Local services and amenities, neighborhood social capital, and health
Introduction
Recent work on health and place has returned public health to its roots of examining the impact of the environment on health (Snow, 1855). Over the past 10–15 years, this research has examined the impact of the environment at various levels of aggregation, from neighborhoods to nations. At the local level, this research has followed several strands, such as the contextual effects of neighborhoods, the impact of differential access to services and amenities, the effect of a neighborhood's collective efficacy and social cohesion, and the relationship between social capital and health. Of these four approaches, social capital has generated the most debate: some scholars discuss social capital as a key epidemiological variable, while others discount or dismiss its utility. In the research reported in this paper, we employed qualitative methods to examine whether the concept of social capital can explain processes at the neighborhood level that residents identify as being important for their health.
We were especially interested in examining the neighborhood context because of the strong associations evident at that level. For example, studies of contextual effects of neighborhoods have used census data to examine the contributions of neighborhood deprivation to morbidity and mortality. Diez Roux and her colleagues found that residents of disadvantaged neighborhoods had a higher risk of coronary heart disease than residents of advantaged neighborhoods, even after controlling for personal income, education, and occupation (Diez Roux et al., 2001). In an earlier study, Haan and her colleagues found that residents of a federally designated poverty area experienced higher rates of mortality than did residents of non-poverty areas, after adjusting for factors such as age, race, and gender and numerous health-related variables (Haan, Kaplan, & Camacho, 1987).
The impact of differential access to services and amenities in neighborhoods has been extensively examined by Sally Macintyre and her colleagues (Macintyre, Maciver, & Sooman, 1993). They have conducted numerous investigations in Glasgow on the structural and material aspects of the environment. They have found that the richness or paucity of neighborhood amenities such as recreational sites and proximity of grocery stores; residents’ perceptions of local problems; and the area's reputation are related to such individual outcomes as health behaviors (Ellaway & Macintyre, 1996), mental health status (Ellaway & Macintyre, 1998), and body size and shape (Ellaway, Anderson, & Macintyre, 1997), after controlling for individual level variables such as gender, age, and social class.
The effect of neighborhoods’ collective efficacy and social cohesion on health also has been shown to have a strong effect on neighborhood health outcomes. Social cohesion refers to the degree to which neighbors share affective and instrumental support with one another whereas collective efficacy goes a step farther and refers to the degree to which neighbors are willing to utilize their social cohesion “to intervene on behalf of the common good” (Kawachi, Kennedy, & Glass, 1999). Sampson and his colleagues (Sampson, Raudenbush, & Earls, 1997) have shown that collective efficacy at the neighborhood level predicted rates of homicide independent of poverty level. Low social cohesion, along with other measures such as concentrated poverty and disorder have been shown to affect mental distress (Ross, 2000; Elliott, 2000; Aneshensel & Sucoff, 1996), and risk taking and deviant peer group membership among teenagers (Brody et al., 2001; Kowaleski-Jones, 2000).
A number of researchers have focused on social capital in discussing health disparities. For example, Kawachi, Kennedy, Lochner, and Prothrow-Smith (1997) showed a strong association at the level of states between social capital, as represented by aggregate responses to questions on social surveys on the degree of trust in others, and mortality. States in which people surveyed were more likely to believe that “you can’t be too careful with people” had, on average, higher mortality rates. Recent work at the municipal level has shown that residents who live in metropolitan statistical areas with greater stores of social capital, as measured by measures of trust, efficacy, personal safety, reciprocity, voting participation and civic engagement, report fewer problems in having access to health care (Hendryx, Ahern, Lovrich, & McCurdy, 2002). At the neighborhood level, Lochner and her colleagues found that social capital at the neighborhood level, as measured by reciprocity, trust, and civic participation, was associated with lower neighborhood mortality rates after adjusting for neighborhood material deprivation (Lochner, Kawachi, Brennan, & Buka, 2003).
