S OCIAL C APITAL , GENDER EQUITY AND H EALTH : E VIDENCE FROM THE WHO - - PowerPoint PPT Presentation

SOCIAL CAPITAL, GENDER EQUITY AND HEALTH: EVIDENCE FROM THE WHO SAGE SURVEYS

Nandita Bhan, GEH authors, Anita Raj Center on Gender Equity and Health (GEH) University of California, San Diego Working Paper Presentation for 30 October 2017

Background

• Health and wellbeing predominantly a construction of

individual and household determinants

• Contextual determinants are neglected
• Considered residual in models
• Harder to act upon – tailor interventions
• Harder to measure
• Increasing systematic inquiry into ‘context’
• Recognition that individuals flourish or harmed by their environment
• Interventions at collectives, environmental determinants and policies

Conceptualizing Social Capital

• Durkeim: anomie - individuals do not feel attached to the

collective

• Bourdieu – economic, social and cultural capital
• Coleman – reciprocity and trust -> insurance
• Putnam – decline in social capital
• ….. Many of you
• However, harder to integrate these ideas in health studies
• Level of measurement unclear
• Defining the ‘collective’
• Limited understanding of mechanism
• Debate on terminology: social capital vs. cohesion?

Definition

• Social capital is a form of economic and cultural capital, in

which networks are central, transactions are marked by reciprocity, trust and cooperation, and market agents produce goods and services not only for themselves but for a common good.

• Resources
• Relationships
• Impact
• Traditionally used to explain why groups do better despite

adversity

• Reflection of many things – bonding and bridging

Contextualizing ‘Context’

• Industrialization and urbanization transforming social

capital in an irreversible way (Durkheim, Simmel, Weber)

• Is the conceptualization of social capital from developed countries

applicable to LMICs?

• How can social capital and contextual transformations be seen

from the prism of urbanization in LMICs, including population changes brought on by migration?

• Do contextual determinants interact with gender and

impact men and women differently?

Study Objective

• Investigate the relationships

between 4 aspects of social capital in the transitioning context of LMICs and their associations with

• Active travel
• Recreation
• Depression
• Are they outcomes of social

capital or are they manifestations of societal breakdown?

Why are these outcomes important?

• Rising burden of chronic conditions linked to both physical

inactivity and depression.

• Physical activity is the 4th leading risk factor; but offers the

largest range of interventions

• Individual (recreation) and systems (systems for active travel) level
• Recreation
• Mechanistic links – social capital drives agency or determines

engagement, thereby influencing these outcomes directly

• Growing evidence that these outcomes linked to urbanization
• Is urbanization driving the social change or part of it?
• Urbanization includes infrastructure, norms and relationships

Markers of Social Capital

Connectedness Perception of Safety Perception of trust on others Participation to create change

Data and Sample

• WHO Study on Global AGEing and Adult Health (SAGE) (Wave 1, 2007-10)
• 6 LMICs: China, Ghana, India, Mexico, Russia and South Africa.
• 50+ sample, with sub-samples of sample of younger 18–49 years
• Data collected through standardized survey instrument and training

protocols.

• Response rates : China (93%), Ghana (81%), India (68%), Mexico (53%), Russia

(83%) and South Africa (75%)

• Ethical clearance

Sample

• n=47,443 adult persons; China: 15,050; India: 12,198; Mexico: 5448; Russia:

4947, South Africa: 4227; Ghana: 5573).

Dependent Variables

• Active Travel: physical activity in getting to and from places.
• “Do you walk or use a bicycle (pedal cycle) for at least 10 minutes

continuously to get to and from places?”.

• Recreational Activity: involvement in leisure or fitness (moderate to

vigorous)

• “Do you do any vigorous intensity sports, fitness or recreational (leisure)

activities that cause large increases in breathing or heart rate [like running

• r football], for at least 10 minutes continuously” or “Do you do any

moderate-intensity sports, fitness or recreational (leisure) activities that cause a small increase in breathing or heart rate [such as brisk-walking, cycling or swimming] for at least 10 minutes at a time?”

• Depression: problems related to feeling sad, low or depressed over the last

30 days

Measures for Social Capital

Social Connectedness Visited by friends, been to a different neighborhood, socialized with co-workers outside of work, attended religious services or went out of home to attend social meetings or events. Trusting neighbors “great extent”, “neither great nor small” and “small extent”. Trusting co-workers “great extent”, “neither great nor small” and “small extent”. Trusting strangers Classified as to a “great extent”, “neither great nor small” and “small extent”. Social participation Attended public meetings, met with a community leaders, attended groups or clubs, and worked to fix or improve something. Perception of safety at home “In general, how safe from crime and violence do you feel when you are alone at home?” : “very safe”, “slightly safe” and “unsafe”. Perception of safety

• n the street

“How safe do you feel when walking down your street alone after dark?”: “very safe”, “slightly safe” and “unsafe”.

