Social Capital and Well-being

Michael S. Abrams

24 February 2008 MA in Individualized Studies Goddard College

TABLE OF CONTENTS Preface

II. Social Capital and Well-being a. Social Capital and Health b. Social Capital and Mental Health c. Inequality and Health

III. An Alternative Approach IV. Conclusion

References

Preface
On the occasion of my first residency at Goddard College, the cab driver who drove me to the school from the airport proffered his opinion that Burlington, and Vermont in general, were exceptionally great places to live. "Why? I asked. "Quality of life," he immediately respondedperhaps not realizing that his answer could be considered tautological, but also entirely unaware that my avowed purpose in pursuing the MA in Individualized Studies was specifically to investigate the many measures that have been developed to assess 'quality of life' at the societal level. If I were ever to doubt whether levels of social capital were associated with a community's quality of life, I need only study Robert Putnam's 'social capital' map of the US. (Putnam is the American political scientist who is universally given the credit of almost single-handedly bringing the academic concept of social capital into the popular lexicon.) East of the Mississippi--by Putnam's careful quantitative assessment--Vermont stands alone as the single state that can boast an impressive level of social capital. If one provisionally were to accept that a high level of social capital was prerequisite to a good quality of life, my cab driver's intuition about Vermont would dovetail perfectly with Putnam's painstaking analysis. Social capital has a plethora of definitions, but all of them have some bearing on the strength of the social fabric that binds us together. This is reflected in such items as the degree to which we trust our neighbors, and the number of voluntary organizations to which we belong. Through his writings, Putnam has endeavored to raise popular awareness of the degree to which the quality of life that a society can offer is a function of the level of social capital that it embodies. In this paper I will attempt to critically examine his hypothesis. I will try to understand the degree to which well-beingespecially as it manifests both in physical and mental healthcan be linked to social capital. It would appear that healthboth physical and mentalprovides the ultimate test of the impact of any particular factor on well-being,

for the following reasons. First: it would be hard to imagine a meaningful definition of human well-being that did not list health as a critical component. Second: although there are obviously degrees of health--whether physical or mental--such degrees tend to be objectively verifiable. My goal is to understand the relation between social capital and human well-being, but specifically in terms of its implications for my eventual purpose of evaluating the various indicators that have been developed to assess quality of life at the societal level. (Such indicators include the Human Development Index, the Genuine Progress Indicator, and several others.) To the degree that I am successful, I should be in a better position to make meaningful judgments about the usefulness of any such indicator. Michael S. Abrams Sao Paulo, Brazil

I.

What is Social Capital?

As a starting point for our discussion, we will use what would appear to be a basic formulation: Social capital is a form of capital that exists within relationships among individuals. (Karner, 2001, p. 2637) So, social capital is a form of capital, one of the fundamental concepts in Economics. Then, just what is capital? Pierre Bourdieu, the first social scientist to develop a theory of social capital, defined capital as accrued labor which can be tapped by individuals or groupseither to further their specific interests, or to amass still more capital. (Karner, 2001, p. 2637) From the point of view of the individual, [s]ocial capital constitutes a specific kind of resource that is available to an actor. Unlike other resources, social capital is based on reciprocity and thus comes with the expectations that obligations will be repaid as requested by other individuals in the network. (Karner, 2001, p. 2637) The French social theorist Bourdieu, together with two Americanssociologist James Coleman and political scientist David Putnamare generally regarded as having been the most important influences on the contemporary theory of social capital. (Hawkins, 2005, p. 2218) Bourdieus particular focus was on the elite in French society. He was interested in elucidating disguised or invisible forms of social capital that were deployed by elites to maintain social inequality. He saw the nonmaterial exchanges inherent in social relationships as producing resources that members of elites drew upon to maintain their positions within the existing social structure. (Hawkins, 2005, p.2219) Contrasting with Bourdieus anti-democratic formulation, Coleman sough a far more benign conceptualization: His interest in social capital came out of his research on the importance of family and community in educational results. He found that familial and community resources, which he defined as social capital, were sufficiently powerful to compensate for economic disadvantages. For Coleman . . . not only individuals benefited from social capital, but also society as a whole. (Hawkins, 2005, p. 2219) For Coleman, social capital was not monolithic, but rather manifested in a variety of distinguishable forms:

1) Obligations and expectations. A social network may rely on favors. An individual in the network who has done many favors for other members, but who has not requested any favors from them, can be said to have accumulated a certain amount of social capital within the network. Such capital can be utilized when the individual needs to request a favor from another member of the network. Obligations and expectations constitute a form of social capital that depends on trust. One does favors for other members within the social network because one trusts that these favors will ultimately be reciprocated. Therefore, the strength of such networks can be inferred from the amount of outstanding obligations, which corresponds to the degree to which this trust is manifest. 2) Information potential. Knowledge and information can be a critical resource for the accomplishment of ones objectives. Participation in a network can enable one to avail oneself of the knowledge that others have accrued. 3) Norms and effective sanctions Within a social system, norms can support and provide rewards for specific behaviors. Norms that encourage the subjugation of self-interest to the needs of the community are an especially powerful form of social capital. 4) Authority relations. For groups that are organized in the service of a particular issue, the designation of a leader considerably amplifies the social capital of each of their members. 5) Appropriable social organization When the issue for which a social organization was constituted is resolved, the organization often continues to exist by redefining its goals. The organization itself constitutes a form of social capital, one that can be appropriated for a new purpose. 6) Intentional organization An intentional organization is an organization formed for the purpose of directly benefiting its members. Examples include joint business ventures and PTA chapters. This form of social capital advances the interest of those who invest in it. There are two by-products of intentional organization: a public good that benefits others who did not invest directly, and a social g organization that can be appropriated for other purposes. (Karner, 2001, pp. 2638-39)