Though the social capital-health conceptualization has been utilized extensively in recent health research, the use of social capital as a concept has been criticized for a lack of conceptual clarity and obscuring fundamental relationships between health and the environment. For example, social capital has been used to describe civic and interpersonal trust, civic participation, social cohesion, and collective efficacy (Macinko & Starfield, 2001). The variability of its definition and use has been criticized because it has become a catch-all concept without distinct meaning or value (Macinko & Starfield, 2001; Fine, 1999; Portes, 1998; Woolcock, 1998). Muntaner and his colleagues have criticized the utilization of social capital on conceptual and political grounds (Muntaner, Lynch, & Smith, 2001). They have argued that the use of social capital in public health research obscures the structural inequalities of class, race, and gender that are the main social factors that impact health. Pearce and Smith (2003) recently have advanced this argument, adding that social capital, among other variables, is a function of macro-level social and economic forces and can lead to “blame the victim” social policies.
One of the more problematic methodological issues regarding social capital is whether it is a variable that reflects the characteristics of individuals or groups. Macinko and Starfield (2001) point out that Portes (1998) counts social capital as a property of individuals; Loury (1992) and Coleman (1990) count it as a property of individuals and their social relations, Bourdieu and Wacquant (1992) count it as the property of groups and Putnam, Leonardi, and Nanetti (1993) refer to social capital as a characteristic of groups and specifically political units. In utilizing a particular variable to describe a relationship between the environment and health outcomes, it clearly is important to have conceptual clarity regarding the unit of analysis, though as of now, there is no standardized definition of the term. Baum and Ziersch (2003) recently have pointed out that these parallel usages of the term have developed because of theorists’ different exegesis of the same term.
More recently, Putnam (2000) stated that although social capital is a characteristic of social networks it serves to benefit both individuals and groups. In this same work, Putnam discussed two distinct types of social capital: bonding and bridging.1 Bonding social capital results from reciprocity of close-knit groups and reflects the degree of social connectedness that individuals have with others in their immediate lives, such as friends, families, neighbors, and co-workers. Conversely, bridging social capital is a property of individuals’ and networks’ connections to other individuals and networks not immediately in one's circle, and perhaps very far from it. In developing this conceptualization, Putnam draws on Granovetter's (1973) conceptualization of “the strength of weak ties”, which posits that one's ability to access goods and influential social networks is tied to the extent and depth of one's far-flung connections. Macinko and Starfield (2001) point out that empirical evidence from Granovetter (1973) and Wallis (1998) demonstrates that bonding social capital without the aid of bridging social capital does little to improve efforts to improve inner-city neighborhoods with regard to increased economic opportunities.
Given the on-going debate regarding social capital, we undertook this research to better understand the potential confluence of the impact of neighborhood social relationships and access to amenities and services on health. In an attempt to disentangle and clarify these concepts, we utilized key informant interviews and focus groups to understand ways in which residents of diverse neighborhoods in one large California city perceived that their local communities were affecting their health and the health of their families and neighbors.
In utilizing interviews and focus groups, we aimed to capture a relatively naturalistic, phenomenological view of community quality of life, in order to examine the ways in which local neighborhoods affect individuals’ health (Raphael et al., 2001). We focused our questions on ascertaining how residents of various neighborhoods perceive the amenities and liabilities of their neighborhoods, how they respond to such phenomena, and the ways in which they perceive that these amenities and liabilities affect their health and the health of their families and neighbors. This approach follows Kawachi and Berkman's (2000) conceptualization of the three pathways through which social capital could affect health at the neighborhood level: access to services and amenities, psychosocial processes, and health-related behaviors.
We chose to use qualitative methods because they are appropriate to utilize when a concept is not clearly mapped. These methods are able to assess a fuller-fledged picture of what a concept might entail since qualitative methods gain insight into individuals’ understanding of events under study that cannot fully be examined via close-ended surveys. Swann and Morgan (2002) point out that “qualitative methods are uniquely useful in the study of social capital, because they allow us to look beneath the surface at the hard-to-measure processes and actions of people's relationships to others, at community structures and the ‘life’ of communities and networks”.
Section snippets
Methods
We conducted interviews with neighborhood leaders and focus groups with African American and White residents from nine distinct socioeconomically and racially diverse neighborhoods in Oakland, California. In utilizing open-ended interviews and focus group discussions, we aimed to investigate local residents’ perceptions of whether and how local resources and liabilities affect health. Following several main strands of the health and place literature, we focused on neighborhood amenities and
Results
We identified three main themes on neighborhoods and health from the interviews and focus groups. The main themes were the meaning of neighborhood, neighborhood amenities and liabilities, and the mobilization and activism of neighborhoods. We subdivided the theme of neighborhood amenities and liabilities into the following six subthemes: safety, natural physical beauty and open space, food stores, pollution, municipal services, and stress.
