentions and behaviors, attitudes towards food, and perceived disease risk. Intervention families receive a visual pedigree detailing their FHH of diabetes, heart disease, breast and bowel cancer, a health education workbook to ascertain members’ disease risk (i.e. average or above average risk), and screening and primary prevention recommendations. After completion of follow-up assessments, controls will receive their pedigree and workbook. The primary hypothesis is that attitudes and lifestyle behaviors will improve more within families exposed to FHH feedback, although the extent of this improvement may vary between families from different ethnic backgrounds. Additionally, the extent of improvement in the treatment group will be moderated by the level of family disease risk, with above-average risk leading to greater improvement. A secondary aim will explore different family members’ roles in message distribution and collective responses to risk using social network approaches and to compare network functioning between families with different ethnic backgrounds.

Discussion

Results will guide future health promotion programs aimed at improving lifestyle factors. This research will assess whether FHH can motivate families to adopt family-level strategies to support health promoting behaviors. Secondary analyses aim to identify change agents within the family who are particularly effective in shifting normative behaviors.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12613001033730. Retrospectively registered: 17 September, 2013.

Does the mortality risk of social isolation depend upon socioeconomic factors?

This study considers whether socioeconomic status influences the impact of social isolation on mortality risk. Using data from the Alameda County Study, Cox proportional hazard models indicate that having a high income worsens the mortality risk of social isolation. Education may offset risk, however, and the specific pattern that emerges depends on which measures for socioeconomic status and social isolation are included. Additionally, lonely people who earn high incomes suffer especially high risk of accidents and suicides as well as cancer. Further research is needed that contextualizes the health risks of social isolation within the broader social environment.

Social capital, mortality, cardiovascular events and cancer: a systematic review of prospective studies

BACKGROUND

Social capital is considered to be an important determinant of life expectancy and cardiovascular health. Evidence on the association between social capital and all-cause mortality, cardiovascular disease (CVD) and cancer was systematically reviewed.

METHODS

Prospective studies examining the association of social capital with these outcomes were systematically sought in Medline, Embase and PsycInfo, all from inception to 8 October 2012. We categorized the findings from studies according to seven dimensions of social capital, including social participation, social network, civic participation,social support, trust, norm of reciprocity and sense of community, and pooled the estimates across studies to obtain summary relative risks of the health outcomes for each social capital dimension. We excluded studies focusing on children, refugees or immigrants and studies conducted in the former Soviet Union.

RESULTS

Fourteen prospective studies were identified. The pooled estimates showed no association between most social capital dimensions and all-cause mortality, CVD or cancer. Limited evidence was found for association of increased mortality with social participation and civic participation when comparing the most extreme risk comparisons.

CONCLUSIONS

Evidence to support an association between social capital and health outcomes is limited. Lack of consensus on measurements for social capital hinders the comparability of studies and weakens the evidence base.

Capital interplays and the self-rated health of young men: results from a cross-sectional study in Switzerland

Introduction

We apply capital interplay theory to health inequalities in Switzerland by investigating the interconnected effects of parental cultural, economic and social capitals and personal educational stream on the self-rated health of young Swiss men who live with their parents.

Methods

We apply logistic regression modelling to self-rated health in original cross-sectional survey data collected during mandatory conscription of Swiss male citizens in 2010 and 2011 (n = 23,975).

Results

In comparison with sons whose parents completed mandatory schooling only, sons with parents who completed technical college or university were significantly more likely to report very good or excellent self-rated health. Parental economic capital was an important mediating factor in this regard. Number of books in the home (parental cultural capital), family economic circumstances (parental economic capital) and parental ties to influential people (parental social capital) were also independently associated with the self-rated health of the sons. Although sons in the highest educational stream tended to report better health than those in the lowest, we found little evidence for a health-producing intergenerational transmission of capitals via the education stream of the sons. Finally, the positive association between personal education and self-rated health was stronger among sons with relatively poorly educated parents and stronger among sons with parents who were relatively low in social capital.

Conclusions

Our study provides empirical support for the role of capital interplays, social processes in which capitals interpenetrate or co-constitute one another, in the intergenerational production of the health of young men in Switzerland.

The importance of economic, social and cultural capital in understanding health inequalities: using a Bourdieu-based approach in research on physical and mental health perceptions

In this article we adopt a Bourdieu-based approach to study social inequalities in perceptions of mental and physical health. Most research takes into account the impact of economic or social capital on health inequalities. Bourdieu, however, distinguishes between three forms of capital that can determine peoples' social position: economic, social and cultural capital. Health research examining the effects of cultural capital is scarce. By simultaneously considering and modelling indicators of each of Bourdieu's forms of capital, we further the understanding of the dynamics of health inequalities. Using data from a large-scale representative survey (N = 1825) in Flanders, Belgium, we find that each of the forms of capital has a net effect on perceptions of physical and mental health, which persists after controlling for the other forms of capital and for the effects of other correlates of perceived health. The only exception is that the cultural capital indicators are not related to mental health. These results confirm the value of a Bourdieu-based approach and indicate the need to consider economic, social and cultural capital to obtain a better understanding of social inequality in health.

A relational approach to health practices: towards transcending the agency-structure divide

Many health scholars find that Pierre Bourdieu's theory of practice leaves too little room for individual agency. We contend that, by virtue of its relational, field-theoretic underpinnings, the idea of leaving room for agency in Bourdieu's theory of practice is misguided. With agency manifested in interactions and social structures consisting of relations built upon relations, the stark distinction between agency and structure inherent to substantialist thinking is undermined, even dissolved, in a relational field-theoretic context. We also contend that, when treated as relationally bound phenomena, Bourdieu's notions of habitus, doxa, capital and field illuminate creative, adaptive and future-looking practices. We conclude by discussing difficulties inherent to implementing a relational theory of practice in health promotion and public health.

A theory of how rural health services contribute to community sustainability

Study and opinion suggest that health services play a significant role in supporting the social fabric of fragile rural communities. We draw on empirical evidence about the added-value contributions of health services to communities and unite it with theory of capitals to propose a theoretical model depicting how rural health services contribute to community sustainability. While providing an analytical framework, the paper also points to construction of a measurement tool for enabling planners to measure the contributions of diverse sectors to community sustainability and predict or measure the impact of changes to models of service delivery on the future of rural communities.