Social capital: What's it good for? Exploring the relationship between community social structure and access to health care.

摘要

Social capital has been suggested as a community-level characteristic and research exploring its link with population health has proliferated in the last decade. Increasingly, however, criticisms are being aired, given the widely varying and ambiguous definitions of social capital and the lack of clarity regarding its causal mechanisms with health.;This dissertation explores community social capital and its potential for explaining community variation in access to care. The main research questions are: (1) What is community social capital and what are theoretical pathways between social capital and health? (2) How is community social capital related to health care access, and outcomes (through supply, demand, or other mechanisms)? and (3) Does a community's social capital improve access to health care among its population?;I address the first two questions by reviewing the literature and developing a conceptual framework to study community social capital and access to care. Public health researches have generally operationalized social capital as norms, values, and attitudes (e.g., generalized social trust); a more social structural definition that focuses on networks, organizations, and linkages may offer more theoretical and methodological clarity. Furthermore, there are distinct types of social capital (bonding, bridging, and linking) and each affects community health in different ways. Finally, societal inequalities affect the level and type of community social capital and should be considered when examining social capital's effects on community health.;I address the third question by examining zip code level data from Florida on: preventable hospitalizations; bonding, bridging, and linking social capital; ability to pay; and primary care resources. Controlling for age and gender differences, greater bonding, bridging and, to some degree, linking social capital (non-profit organizations) decreased preventable hospitalizations, however many of these relationships changed when other demographic variables like education and race were included. In the final models, some bonding and bridging ties improved access, but linking ties did not. Racial and ethnic interaction measures or cross-cutting ties proved consistently important for access to care among the non-elderly. Linking social capital is an important theoretical distinction, but further work is needed to fully operationalize this concept.