The meaning of neighborhood
Like Suzanne Keller (1968) reported over 30 years ago, we found that people generally define their neighborhoods in two ways: their immediate neighborhood, often comprised of their block or less, as well as a much larger area, which corresponds to larger communal, historical, commercial, and/or municipal boundaries. For residents of middle-income neighborhoods, borders of neighborhoods often coincided with the beginning of what is perceived to be a lower-income, higher-crime neighborhood or
Neighborhood amenities and liabilities
In all the focus groups, participants discussed neighborhood amenities and liabilities that they perceived to be affecting residents’ health. The amenities and liabilities fell into six categories: safety, natural physical beauty/open space, food stores, pollution, municipal services, and stress.
The mobilization and activism of neighborhoods
Respondents in low- and middle-income neighborhoods spoke directly about the time and energy they put into their neighborhoods to work with others against problems, with one woman even using the term “investment”. For example, this woman who was from a low-income neighborhood commented:
…it's an investment, but it's not only financial. My baby was born and raised on (this street), I’ve invested my life on this street…I’ve invested a lot into this community you know, and we’ve done a lot on
Discussion
In these interviews and focus groups, residents clearly discussed aspects of their neighborhoods that could be classified as bonding and bridging social capital. The woman quoted above who discussed her neighborhood activism as an investment unknowingly drew on the concept of social capital, and highlighted an important aspect of the concept of social capital that has remained underdeveloped in the literature. We would propose that social capital is a useful concept at the neighborhood level
Acknowledgements
This research was supported by the California Wellness Foundation and supported in part by the John D. and Catherine T. MacArthur Foundation Research Network on SES and Health. The authors thank Jill Allen, Rakale Collins, and Joan Ostrove for leading the focus groups, and Flora Krasnovsky and Nina Mullan for their help in organizing the focus groups. The authors greatly appreciate the anonymous reviewers from Social Science & Medicine whose comments helped to strengthen the paper. AA
References (42)
- et al.
Does housing tenure predict health in the UK because it exposes people to different levels of housing related hazards in the home or its surroundings?
Health and Place
(1998) The stress process in neighborhood context
Health Place
(2000)- et al.
The M–C–M′ cycle and social capital
Social Science & Medicine
(2003) - et al.
Social capital and neighborhood mortality rates in Chicago
Social Science & Medicine
(2003) - et al.
Making the links between community structure and individual well-beingCommunity quality of life in Riverdale, Toronto, Canada
Health & Place
(2001) - et al.
The neighborhood context of adolescent mental health
Journal of Health and Social Behavior
(1996) - et al.
Social capital (glossary)
Journal of Epidemiology and Community Health
(2003) - et al.
Invitation to reflexive sociology
(1992) - et al.
The influence of neighborhood disadvantage, collective socialization, and parenting on African American children's affiliations with deviant peers
Child Development
(2001) Grounded theory
Foundations of social theory
Neighborhood of residence and incidence of coronary heart disease
New England Journal of Medicine
Does area of residence affect body size and shape?
International Journal of Obesity
Does where you live predict health related behaviors? A case study in Glasgow
Health Bulletin
The development of the state is dead-long live social capital
Development and Change
Getting a jobA study of contacts and careers
Poverty and health. Prospective evidence from the Alameda County Study
American Journal of Epidemiology
Residential segregation of Blacks by income groupEvidence from Oakland
Population Research and Policy Review
Access to health care and community social capital
Health Services Research
Social capital, income inequality, and mortality
American Journal of Public Health
Social capital and self-rated healthA contextual analysis
American Journal of Public Health
Cited by (183)
Social barriers to safe sanitation access among housed populations in the United States: A systematic review
2024, International Journal of Hygiene and Environmental HealthEviction as a community health exposure
2024, Social Science and MedicineNeighborhood resources and risk of cognitive decline among a community-dwelling long-term care population in the U.S.
2023, Public Health in PracticeCity streetscapes and neighborhood characteristics of fatal opioid overdoses among people experiencing homelessness who use drugs in New York City, 2017–2019
2022, International Journal of Drug Policy