Results

Prevalence (%) of active travel, recreation and depression across study countries

Active Travel (none) Recreation (yes) Moderate to severe Depression China 30.17 17.8 3.9 India 23.81 15.7 22.03 Mexico 40.43 8.58 19.92 Russia 29.94 11.67 16.78 South Africa 60.19 9.51 22.73 Ghana 24.75 15.13 19.41 <0.001 <0.001 <0.001

Patterning of Connectedness by Country and Gender

10 20 30 40 50 60 70 80 Men Women Men Women Men Women Men Women Men Women Men Women China India Mexico Russia South Africa Ghana

%

Degree of Social Connectedness Low High

Patterning of feeling unsafe on the street by country and gender

10 20 30 40 50 60 Men Women Men Women Men Women Men Women Men Women Men Women China India Mexico Russia South Africa Ghana

% Feeling Unsafe on the Street

Slightly Unsafe Unsafe

Patterning of feeling unsafe at home by country and gender

10 20 30 40 50 60 Men Women Men Women Men Women Men Women Men Women Men Women China India Mexico Russia South Africa Ghana

%

Feeling unsafe at home

Slightly Unsafe Unsafe

Patterning of Trust on strangers and neighbors by country and gender

10 20 30 40 50 60 70 80 90 100

Men Women Men Women Men Women Men Women Men Women Men Women China India Mexico Russia South Africa Ghana

%

Strangers - Small Extent Neighbor- Small Extent

Patterning of social participation by country and gender

10 20 30 40 50 60 70 80

Men Women Men Women Men Women Men Women Men Women Men Women China India Mexico Russia South Africa Ghana

%

Low High

Regression results: Outcome - Moderate to High Depression

Levels of social connectedness and participation to create change Connected Participation Medium 1.07 (0.83,1.37) 1.21 (0.93,1.56) Low 2.29* (1.78,2.96) 1.99* (1.56,2.55) Female 1.5* (1.35,1.67) 1.55* (1.38,1.74) Medium*Female 0.99 (0.85,1.15) 0.91 (0.78,1.07) Low*Female 0.82* (0.71,0.95) 0.78* (0.67,0.90) Urban 0.86* (0.80,0.92) 0.85* (0.80,0.91)

• Adjusted for age, country and education
• R2 for the participation models twice that of connectedness

Gender inequities in perception of safety

At home In the street Slightly unsafe (%) Unsafe (%) Slightly unsafe (%) Unsafe (%) Male 23.03 4.16 33.1 8.45 Female 30.5 5.96 41.2 14.3

Regression results for all outcomes by perception

• f safety

At home In the streets Active Travel Recreation Depression Active Travel Recreation Depression Slightly unsafe 1.48* (1.25,1.75) 0.89 (0.72,1.11) 2.09* (1.68,2.61) 1.38* (1.17,1.62) 0.93 (0.77,1.13) 1.69* (1.35,2.11) Unsafe 1.58* (1.12,2.22) 0.83 (0.50,1.36) 2.21* (1.49,3.29) 1.65* (1.28,2.13) 0.71 (0.49,1.02) 2.18* (1.60,2.97) Female 1.36 (1.29,1.44) 0.70* (0.66,0.75) 1.56* (1.44,1.69) 1.46* (1.37,1.55) 0.68* (0.63,0.74) 1.54* (1.41,1.68) Slightly unsafe *female 0.87* (0.79,0.96) 1.1 (0.97,1.26) 0.75* (0.66,0.85) 0.82 (0.75,0.90) 1.09 (0.97,1.23) 0.81* (0.71,0.92) Unsafe*femal e 0.77* (0.63,0.94) 1.17 (0.88,1.57) 0.85 (0.68,1.06) 0.72* (0.62,0.83) 1.25* (1.01,1.54) 0.82* (0.69,0.97) Urban 1.06* (1.01,1.12) 2.09* (1.96,2.23) 0.87* (0.81,0.92) 1.07* (1.02,1.12) 2.09* (1.96,2.23) 0.86* (0.80,0.92)

Regression results for active travel and recreation by trust

Neighbor Trust Stranger Trust Active Travel Recreation Active Travel Recreation Not great or small extent 1.15 (0.97,1.36) 1.22 (0.98,1.5) 1.35* (1.01,1.82) 0.34* (0.24,0.48) Small Extent 0.92 (0.75,1.13) 1.08 (0.84,1.39) 1.35* (1.04,1.75) 0.39* (0.29,0.52) Female 1.32* (1.24,1.4) 0.77* (0.71,0.83) 1.85* (1.59,2.15) 0.57* (0.48,0.68) Not great/not small* Female 0.98 (0.89,1.09) 0.83* (0.73,0.95) 0.77* (0.64,0.92) 1.36* (1.09,1.7) Small Extent*Female 0.99 (0.88,1.12) 0.97 (0.83,1.13) 0.67* (0.57,0.78) 1.32* (1.09,1.58) Urban 1.07* (1.02,1.13) 2.09* (1.97,2.24) 1.08* (1.03,1.13) 2.11* (1.98,2.25)

Discussion

• Markers of social capital associated with health outcomes
• Relationships vary; highlighting differences in degree and mechanism
• Urbanisation is an important aspect determining these outcomes
• Validation of previous work linking urbanization to health behaviors and

mental health

• Gender is a determinant for the outcomes
• Men and women may be internalizing and impacted by community contexts

in different ways

• Counter balancing health harming effects, with resilience and coping that

women may develop to inequitable community contexts.

• Implications of these findings?
• For policy and programs

Implications

• Bonding and bridging social capital explains group relations,

ethnicity networks in LMICs

• Negative aspects
• Reproduction of inequality
• Do citizens trust institutions
• Can be used to assess civic engagement and political participation
• For research and interventions on collectives to have meaning,

social capital needs to be examined in-depth

Thank You!