The impact of sense of belonging on health: Canadian evidence

Sense of belonging to the community is presented as a fundamental human need, with existing evidence of its correlation with health. The relationship between belongingness and health is nevertheless endogenous as better health may foster belongingness in the community. We empirically examine the causal effect of belongingness on health using data from Canada, taking advantage of the multicultural nature of the Canadian society. We use data from the Canadian Community Health Survey from 2009 to 2014 augmented with other survey and administrative data. We address the endogeneity problem with instrumental variables, and construct instruments as the difference between the individual’s and the neighbourhood’s ethnocultural and homeownership characteristics. To account for the nonlinearity of the belongingness and health variables, we estimate our instrumental variables models by two-stage residual inclusion and a Bayesian estimation procedure. Our findings indicate that higher belongingness improves health, both for subjective measures like self-assessed health and objective measures like chronic conditions. While all age groups are positively affected, the effects are stronger for older adults, as well as for women. Health behaviours and healthcare utilization are potential mechanisms by which belongingness appears to affect health, in particular reduced smoking, and better access to a regular provider of care.