Chavez Roberta, Kemp Lynn, Harris Elizabeth
Centre for Health Equity, Training, Research, and Evaluation, Old Clinical School Building, University of New South Wales, Locked Mail Bag 7103, Liverpool, BC NSW, 2170, Australia.
J Health Serv Res Policy. 2004 Oct;9 Suppl 2:29-34. doi: 10.1258/1355819042349871.
Research into the social determinants of health inequalities is increasingly focusing on macro-level forces affecting individuals and communities. The concept of social capital has been at the centre of this research as a potential explanatory framework for understanding these inequalities. The aim of this study was to identify the components that define social capital and its relationship to self-reported health in two neighbourhoods known to be disadvantaged in south-western Sydney.
This study uses data from cross-sectional household (door-knock) surveys originally developed as evaluation tools for neighbourhood based interventions. Secondary analyses including factor analysis and multiple regression analysis were used to provide empirical evidence of the components defining social capital and how these, as a concept, were associated with self-reported health.
The study revealed six common social capital components in each sample and an additional component in one neighbourhood. These included neighbourhood attachment, support networks, feelings of trust and reciprocity, local engagement, personal attachment to the area, feelings about safety and proactivity in the social context. The social capital model incorporating demographic and socio-economic characteristics explained 23.4% of health variance in one neighbourhood, and 19.3% in the other. Examining the social capital:health relationship revealed that with the exception of feelings of trust and reciprocity, no other social capital component made significant contributions to explaining health variance and that macro-level factors such as housing conditions and employment opportunities emerged as key explanatory factors.
If interventions are to use social capital as a way of addressing health inequalities, these need to look closely at the role of trust for improving health outcomes of deprived populations as well as ensuring access to resources and infrastructure.
对健康不平等的社会决定因素的研究越来越关注影响个人和社区的宏观层面力量。社会资本概念一直是这项研究的核心，作为理解这些不平等现象的潜在解释框架。本研究的目的是确定在悉尼西南部两个已知处于不利地位的社区中定义社会资本的组成部分及其与自我报告健康状况的关系。
本研究使用来自横断面家庭（挨家挨户敲门）调查的数据，这些数据最初是作为基于社区的干预措施的评估工具开发的。包括因子分析和多元回归分析在内的二次分析被用来为定义社会资本的组成部分以及这些组成部分作为一个概念如何与自我报告的健康状况相关联提供实证证据。
该研究在每个样本中揭示了六个常见的社会资本组成部分，在一个社区中还发现了一个额外的组成部分。这些包括社区归属感、支持网络、信任和互惠感、社区参与、对该地区的个人归属感、对安全的感受以及在社会环境中的积极性。纳入人口统计学和社会经济特征的社会资本模型解释了一个社区中23.4%的健康差异，在另一个社区中为19.3%。对社会资本与健康关系的研究表明，除了信任和互惠感之外，没有其他社会资本组成部分对解释健康差异有显著贡献，住房条件和就业机会等宏观层面因素成为关键解释因素。
如果干预措施要将社会资本作为解决健康不平等问题的一种方式，就需要密切关注信任在改善贫困人口健康结果以及确保获得资源和基础设施方面的作用。