These forms may be quite disparate, but each of them share two common elements:(1) Social capital appears as an aspect of social structures, and (2) actors are able to use social capital as a resource to achieve their goals within the social structure. (Karner, 2001, p. 2638) In addition to developing a typology of social capital, Coleman also identified several canonical factors by which social capital could increase or decrease: Networks could exhibit greater or lesser degrees of closure, or of stability. Their members could be motivated by a common ideology. They could have access to more resources as the result of affluence. Finally, they could flourish as the result of the availability of official aid. (Karner, 2001, p. 2640) Robert Putnam, the third figure in the social capital triumvirate, found his inspiration in his efforts to understand why northern Italy manifested far higher levels of civil integration than southern Italy. In 1970, Italy created a net of 20 regional governments that collectively spanned the country. These governments had the same form, but each sprouted within the context of a unique configuration of social, economic, political and cultural conditions. Any number of spectrums were represented, including the one from the pre-industrial to the post-industrial, from the traditionalist Catholic to the radical Communist, from the quasifeudal to the thoroughly modern. Several of the governments that were created floundered in corruption and inefficiency. But others were amazingly successfulto the extent of generating an impressive array of innovative social, economic and environmental programs. Putnam and his colleagues sought the underlying cause for the radically different resultswhy some of the governments flourished, and others floundered. He found that the critical factor was not ideology or standard of living, nor was it in the respective stabilities of the societies alone, nor in their respective degrees of political harmony. The critical factor was the degree of civic engagement, as reflected in such statistics as voter turnout, newspaper readership, and the level of membership in clubs and voluntary associations. (Putnam, 1993, p. 2)

Perhaps his graphic conclusions merit quoting at length: Some regions of Italy, such as Emilia-Romagna and Tuscany have many active community organizations. Citizens in these regions are engaged by public issues, not by patronage. They trust one another to act fairly and obey the law. Leaders in these communities are relatively honest and committed to equality. Social and political networks are organized horizontally, not hierarchically. These civic communities value solidarity, civic participation and integrity. And here democracy works. At the other pole are the uncivic regions, like Calabria and Sicily, aptly characterized by the French term incivisme. The very concept of citizenship is stunted there. Engagement in social and cultural associations is meager. From the point of view of the inhabitants, public affairs is somebody elses businessi notabili, the bosses, the politiciansbut not theirs. Laws, almost everyone agrees, are made to be broken, but fearing others lawlessness, nearly everyone demands sterner discipline. Trapped in these interlocking vicious circles, nearly everyone feels powerless, exploited, and unhappy. It is hardly surprising that representative government here is less effective than in more civic communities. (Putnam, 1993, p. 3) The Italian civic communities have their roots in the communal republics that were established in early medieval times in such places as Florence, Balogna and Genoa. It would appear that the tradition of an active citizen dies hard. Putnam believes that he can discern a virtually continuous path from the guilds, religious fraternities and tower societies for self-defense of those times to the cooperatives, mutual aid societies, neighborhood associations, and choral societies of our own. (Putnam, 1993, p.3) Fully aware that his findings had an enduring relevance, Putnam went on to apply the concept of social capital to his study of civic culture in the United States; in an article published in 1995 . . . he brought the concept of social capital into the world of political debate and the popular media, first in the United States and then internationally. (Hawkins, 2005, p. 2219) For Putnam social capital was a powerful latent factor to be tappedwhether the issue at hand was the encouragement of economic development or the development of more effective government. (Putnam, 1993, p. 3) He cited three reasons for its potential to spur progress in both realms. First, it provides a basis for a generalized reciprocity that makes for a more efficient society. Second, it makes it easier to obtain information about the trustworthiness of individuals, and therefore helps reduce the possibility of

opportunism and malfeasance. Finally, it embodies and reflects previous successful efforts at collaboration in such a way as to provide a basis for future efforts. (Putnam, 1993, pp. 3-4) The key to social capital is the difference it makes in peoples ability to cooperate. The ability of people in the population to form groups cooperating for joint projects is at the heart of social capital. Social capital refers to those instances in which individuals cooperate either out of trust, from personal motives, or as the result of group pressure but only in the event in which the group is voluntarily chosen and may be left. It specifically excludes the situation where the cooperation is not voluntary, but rather is enforced by some party external to the group. (Paldam, 2000, p. 633) It is entirely possible for a group to be created by an outside agent, but thereafter common experiences result in the members learning to trust and rely on one another. The classic example of this, of course, is the Army platoon. In such instances, the social capital would correspond to the amount by which the trust that develops within the group exceeds the level at which it is enforced by the third party. (Paldam, 2000, p. 633) Coleman specifically defines social capital as the degree to which an individual can voluntarily work with others. Numerous writers have grounded this willingness to cooperate with others in the ability to trust. Therefore, social capital might also be defined as the degree of trust that the individual has in others. (This trust is likely to be reciprocated, and is termed the individuals goodwill.) Another definition relates to the degree to which an individual can receive benefits based on her goodwill. Finally, we can define the social capital of a group as the average social capital of the individuals that constitute that group. (Paldam, 2000, p. 635) Trust and cooperation are interdependent. It would appear that trust is primary to most cooperation. However, by working together people further build trust. To the degree to which trust and cooperation are interdependent, we can base the concept of social capital in their simultaneous presence and have some hope that it corresponds to an empirical aspect of a societys functioning. (Paldam, 2000, p. 636) An alternative definition to the trust-cooperation definition of social capital is the network definition: an individuals social capital is the number of networks that he has

