Department of Public Health, La Trobe University and the Australian Prevention Partnership Centre, Australia.
Menzies Centre for Health Policy, University of Sydney, and the Australian Prevention Partnership Centre, Australia.
Soc Sci Med. 2020 Jul;257:111930. doi: 10.1016/j.socscimed.2018.09.006. Epub 2018 Sep 8.
In the 21 years since social capital first appeared in the public health literature, the evidence base has grown enormously, now reaching 28 systematic reviews encompassing more than 850 individual studies. We summarise this evidence and explain why conclusions relating to both the relationship between social capital and health, and the effectiveness of interventions to promote population health remain elusive and contradictory. A critical factor is the inadequate way that context is treated in the research, and especially how context interacts with efforts to promote health in a dynamic fashion. Of all the different types of interventions one could employ to improve the health of the public, 'social capital' interventions are likely to be the most context specific and especially affected by the boundaries placed around the context. A way forward is offered that requires a combination of insights from systems thinking, community-based participatory research, and intervention and improvement sciences. This requires renewed focus on the specific components of social capital, an understanding of how context interacts dynamically with efforts to improve health, a greater role for practice in the design, implementation, adaptation and evaluation of interventions, and the support of researchers to develop better methods for recognising and classifying the knowledge generated by complex interventions.
自社会资本首次出现在公共卫生文献中以来的 21 年里,证据基础已经大大扩展,现在已经涵盖了 28 项系统评价,其中包含了超过 850 项单独的研究。我们总结了这些证据,并解释了为什么与社会资本与健康之间的关系以及促进人口健康的干预措施的有效性相关的结论仍然难以捉摸且相互矛盾。一个关键因素是研究中对背景的处理方式不够充分,特别是背景与以动态方式促进健康的努力如何相互作用。在所有可以用来改善公众健康的不同类型的干预措施中,“社会资本”干预措施可能是最具体的背景,并且特别容易受到围绕背景设置的限制的影响。提供了一种前进的方式,需要将系统思维、基于社区的参与式研究以及干预和改进科学的见解相结合。这需要重新关注社会资本的具体组成部分,了解背景如何与改善健康的努力动态相互作用,在设计、实施、调整和评估干预措施方面更多地发挥实践的作用,并支持研究人员开发更好的方法来识别和分类复杂干预措施产生的知识。