Social capital and the third way in public health

Abstract

The construct of social capital has recently captured the interest of researchers in social epidemiology and public health. We review current hypotheses on the social capital and health link, and examine the empirical evidence available as well as its implications for health policy. With regard to theory, we contend that the construct as currently employed in the public health literature, lacks depth compared to its uses in social science. In addition, social capital presents itself as an alternative to materialist structural inequalities (class, gender and race) by bringing to the forefront of social epidemiology an appealing common sense idealist social psychology to which everyone can relate (e.g., good relations with your community are good for your health). The use of social capital invokes a romanticized view of communities without social conflict (e.g., Neo - Tocquevillian nineteenth century associationalism) and favours an idealist psychology over a psychology connected to both material resources and social structure. We argue that the evidence on social capital as a determinant of better health is still scant or ambiguous - depending on the definition that is used. Even if confirmed, social capital hypotheses call for social determinants beyond the proximal realm of social psychology. We also maintain that social capital is used in public health as an alternative to both state-centred economic redistribution (e.g., living wage, full employment, and universal health insurance) and party politics (e.g., gaining control of the executive branch of the government). Social capital represents a ' privatization ' of both economics and politics. Such uses of social capital mirror recent Third Way policies in Germany, UK and US. If Third Way policies end up losing support in Europe, its prominence there might be short lived. In the USA, where the working class is less likely to influence social policy, interest in social capital could be longer lived or, alternatively, could drift in the academic limbo like other psychosocial constructs which at one point were heralded as the next ' big idea '.