built. A third definition is the total amount of benefits that the individual can draw on her networks, when necessary. (Paldam, 2000, p. 641) We might question to what degree our definition of social capital as trustcooperation is compatible with Putnams, which was based on civic engagement. Results from the World Values Survey for 32 countries show a high, but not perfect, correlation between trust and perceived political participation. (Trust is tested by responding to the question, Generally speaking, do you believe that most people can be trusted, or cant you be too careful in dealing with people?) Problematizing the results are four countries that appear to be extreme outliers: China (with very high trust), Brazil (seemingly with no trust), and Switzerland and the Netherlands (both with very high levels of political participation). The anomalous results with China and Brazil might point to the necessity of using a question based on trustpayoff, such as: How many of your friends will trust you with a loan? (Paldam, 2000, p.642) In contemporary discussions of social capital three varieties are generally recognized: bridging, bonding, and linking. Bonding social capital corresponds to the strong ties between such groups as families and friends. Putnam cites fraternal organizations and church reading groups as examples of bonding social capital. Bridging social capital refers to the weak ties we have with distant friends, and business associates. Putnam cites civil rights movements and ecumenical religious organizations as examples. Finally, linking social capital refers to relations between individuals and groups in different social strata in a hierarchy where power, social status, and wealth are accessed by different groups. (Social Analysis and Reporting Division, 2001, p. 11) In fact, social capital is a multidimensional variable that relies on three factors: relationships, norms and trustboth within and between groups and institutions. The three dimensions of social capital are: 1) Structural/Cognitive. Structural social capital describes the relationships, networks, associations and institutions that link together people and groups. It can be measured by counting the number of voluntary organizations, or by determining the percentage of people who

participate in them. Some consider an individuals social capital to be the degree of participation in organizations beyond the workplace. Cognitive social capital consists of values, norms, reciprocity, altruism and civic responsibility, sometimes called collective moral resources. An individuals cognitive social capital can be associated with trust and feelings of belonging. It can be measured by surveys of how well individuals trust their neighbors, and how strong their civic identity is. 2) Bonding/Bridging Bonding social capital can be considered inward-focused and characterized by homogeneity, strong norms, loyalty and exclusivity. It is intra-group, and relies on strong ties. Examples of bonding capital include families and small close-knit migrant groups. Bridging social capital is outward-looking, linking disparate groups within society. As the ties it invokes are necessarily weaker, it can be considered more fragile than the bonding variety. Bridging social capital is manifest in a persons social networks. Bonding social capital can either be benign or malign, manifesting both in strong families as in terrorist cells. However, bridging capital is almost always benignand binding disparate groups, it can enable positive social action. 3) Horizontal/ Vertical This distinction pertains to whether the individuals that are linked are of similar or different strata in society. (McKenzie & Hapham, 2006, pp. 14-15) Not the least of its values, social capital has the potential of being an important unifying concept in the social sciences. It offers a common theoretical language that can allow historians, political scientists, anthropologists, economists, sociologists, and policymakers to work together in an open and constructive manner. (Karner, 2001, p. 2641) All of the social sciences use the concept, but not necessarily with the same name. It is generally recognized that a greater degree of cooperation between these fields could

lead to far greater progress. One of the main virtues of social capital is that it is close to becoming a joint concept for all the social sciences. (Paldam, 2000, p. 631)

a.

Measurement

There is general agreement on the importance of the concept of social capital, both academically and in public policy. However, there has yet emerged no clear consensus on how to measure it. (Hawkins, 2005, p. 2219) The attempt to determine the amount of social capital in a community is problematic. First, it is questionable whether it should be determined simply by aggregating the measures of the social capital of its individuals. But there are even more fundamental problemsregarding the nature of the entity whose social capital should be measured. What is a communityis it geographical or psychological or functional . . . ? If it is geographical, then what area size should we measure and who should define it the community or the policy makers? (McKenzie & Hapham, 2006, p. 17) Further there are numerous examples of situations where neighborhood is less important than other social ties: [A] refugee living in a stable neighborhood of a large city may find support in the city-wide refugee community from the same country far more important than the neighborhood community. Many faith groups find their faith community more important than their residential community, especially if they are in the minority in their geographical area. Socially excluded groups such as those suffering from mental illness may link with each other through support groups which increasingly are based on telephone lines and the Internet. (McKenzie & Hapham, 2006, p. 17) The best regarded measure of social capital is Putnams Instrument, which is the per capita number of voluntary organizations in a given population. As organizations can differ vastly in the intensity of the contacts that they can offer to the individual, we can also consider a version of Putnams Instrument in which the calculation of the number of organizations is weighted by the intensity of these contacts. Putnams Instrument can serve as a proxy for social capital as trust-cooperation. However, it cannot be regarded as a true measure, because the number of organizations can be greatly influenced both by culture and the populations degree of affluence. (Paldam, 2000, pp. 636-37)

