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The contextual effects of social capital on health: a cross-national instrumental variable analysis

Author

Listed:
  • Daniel Kim

    () (RAND Corporation)

  • Christopher F Baum

    () (Boston College
    DIW Berlin)

  • Michael Ganz

    (Outcomes Research, Abt Bio-Pharma Solutions, Inc.)

  • S.V. Subramanian

    (Department of Society, Human Development, and Health, Harvard School of Public Health)

  • Ichiro Kawachi

    (Department of Society, Human Development, and Health, Harvard School of Public Health)

Abstract

Past observational studies of the associations of area-level/contextual social capital with health have revealed conflicting findings. However, interpreting this rapidly growing literature is difficult because estimates using conventional regression are prone to major sources of bias including residual confounding and reverse causation. Instrumental variable (IV) analysis can reduce such bias. Using data on up to 167,344 adults in 64 nations in the European and World Values Surveys and applying IV and ordinary least squares (OLS) regression, we estimated the contextual effects of country-level social trust on individual self-rated health. We further explored whether these associations varied by gender and individual levels of trust. Using OLS regression, we found higher average country-level trust to be associated with better self-rated health in both women (beta=0.051, 95% confidence interval 0.011 to 0.091, P=0.01) and men (beta=0.038, 0.0002 to 0.077, P=0.049). IV analysis yielded qualitatively similar results, although the estimates were more than double in size (in women, using country population density and corruption as instruments: beta=0.119, 0.028 to 0.209, P=0.005; in men: beta=0.115, 0.025 to 0.204, P=0.01). The estimated health effects of raising the percentage of a country's population that trusts others by 10 percentage points were at least as large as the estimated health effects of an individual developing trust in others. These findings were robust to alternative model specifications and instruments. Conventional regression and to a lesser extent IV analysis suggested that these associations are more salient in women and in women reporting social trust. In a large cross-national study, our findings, including those using instrumental variables, support the presence of beneficial effects of higher country-level trust on self-rated health. Past findings for contextual social capital using traditional regression may have underestimated the true associations. Given the close linkages between self-rated health and all-cause mortality, the public health gains from raising social capital within countries may be large.

Suggested Citation

  • Daniel Kim & Christopher F Baum & Michael Ganz & S.V. Subramanian & Ichiro Kawachi, 2011. "The contextual effects of social capital on health: a cross-national instrumental variable analysis," Boston College Working Papers in Economics 786, Boston College Department of Economics.
  • Handle: RePEc:boc:bocoec:786
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    References listed on IDEAS

    as
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    Citations

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    Cited by:

    1. Habibov, Nazim, 2016. "Effect of corruption on healthcare satisfaction in post-soviet nations: A cross-country instrumental variable analysis of twelve countries," Social Science & Medicine, Elsevier, vol. 152(C), pages 119-124.
    2. Fiorillo, Damiano & Sabatini, Fabio, 2015. "Structural social capital and health in Italy," Economics & Human Biology, Elsevier, vol. 17(C), pages 129-142.
    3. Xindong Xue & W. Robert Reed, 2015. "The Relationship Between Social Capital And Health In China," Working Papers in Economics 15/05, University of Canterbury, Department of Economics and Finance.
    4. Damiano Fiorillo, 2016. "Workers' health and social relations in Italy," Journal of Economic Studies, Emerald Group Publishing, vol. 43(5), pages 835-862, October.
    5. Nicholas Rohde & Conchita D’Ambrosio & Kam Ki Tang & Prasada Rao, 2016. "Estimating the Mental Health Effects of Social Isolation," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 11(3), pages 853-869, September.
    6. Riumallo-Herl, Carlos Javier & Kawachi, Ichiro & Avendano, Mauricio, 2014. "Social capital, mental health and biomarkers in Chile: Assessing the effects of social capital in a middle-income country," Social Science & Medicine, Elsevier, vol. 105(C), pages 47-58.
    7. Olafsdottir, Sigrun & Bakhtiari, Elyas & Barman, Emily, 2014. "Public or private? The role of the state and civil society in health and health inequalities across nations," Social Science & Medicine, Elsevier, vol. 123(C), pages 174-181.
    8. repec:eee:socmed:v:189:y:2017:i:c:p:25-34 is not listed on IDEAS
    9. Ko, Michelle & Derose, Kathryn Pitkin & Needleman, Jack & Ponce, Ninez A., 2014. "Whose social capital matters? The case of U.S. urban public hospital closures and conversions to private ownership," Social Science & Medicine, Elsevier, vol. 114(C), pages 188-196.
    10. Habibov, Nazim & Cheung, Alex, 2016. "The impact of unofficial out-of-pocket payments on satisfaction with education in Post-Soviet countries," International Journal of Educational Development, Elsevier, vol. 49(C), pages 70-79.
    11. Wang, Lu & Hu, Wei, 2013. "Immigrant health, place effect and regional disparities in Canada," Social Science & Medicine, Elsevier, vol. 98(C), pages 8-17.
    12. Wim Hardyns & Veerle Vyncke & Arne Boeck & Lieven Pauwels & Sara Willems, 2016. "Are Collective Efficacy, Disorder and Social Support Associated with One’s Quality of Life? Evidence from the Multilevel SWING Study in Belgium," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 11(3), pages 739-756, September.
    13. Nazim Habibov & Elvin Afandi, 2016. "Does Life Satisfaction Determine Subjective Health?," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 11(2), pages 413-428, June.

    More about this item

    Keywords

    social capital; social determinants of health; social environment; epidemiology; causal inference; instrumental variable;

    JEL classification:

    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C26 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Instrumental Variables (IV) Estimation

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