Structural social capital and health in Italy☆
Introduction
The claim that social capital plays a role in determining actual and perceived health is commonly accepted in public health studies (Kawachi et al., 1997, Kawachi et al., 1999, Kim et al., 2006, Kim et al., 2011) and has recently attracted the attention of economists and economics journals (Brown et al., 2006, Petrou and Kupek, 2008, Scheffler and Brown, 2008, D’Hombres et al., 2010, Ljunge, 2014). Two critical issues have emerged from previous research on the topic.
First, social capital is a very multidimensional phenomenon and there is no univocal evidence on which of its dimensions is good for health. The relationship between the multiple facets of social capital and health is context-dependent and varies according to a number of individual, social, and institutional features.
Second, even if many studies identify social capital as a significant predictor of individual health, there are reasons to suspect this result to be due to a spurious correlation. It seems reasonable to assume the existence of reverse causality: unhealthy people may face obstacles to social interaction, while healthy people may be more inclined to certain relational activities such as, for example, doing sports with others.
The present paper contributes to the literature by carrying out the first assessment of the relationship between social capital and individual health in Italy. Similar research has been undertaken in North America (see for example Folland, 2007), Latin America (Ronconi et al., 2012), and Eastern Europe (D’Hombres et al., 2010) but, to the best of our knowledge, they have never been performed in Mediterranean countries.
Probit estimates show that, in addition to civil status, age, education, income and work status, individual structural social capital, as measured by the frequency of meetings with friends, is strongly and positively correlated with self-perceived health. However, since the habit of meeting friends may be endogenously determined, we follow some promising previous studies (see for example D’Hombres et al., 2010) and instrument this variable with Mass attendance and meetings with friends at the community level.
Instrumental variables regressions show that the habit of meeting friends is a strong predictor of perceived good health both with two-stages probit estimators and bivariate probit estimators.
The reminder of the paper is structured as follows. The next two sections review the literature on social capital and health. We then describe methodology and data. Section 5 describes and discusses empirical results. Concluding remarks and a brief discussion of policy implications close the paper.
Section snippets
Social capital
Over the past 20 years, the literature has extensively analysed the impact of social interactions on individual health. Various aspects of the relational sphere of individual lives have been addressed, from relationships with family and friends to membership of various kinds of association and community cohesion, often grouped together under the common label of social capital.
After Putnam's seminal work, social capital is usually referred to as “features of social organization such as networks,
Social capital and health
The idea that social relationships matter for health is not new in the sociological debate. Social isolation has historically been found to be associated with poorer mental and physical health. Durkheim (1897) first observed that less socially integrated people were more likely to commit suicide than the most integrated. In the 1950s, sociological studies found that psychiatric disorders, morbidity, and mortality rates are significantly higher for non-married than for married people (Tillman
Methodology and data
Our empirical strategy is in two steps. First, the empirical model of perceived health can be represented through the following model:where H is self-reported health for individual i; SC is our indicator of individual structural social capital; the X vector consists of annual household income and the other variables that are believed to influence self-perceived health; γ and β are the parameter to be estimated and ɛ is a random-error term.
We do not observe the “latent” variable
Determinants of self-perceived good health
Table 2 presents estimates of the health equation (1). To compare relative magnitudes of the effects of the independent variables, we report their marginal effects. Column 1 reports the probit estimate (Eq. (2)) and column 2 presents the linear estimation (Eq. (3)).
Before discussing the impact of individual structural social capital, we briefly present the effect of individual and household variables on self-perceived good health. As the estimates resulting from probit and linear specifications
Conclusions
In this paper we have investigated the relationship between individual structural social capital and individual self-perceived good health in Italy. Results of the empirical analysis support the hypothesis that individual structural social capital improves the health conditions of individuals. Following the previous literature, we argue that the mechanism may work through the diffusion of relevant health information, the establishment of mutual assistance mechanisms, the promotion of healthy
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We are deeply indebted to four anonymous reviewers whose comments allowed a substantial improvement of the paper. We thank Luigi Aldieri, Sergio Destefanis, Francesco Drago, Elena Fumagalli and Alessandra Gualtieri for precious suggestions. Needless to say, usual caveats apply.