One intriguing theoretical approach to measuring social capital is via the wellknown Prisoners Dilemma: Two suspects, A and B, are arrested by the police. The police have insufficient evidence for a conviction, and, having separated both prisoners, visit each of them to offer the same deal: if one testifies for the prosecution against the other and the other remains silent, the betrayer goes free and the silent accomplice receives the full 10-year sentence. If both remain silent, both prisoners are sentenced to only six months in jail for a minor charge. If each betrays the other, each receives a five-year sentence. Each prisoner must make the choice of whether to betray the other or to remain silent. However, neither prisoner knows for sure what choice the other prisoner will make. So this dilemma poses the question: How should the prisoners act? (Wikipedia, n.d.) Clearly the critical issue in the Prisoners Dilemma is trust. The prisoners succeed or fail precisely to the degree that they are able and willing to trust one another. In the context of the Prisoners Dilemma, social capital can therefore be defined as the propensity to play the cooperative solution. (Note that either player does so despite full knowledge thatfor any given choice by the other playerhe can always improve his individual outcome by defecting.) Therefore, we may use the frequency with which the cooperative solution of the Prisoners Dilemma is played as a measure of social capital. (Paldam, 2000, p. 638) Paldam concludes that the most promising measures of social capital are (1) Putnams Instrument and surveys of generalized trust, and (2) network/trust payoffs. It would appear that Putnams Instrument yields the same measures of social capital as the standard polling question regarding generalized trust in mostbut not all countries. (Paldam, 2000, p. 649)

b.

Criticisms

In Putnams optimistic view, social capital was the hidden key to progress both in the political and the economic spheres. But the effects of social capital are not necessarily benign, as it can itself lead to social problems, whether in the form of organized crime associations, prostitution and gambling rings, or youth gangs. Such forms are obviously not the kind that Putnam had in mind when he was considering the impact of voluntary organizations and newspaper readership. (Hawkins, 2005, p. 2219) In particular, Putnam saw social capital as something that primarily benefited society, as opposed to the individual. He argued that there was a direct correlation between the quality of civic culture and levels of poverty, violence and democracy. Such an understanding had an inherent appeal, as it seemed to promise a non-economic therapy that could assuage a variety of social ills. Unfortunately, Putnam had failed to consider the role of economics adequately in the deterioration of civic culture to begin with. (Hawkins, 2005, p. 2219) Another criticism is that social capital can contribute to discrimination, restriction of individual freedom and creativity, lack of economic opportunity, and overwhelming obligations. It can encourage divisiveness, with in-groups and outgroups. It demands conformity, which impinges on personal freedom and expression. Finally, it can result in excessive concentrations of powerwith the Mafia being the classic example. (Karner, 2001, p. 2640) A societys social capital tends to manifest in the form of vested interests that can inhibit necessary social change. Obvious examples of this include guilds, trade organizations, unions, and regional and tribal organizations. Though such organizations are generally benign, they also tend to be heavily invested in the status quo. Further, it is clear that organizations can work against the social interest. Examples of this include networks that are associated with criminal, racist, and violent purposes. (Paldam, 2000, pp. 634-35) Also, participation in a network, by itself, cannot really be considered a sufficient criterion. Networks only have value to the degree they have sufficient resources of value to make a difference. (Karner, 2001, pp. 2640-41)

There are, perhaps, even more serious issues regarding the use of social capital in its tendency to conflate the political and economic spheres. Deliberative and participatory versions of democracy require an atmosphere and an attitude where people see their political interactions as motivated by the best, most just solutions to political problems . . . . [P]eople must see themselves and their interests as capable of being transformed by the political process, and they must constantly strive to have their deliberations informed by as many social perspectives as possible. . . . Economic transformations, on the other hand, assume and require no such attitude of magnanimity and familiarity. Economic transactions generally begin with a fixed interest and work to achieve that interest. Such transactions make little economic sense if ones interests are fundamentally transformed in the process because economic transactions are instrumental not transformative ones. The term social capital ignores the emotionally rich world of meaning that has surrounded the idea of democracy and reduces that world of meaning to the very different language of economics. [Italics mine.] (Smith & Kulynych, 2002, pp. 167-68) Increasingly, the concept of social capitalism is being criticized as a way to preempt discussions that properly belong to the political sphere. The World Bank, in particular, is cited as the perpetrator of a conceptualization of social capital that argues for cutbacks in government services in the name of community self-reliance. In remaining silent on the role of political parties and unions in the amelioration of the kind of power relations that help to maintain an underclass, the World Bank incurs a guilt by omissionputting its considerable weight behind the spurious notion that it is possible to have a meaningful public sphere without conflict and strife. (McKenzie & Hapham, 2006, p. 21)

II. Social Capital and well-being

Having discussed some of the ways in which social capital is defined and measuredand having noted some of the ways in which the concept has been criticizedwe now turn to a discussion of its impact on human well-being. Of particular concern here will be social capitals impact on health (both physical and mental), which is generally accepted as among the most, if not the most, crucial way in which human well-being can manifest itself. Putnams 2000 DDB Needham Life Style Survey demonstrated a link between social involvement and happiness, with monthly club meetings, monthly volunteering, monthly entertaining, and bi-weekly church attendance each having the happiness of four extra years of schooling or a doubling of income. However, one cannot directly infer causality from such a correlation, as both may have their cause in a genetic predisposition both to gregariousness and well-being. (J.F. Helliwell, 2001, p.54) However, differences in social capital are well-correlated both to subjective wellbeing and to suicide rates. This makes it more reasonable to posit that the causal path goes from social capital to subjective well-being, rather than the converse. (Helliwell & Putnam, 2004, p. 1444) Social capital impacts well-being directly. A study in 1967 confirmed marriage to be the social connection showing the strongest positive correlation with subjective well-being. The results of Putnams DDB Needham Life Style Survey confirm marriage to be the most beneficial form of social interactionequivalent to moving 70 percentiles up the income hierarchy. . . . [Italics mine] (J.F. Helliwell, 2001, p. 53) The social circumstances that impact well-being include ones economic standard of living. Indeed, until recently economists have generally equated well-being with standard of living. However, research has begun to sever this equation: while well-being tracks income up to a certain economic level, at some critical point the connection inevitably breaks down. Social factors other than standard of living that influence

