Center for Health Management and Policy, Shandong University, Jinan 250012, PR China.
Int J Equity Health. 2009 Feb 15;8:2. doi: 10.1186/1475-9276-8-2.
A growing body of literature has demonstrated that higher social capital is associated with improved health conditions. However, some research indicated that the association between social capital and health was substantially attenuated after adjustment for material deprivation. Studies exploring the association between poverty, social capital and health still have some serious limitations. In China, health equity studies focusing on urban poor are scarce. The purpose of this study is therefore to examine how poverty and individual-level social capital in urban China are associated with health equity.
Our study is based on a household study sample consisting of 1605 participants in two Chinese cities. For all participants, data on personal characteristics, health status, health care utilisation and social capital were collected. Factor analysis was performed to extract social capital factors. Dichotomised social capital factors were used for logistic regression models. A synergy index (if it is above 1, we can know the existence of the co-operative effect) was computed to examine the interaction effect between lack of social capital and poverty.
Results indicated the poor had an obviously higher probability of belonging to the low individual-level social capital group in all the five dimensions, with the adjusted odds ratios ranging from 1.42 to 2.12. When the other variables were controlled for in the total sample, neighbourhood cohesion (NC), and reciprocity and social support (RSS) were statistically associated with poor self-rated health (NC: OR = 1.40; RSS: OR = 1.34). However, for the non-poor sub-sample, no social capital variable was a statistically significant predictor. The synergy index between low individual-level NC and poverty, and between low individual-level RSS and poverty were 1.22 and 1.28, respectively, indicating an aggravating effect between them.
In this study, we have shown that the interaction effect between poverty and lack of social capital (NC and RSS) was a good predictor of poor SRH in urban China. Improving NC and RSS may be helpful in reducing health inequity; however, poverty reduction is more important and therefore should be implemented at the same time. Policies that attempt to improve health equity via social capital, but neglect poverty intervention, would be counter-productive.
越来越多的文献表明，较高的社会资本与改善健康状况有关。然而，一些研究表明，在调整物质剥夺因素后，社会资本与健康之间的关联大大减弱。探索贫困、社会资本与健康之间关系的研究仍然存在一些严重的局限性。在中国，关注城市贫困人口的健康公平研究很少。因此，本研究旨在探讨中国城市的贫困状况和个体层面的社会资本与健康公平之间的关系。
我们的研究基于两个中国城市的家庭研究样本，共包括 1605 名参与者。对所有参与者，收集了个人特征、健康状况、医疗保健利用情况和社会资本的数据。采用因子分析提取社会资本因素。对二分法的社会资本因素进行逻辑回归模型分析。计算协同指数（如果大于 1，则表示存在协同作用），以检验缺乏社会资本和贫困之间的交互作用。
结果表明，在所有五个维度中，贫困者属于低个体层面社会资本群体的概率明显更高，调整后的优势比范围为 1.42 至 2.12。在总样本中控制其他变量时，邻里凝聚力（NC）和互惠与社会支持（RSS）与自评健康状况较差相关（NC：OR=1.40；RSS：OR=1.34）。然而，对于非贫困亚组，没有一个社会资本变量是统计学上显著的预测因素。低个体层面 NC 和贫困、低个体层面 RSS 和贫困之间的协同指数分别为 1.22 和 1.28，表明两者之间存在加重效应。
在这项研究中，我们表明，贫困和缺乏社会资本（NC 和 RSS）之间的交互作用是中国城市中自评健康状况较差的一个很好的预测因素。提高 NC 和 RSS 可能有助于减少健康不公平现象；然而，减贫更为重要，因此应同时实施。试图通过社会资本改善健康公平但忽视贫困干预的政策将适得其反。
