Is social capital the key to inequalities in health?

Abstract

There has been vigorous debate between the "social capital" and "neomaterialist" interpretations of the epidemiological evidence regarding socioeconomic determinants of health. We argue that levels of income inequality, social capital, and health in a community may all be consequences of more macrolevel social and economic processes that influence health across the life course. We discuss the many reasons for the prominence of social capital theory, and the potential drawbacks to making social capital a major focus of social policy. Intervening in communities to increase their levels of social capital may be ineffective, create resentment, and overload community resources, and to take such an approach may be to "blame the victim" at the community level while ignoring the health effects of macrolevel social and economic policies.

FIGURE 1—

Time trends in income inequality (measured by the Gini coefficient) and age-standardized mortality rates (per 100 000 population) in New Zealand.

FIGURE 2—

Income inequality and life expectancy (from Lynch et al.23) for the same 9 countries reported by Wilkinson et al., but with information updated to 1989–1991 (A) and with the addition of the other 7 countries for which income inequality data are now available for the period 1989–1991. Note. Circles represent country population size.