subjective well-being include: marital status, race, education, employment and age. (Helliwell & Putnam, pp. 1435-36) The results of a meta-analysis of several global and national surveys show the impact of various social factors on well-being: 1) well-being is highest in the young and the elderly, lowest in the middle-aged. 2) well-being tracks income, but only up to a point. 3) Unemployment significantly negatively impacts well-being, and much more than would be predicted by the loss of income that it represents. 4) Education improves health and thus indirectly improves subjective wellbeing, but net of that effect . . . education appears to have no direct impact on subjective well-being. 5) Gender appears to have no strong and straightforward effect on subjective well-being. 6) . . . [B]eing married increases both life satisfaction and happiness, especially when the alternative is being separated or divorced. . . . Having a family enhances subjective well-being, and spending more time with ones family helps even more. 7) Both strong religious beliefs and frequent attendance at a house of worship are linked to subjective well-being. 8) Frequent interactions with friends and neighbors support well-being. 9) Civic participation supports well-being. 10) Living in high-trust area supports well-being. (Helliwell & Putnam, 2004, pp. 1440-43 Note that items 3, 6, 7, 8, 9, and 10 above directly pertain to the amount of social capital upon which the individual is able to draw. Health correlates well with subjective well-being, and it is likely that good health causes subjective well-being. Further, research seems to be confirming that social factors play a critical role in physical health. From this we may conclude that health constitutes one pathway through which social factors influence subjective well-being. (Helliwell & Putnam, p. 1435)

In the following sections, we shall consider the direct impact of social capital on healthboth physical and mental. a. Physical Health

The consensus of a spate of studies on the impact of the extent of social ties on health is that people with more social capital are likely to live longer, and suffer from fewer health disorders. (Field, 2003, p. 58) Putnam suggests that there might be several reasons why social capital impacts health. In his view, social networks 1) can provide the kind of concrete health that can decrease stress levels, 2) provide support for healthy behaviors, 3) enable one to attain medical services more easily, and 4) provide the kind of interaction that can boost ones immunological system. (Field, 2003, p. 58) According to Putnam, There is very strong evidence of powerful health effects of social connectedness. This evidence is not only strong in American states, but also in Finland, Japan and other countries. Controlling for your blood chemistry, age, gender, whether or not you jog, and for all other risk factors, your chance of dying over the course of the net year are cut in half by joining one group, and cut to a quarter by joining two groups. . . . It is not people who are healthy that become joiners; it is clear from the studies that the arrow runs in the other direction, from joining to health. (Putnam, 2001, p. 12) Social capitalboth its presence and absencehave been linked to a variety of health outcomes and behaviors. Social capital has been empirically linked to both reduced mortality and increased self-rated health. Social capital has also been linked to various health-related behaviours, such as smoking, leisure time physical activity, and dietary habits and to the prevalence of various diseases, such as the common cold, coronary heart disease, HIV, depression, and dementia. (Ferlander, 2007, p. 121) However, there is a dual aspect to the effect of social capital on health, reflecting the dual aspect of social capital in general. Strong networks may well provide a buffer against stress, but the demands that participating in them may entail themselves represent a source of stress. They may support healthy lifestyles, but they may as easily support

unhealthy ones. For example, the best predictor that an adolescent will smoke is whether or not her peers smoke. There is a human tendency to follow ones peers. Whether this is beneficial or harmful to ones health depends on the particular norms that prevail in the network. (Ferlander, 2007, p. 122) However, at least some of the results do appear to be unambiguous. A 1979 study of a random sample of 5000 residents of Alameda County, California assessed the health effects of four types of social ties: marriage, contacts with close friends, church memberships, and membership in other types of social organizations. For each type, a greater number of ties was associated with a lower mortality rate. The impact was greatest for marriage, followed by the others in the order given above. It was shown that a weighted index combining the four types predicted not only mortality as a whole, but each of its component subdivisions: heart disease, cancer, cerebrovascular and circulatory, and other. For each participant, a variety of data was gathered, including: socio-economic status, self-reported health status at the time of initial survey, year of death, behaviors that could impact health, and availability/use of health care services. The connection between social networks and mortality was shown to be independent of all such control variables. This made it virtually impossible that differences in health status at the time of the initial survey were the underlying determining factor both of the size of the social networks and of the health outcomes. (J.F. Helliwell, 2001, pp. 49-50) There are ways in which a societys social capital directly impacts the health and well-being of its members. For example, respect for the rights of others gets a thorough testing on the highways that we share. Therefore, the incidence of traffic fatalities provides a good measure of social cohesion. Indeed, more than a third of the crosscountry variance of the late 1990s traffic fatalities is associated with mid 1990s national differences in average survey answers to the trust question . . . (The trust question is, In general, do you think that most people can be trusted, or that you cant be too careful in dealing with people.) (J.F. Helliwell, 2001, p. 50) A study was performed to show the correlation of poverty, social capital, and income inequality with each of the four nationally-modifiable sexually-transmitted diseases in the US: gonorrhea, syphilis, Chlamydia, and AIDS. State-wide rates of all

