Wang Hongmei, Schlesinger Mark, Wang Hong, Hsiao William C
University of Nebraska Medical Center, Health Services Research and Administration, 984375 Nebraska Medical Center, Omaha, NE 68198, USA.
Soc Sci Med. 2009 Jan;68(1):133-42. doi: 10.1016/j.socscimed.2008.09.038. Epub 2008 Nov 3.
Despite increasing evidence that social capital is positively associated with health, the pathways that link social capital to health are not definitive and invite further investigation. This paper uses household survey data from 22 villages in China in 2002 to test the relationship between social capital and the self-reported health status of the rural population. Focusing on the cognitive dimension of social capital, this paper complements current social capital research by introducing an overlooked distinction between trust and mistrust. Trust and mistrust are measured at the individual and aggregate levels, and the distinct ways in which they affect general and mental health are explored. We adopt an ordered logistic regression using survey procedures in SAS version 9.1 to account for the stratified and clustered data structure. The results suggest that: (1) individual-level trust and mistrust are both associated with self-reported health in rural China--trust is positively associated with both general health and mental health, while mistrust is more powerfully associated with worse mental health; and (2) the effects of individual-level trust and mistrust are dependent on village context--village-level trust substitutes for individual-level trust, while individual-level mistrust interacts positively with village-level mistrust to affect health. However, an unexpected protective health effect of mistrust is found in certain types of villages, and this unique result has yet to be examined. Overall, this study suggests the conceptual difference between trust and mistrust and the differential mechanisms by which trust and mistrust affect health in rural China. It also suggests that effective policies should aim at enhancing trust collectively or reducing mistrust at the personal level to improve health status in rural areas of China.
尽管越来越多的证据表明社会资本与健康呈正相关，但将社会资本与健康联系起来的途径并不明确，有待进一步研究。本文利用2002年中国22个村庄的家庭调查数据，检验社会资本与农村人口自我报告的健康状况之间的关系。本文聚焦于社会资本的认知维度，通过引入信任与不信任这一被忽视的区别，对当前的社会资本研究进行了补充。在个体和总体层面测量信任和不信任，并探讨它们影响总体健康和心理健康的不同方式。我们采用SAS 9.1版本中的调查程序进行有序逻辑回归，以处理分层和聚类的数据结构。结果表明：（1）个体层面的信任和不信任都与中国农村地区自我报告的健康状况相关——信任与总体健康和心理健康均呈正相关，而不信任与较差的心理健康的关联更为强烈；（2）个体层面的信任和不信任的影响取决于村庄背景——村庄层面的信任可替代个体层面的信任，而个体层面的不信任与村庄层面的不信任呈正交互作用以影响健康。然而，在某些类型的村庄中发现了不信任对健康的意外保护作用，这一独特结果尚待研究。总体而言，本研究揭示了信任与不信任之间的概念差异，以及信任和不信任在中国农村地区影响健康的不同机制。研究还表明，有效的政策应旨在集体增强信任或减少个人层面的不信任，以改善中国农村地区的健康状况。
