Social capital and health promotion: a review

Interest in social capital and health has emerged at an exciting time. In p ublic health, there is a renewed interest in mechanisms that link social in equalities and health. In epidemiology, there has been a critical interroga tion of methods and a call for a more explicit use of theory. In health pro motion over the last 20-30 years, social health interventions have been som ewhat marginalised in an era dominated by interest in traditional cardiovas cular disease risk factors. Now that social hypotheses are being reborn in health, there is a risk that the sophistication that has developed in socia l health promotion and the literatures that have informed it could be overl ooked. In this paper, we present a brief history of social capital and how it has come into recent prominence through the debate linking income inequa lity and health. We present the background to this, the earlier literatures on social environmental influences on health and the possible processes th ought to underlie this relationship. Social capital has relational, materia l and political aspects. We suggest that, although the relational propertie s of social capital are important leg, trust, networks), the political aspe cts of social capital are perhaps under recognised. The paper also reviews how complex social processes at the community level have come to be operati onalised by social theorists and intervention agents in other fields. We su ggest that social capital research so far has inadequately captured the und erlying constructs, in particular the qualitative difference between the ma cro/context level and the micro/individual level. While being cautious abou t the science, we conclude that social capital's power as rhetoric and as a metaphor may be of value. We conclude by suggesting that the coalescence o f interests in context-level influences on health now invites a revitalisat ion of theories and interventions inspired by diverse fields, such as geogr aphy and ecological community psychology. (C) 2000 Elsevier Science Ltd. Al l rights reserved.