four diseases correlated well with social capital, as measured by Putnams Comprehensive Social Capital Index for US states. (It combined "14 variables that span the domains of community organizational life, involvement in public affairs, volunteerism, informal sociability, and social trust.") Of the three variables, only social capital proved to be a useful predictor for gonorrhea and syphilis rates, with correlations r2 =.45 and .348, respectively. All three variables had significant correlations with Chlamydia (r2 = .128, .283, and .156, respectively). Finally, only social capital and income inequality were useful predictors of AIDS (r2 = .248 and .220, respectively). (Holtgrave & Crosby, 2003, p. 62-64) Geographical studies appear to confirm these findings: If you consider social capital to be a continuous variable, then areas with high social capital may be expected to have a lower rate of illnesses associated with problems of social cohesion compared with areas of low social capital. Indeed, there are reports that areas with high levels of social capital have lower suicide rates, lower all-cause mortality and longer life-expectancy. (Holtgrave & Crosby, 2003, p. 63)

b. Mental Health

Spatial patterns of social capital are also reflected in the incidence of problems with mental health. People in some places have better mental health than people in other places. This is not just a reflection of their genetic vulnerability, the physical environment, or their socioeconomic status. It also reflects the fabric of society the way in which communities are set up and people live. (McKenzie & Hapham, 2006, p. 11) Concerns with the ways in which society impacted mental health date back at least to Durkheims mid-century classic Suicide. As early as the 1930s, researchers showed that variations in the incidence of mental illness in Chicago neighborhoods were associated with their respective levels of social cohesion. (McKenzie & Hapham, 2006, p. 11) Mental illness has a powerful influence on overall health. Examples include the impact of depression and stress. Depression impacts the functioning of the endocrinal and immunological systems so as to make one susceptible to a large number of physical illnesses. Stress is known to be a factor in the onset of the common cold, and has been shown to delay the healing of wounds. (World Health Organization, 2001, p. 9) Mental illness is not as different from physical illness as is commonly supposed: The artificial separation of biological from psychological and social factors has been a formidable obstacle to a true understanding of mental and behavioural disorders. In reality these disorders are similar to many physical illnesses in that they are the result of a complex interaction of all these factors. (World Health Organization, 2001, p. 10) The physiological and behavioral ways by which physical and mental health can affect each other are distinct but not independent. Health behaviors can affect physiology for example, smoking and lack of exercise can weaken the immune system.

Conversely, physiological functioning can impact health behaviorfor example, not getting enough sleep can lead to forgetting medical regimens. What results is a comprehensive model of mental and physical health, in which the various components are related and mutually influential over time. (World Health Organization, 2001, p. 8) In the last two decades, the field of behavioral medicine has accumulated an impressive amount of evidence that links mental and physical health. Some notable examples of this include: 1) Women with advanced breast cancer who participate in supportive group therapy live significantly longer than women who do not participate in group therapy. 2) Depression is a reliable predictor of heart disease 3) Realistic acceptance of ones own death is associated with decreased survival time in AIDS. (World Health Organization, 2001, p. 8) It might be hoped that building social capital could result in the reduction of health costs and in illness rates. Interest has focused on mental health in particular because it ranks among the three biggest drains on life-years by disability, globally. Also, it is reasonable to conjecture that the primary way in which social capital impacts physical health is via predominantly psychological factors. (McKenzie & Hapham, 2006, p. 12) Research has established that social support can serve as a buffer against illness in many contexts. It has been shown that the mortality rates for better-connected individuals are significantly lower than those of their more isolated peers. Lack of social support has been established as a risk factor for events as widely varied as accidents, suicide, heart disease, and depression. To the degree such illnesses are the result of stress, there is a simple explanation, since social support is believed to buffer the individual against both chronic and acute stress through the provision of emotional, informational and instrumental support. (McKenzie & Hapham, 2006, p. 13) But recently, a meta-analysis was performed of 21 studies of the effects of social capital on mental health14 of the studies were at the individual level, and 7 were at the ecological level. The studies at the individual level found strong evidence for an inverse association between cognitive social capital (trust) and common mental disorders. However, there was less evidence for an inverse association between cognitive social capital and child mental illness, and combined measures of social capital and common

mental disorders. The ecological studies were too diverse in methodology, the populations investigated, and the mental illness outcomes studied to allow for useful comparisons. It concluded that the strength of the current evidenceespecially at the ecological levelis not sufficient to prescribe social capital approaches to reduce the incidence of mental illness. (De Silva, McKenzie, Hapham, & Huffy, 2005, p. 626) For reasons that are very similar to those that have already been discussed, social capital does not unambiguously support mental health. Social capital can help as well as hinder well-being. Social ties born through participation were expected to decrease mental distress. Theoretically, these lead to asset networks, critical forms of support and mutual obligation within the community. They increase cohesiveness and create a sense of duty and collective problem-solving behaviors. The data indicated, however, that in the case of mental well-being, such connections were not only asset networks but also webs of obligation. Instead of reducing distress, the extent of participation in various organizations actually tended to be associated with higher distress. Because many of the organizations that the residents participated in were located within a community it may be that these voluntary ties further burdened individuals already struggling with their own environmental and economic stressors. The obligations of time and energy required of the active participant in the inner city may simply serve as another form of stress, rather than as a mediator of the stress process. (Usher, 2006, p. 118)

c.

