Social capital, place and health

Geographical variations in health status and health outcomes have long posed a challenge to geographers and epidemiologists. Explanations have moved from a focus on the environmental determinants of ill-health to an emphasis on material circumstances and lifestyle. The realization that even after allowing for these factors, there remains unexplained variation has led to a shift in analytical attention to the notion of social capital in determining health outcomes. There are important conceptual debates about social capital, sparked off recently by the influential work of Robert Putnam. Several types of social capital – bonding, bridging, and linking – have been distinguished, and approaches to measurement focus on various structural and cognitive components of the concept. The specific issue raised by geographical approaches to this question is whether social capital is a true contextual construct (a property of places or contexts) or merely a compositional feature (i.e., the sum of the properties of the individuals who make up the population of a place). The article briefly outlines a range of research, using both quantitative and qualitative methodologies, which bears on the question of whether levels of social capital in a place affect health outcomes, and it also summarizes some key points of dispute in the social capital debates.