Inequality and Health

There would appear to be a basic connection between social capital, inequality, and health. Richard Wilkinson . . . found some evidence that social inequality tends to reduce social stability and undermines social networks, leading to higher levels of anxiety, stress and ill-health. Similar comparative research in the USA . . . confirmed the broad association that he identified between health and social cohesion. (Field, 2003, p. 57) Social capital has been shown to have less of an impact on health than socioeconomic status. It is likely that the kind of social capital that connects individuals with their better-off and worse-off compatriots has more of an impact on health than the kind that connects them with their socioeconomic peers. This might explain the finding that countries with more economic equality have greater life expectancies. (Field, 2003, p. 59) Among nations, health correlates with equalitynot with per capita GDP. It is . . . the most egalitarian rather than the richest developed countries which have the best health. (Field, 2003, p. 75) Data for 11 developed countries in 1970 show that life expectancy is negatively correlated with post-tax income inequality, as measured by the Gini coefficient. (The Gini coefficient measures the degree that a society deviates from a state of perfect egalitarianism. It varies from 0 to 1--with 0, corresponding to perfect equality, and 1, corresponding to the theoretical situation where a single individual controls all the wealth and everyone else has none.) (Mustard, 1998, pp. 7-8) A study of metropolitan areas in the US showed that higher levels of inequality predicted higher levels of mortality. Those areas with the highest income inequality had significantly greater age-adjusted mortality than those of low inequality and . . . this relationship was independent of absolute levels of mean household income. These findings were robust across three different measures of the income distribution. (Mustard, 1998, pp. 8-9)

The findings that link income inequality to physical health (either through life expectancy or mortality) have been criticized as not being robust with respect to the particular inequality measure that is chosen. Another criticism regards the meaningfulness of international comparisons of income inequality. However, neither of these criticisms have proved to be compelling. (Mustard, 1998, pp. 9-10) One proposed way by which higher levels of income inequality can adversely impact the individuals health is that income inequality may be associated with a set of social processes and economic policies that systematically under-invest in physical and social infrastructure, and with these under-investments then having consequences for health. Another explanation is that large disparities in income distribution may have direct consequences on peoples perceptions of their relative place in the social environment, leading to behavioral and cognitive states which influence health. (Mustard, 1998, pp. 14-15) Income inequality also has an impact on mental health. Low income inequality has been identified as a risk-lowering factor for mental health at the community level. (K.McKenzie, 2006, p. 30)

III. An Alternative Approach

Both social capital and healthespecially, mental healthare complex concepts. Intuitively we may feel confident that a causal relation should exist between them surely, ones connectedness, trust, sense of belonging, civic participation, etc. have positive ramifications for ones health and well-being. For example, one researcher discusses several complex graphical models that purport to detail the precise causal pathways in which low levels of social capital inevitably results in poor mental health at the community level. (K.McKenzie, 2006, pp. 27-36) I propose that there is a connection between social capital and well-beingand, in particular, the kind of well-being that is associated with physical and mental health but that this connection should not necessarily be understood solely in terms of elaborate networks of causal relations. My approach starts with the recognition that many, if not all, of the behaviors associated with the concept of social capital are themselves basic human needs. When any basic human need is thwarted, there will necessarily be an adverse effect on well-being. One important aspect of this adverse effect could plausibly manifest as a worsening of the individuals physical and/or mental health. In his Hierarchy of Needs, Abraham Maslow , recognized that after the individuals physiological and safety needs were met, the very next level was the satisfaction of needs pertaining to love and belonging, which include friendship and family; this would correspond well to what we have been discussing as bonding social capital. Recall that the one unambiguous result of a meta-analysis of studies of the impact of social capital on mental health found that bonding social capital, in particular,

made a significant difference in the mental health of individuals. (De Silva, McKenzie, Hapham, & Huffy, 2005, p. 626) More recently, the economist Manfred Max-Neef has proposed a schema that attempts to significantly improve upon Maslows hierarchical formulation. According to Max-Neef, there are, in fact, nine basic human needs: Subsistence, Protection, Affection, Understanding, Participation, Creation, Leisure, Identity and Freedom. In his schema, the only strict hierarchy is between Subsistencethe precondition of life, itself--and the remaining categories. Each need interacts with the four basic human modalities of Being, Having, Doing, and Interacting; the result is his Matrix of Human Needs. While these needs are purported to be constant throughout all times and cultures, the particular means that are available for satisfying any of them are entirely dependent on the time and culture. (Max-Neef, 1992, p. 199) In contrast to Maslows hierarchy, the Matrix of Human Needs attempts to understand human needs as a system. Human needs must be understood as a system; that is, all human needs are interrelated and interactive. With the sole exception of the need of subsistence . . no hierarchies exist within the system. On the contrary, simultaneities, complementaries and trade-offs are characteristic of the process of needs satisfaction. (Max-Neef, 1992, p. 199) In Max-Neefs schema, Affection, Participation, and Identity are the needs most associated with what we have been calling social capital. Affection, in the context of Having, can manifest as the need for friendships and family. Participation, in the context of Doing, can manifest as the need to cooperate, to dissent, and to express opinions; in the context of Interacting, it manifests as associations, parties, churches and neighborhoods. Identity, in the context of Being, can manifest as the need for a sense of belonging. Poverty is conventionally defined either as an absolute or relative lack of income. However, with the recognition that there are nine basic needs, we can speak of nine corresponding forms of poverty. Each of these poverties can be said to have its own particular pathology. (Max-Neef, 1992, p. 200) Thus, it should not be unreasonable to infer that a lack of social capitalwhich, as we have seen, can be associated with deprivation regarding at least three of the nine .

basic needs identified by Max-Neef, and in all four of his basic modalitiescould result in the particular kind of pathologies that we subsume within the categories of physical and/or mental illness.

IV. Conclusion

As we have noted several times in this report, the concept of social capital has an inescapably dual character. There are numerous results which confirm the intuitive idea that higher levels of social capital support well-being in general, and both physical and mental health in particular. On the other hand, for almost every supposed benefit of social capital there might seem to correspond some significant drawback. From our study, however, it appears very likely that individuals flourish according their ability to draw on their networks for support, or trust their neighbors to be fair in their dealings with them. Regarding two social milieus that are identical in every other aspect, the one that supports higher levels of cooperation might reasonably be expected also to support a higher general level of well-being. On this basis, one may provisionally require that any meaningful measure of a societys quality of life include some way of accounting for its social capitalfor example, as measured by a survey that asked the trust question. There is however one aspect of social capitalor, more properly, the consequences of social capitalon which a very strong consensus appears to have emerged regarding its ability to impact well-being, both in individuals and at the community level.. This concerns how evenly, or unevenly, the communitys aggregate wealth is distributed among its members. (Annual income is generally used as a convenient proxy for this wealth.) Therefore, it seems indisputable that we should require that assessments of societal quality of life include some provision for taking account the degree of economic inequality within the societyfor example, through the Gini coefficient.

References
De Silva, M. J., McKenzie, K., Hapham, T., & Huttly, S. R. (2005, August). "Social capital and mental illness: a systematic review." Journal of Epidemiology and Community Health, 59(8), 619-27. Ferlander, S. (2007, June). "The importance of different forms of social capital for health." Acta Sociologica, 50(2), 115-28. Field, J. (2003). Social Capital. New York: Routledge. Hawkins, S. (2005). "Social capital." In M. C. Horowitz (Ed.), New Dictionary of the History of Ideas (pp. 2218-20). Detroit: Charles Scribner's Sons. Helliwell, J. F. (2001). "Social capital, the economy and well-being." The Review of Economic Performance and Social Progress, 01(3), 43-60. Helliwell, J. F., & Putnam, R. D. (2004, September 29). "The social context of wellbeing." Philosophical Transactions: Biological Sciences, 359(1449), 1435-46. Holtgrave, D., & Crosby, R. A. (2003, February). "Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS case rate in the United States." Sexually Transmitted Infections, 79(1), 62-64. Retrieved February 13, 2008, from http://sti.bmj.com/contents-by-date.0.shtml Karner, T. X. (2001). "Social capital." In E. F. Borgatta (Ed.),. Encyclopedia of Sociology (2nd ed., pp. 2637-41). New York: Macmillan Reference USA. Max-Neef, M. (1992). "Development and human needs." In P. Ekins, M. Max-Neef (Ed.), Real-Life Economics: Understanding Wealth Creation (pp. 197-213). Florence, Kentucky: Routledge. McKenzie, K. (2006). "Social risk, mental health and social capital." In K. McKenzie (Ed.), Social capital and mental health (pp. 24-38). London: Jessica Kingsley Publishers. McKenzie, K., & Hapham, T. (2006). "Meanings and uses of social capital in the mental health field." In Social Capital and Mental Health (pp. 11-23). London: Jessica Kingsley Publishers.

Mustard, C. (1998, October 31). "Income inequality and inequality in health: Implications for thinking about well-being." Symposium at CSLS Conference on the State of Living Standards and the Quality of Life in Canada, Ottawa, Canada. Retrieved February 13, 2008, from the October 31 2:15-3:45 PM Session Web site: http://www.csls.ca/events/october.asp Paldam, M. (2000, December). "Social capital: one or many? definition and measurement. Journal of Economic Surveys, 14(5). Putnam, R. D. (1993, March 21). "The prosperous community: Social capital and public life." The American Prospect, 4(13). Retrieved February 17, 2008, from http://xroads.virginia.edu/~hyper/DETOC/assoc/13putn.html Putnam, R. D. (2001, March 19-20). "Social capital: Measurement and consequences." Symposium at "The contribution of human and social capital to sustained economic growth and well-being," Quebec City. Retrieved February 19, 2008, from http://www.oecd.org/document/36/0,3343,en_2649_39263294_2674084_1_1_1_1 ,00.html Smith, S. S., & Kulynych, J. (0202, March). "It may be social but why is it capital? The social construction of social capital and the politics of language." Politics & Society, 30(1), 149-86. Social Analysis and Reporting Division. (2001, October). "Social capital: A review of the literature." Unpublished manuscript at Office of National Statistics, United Kingdom. Retrieved February 19, 2008, from http://www.statistics.gov.uk/socialcapital/downloads/soccaplitreview.pdf World Health Organization. (2001). The world health report 2001: Mental health : new understanding, new hope. Geneva, Switzerland: World Health Organization. Retrieved February 14, 2008, from http://www.who.int/whr/2001/en/whr01_en.pdf Wikipedia. (n.d.). "Prisoner's dilemma." Retrieved February 18, 2008, from the Wikipedia Web site: http://en.wikipedia.org/wiki/Prisoner's_dilemma