The influence of social capital and socio-economic conditions on self-rated health among residents of an economically and health-deprived South African township

International Journal for Equity in Health

Anna P Nieboer¹  Jane M Cramm¹ 

[1] Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands

关键词: South Africa;    health status;    socioeconomic status;    social determinants;    social capital;   

Others  :  829508
DOI  :  10.1186/1475-9276-10-51

 received in 2011-05-28, accepted in 2011-11-15,  发布年份 2011

【 摘 要 】

Background

Surprisingly few studies have investigated the interplay of multiple factors affecting self-rated health outcomes and the role of social capital on health in developing countries, a prerequisite to strengthening our understanding of the influence of social and economic conditions on health and the most effective aid. Our study aimed to identify social and economic conditions for health among residents of an economically and health-deprived community.

Methods

Data were gathered through a survey administered to respondents from 1,020 households in Grahamstown a suburb in the Eastern Cape, South Africa (response rate 97.9%). We investigated the influence of social and economic conditions (education, employment, income, social capital, housing quality and neighborhood quality) on self-rated health. We used ordinal logistic regression analyses to identify the relationship of these conditions and self-rated health.

Results

Our study found that education and social capital positively correlated with health; unemployment, poor educational level and advanced age negatively correlated. We found no significant correlations between self-rated health and housing quality, neighbourhood quality, income, gender, or marital status.

Conclusion

We highlight the possible impacts of social capital, employment, and education on health, and suggest that health outcomes may be improved through interventions beyond the health system: creating job opportunities, strengthening social capital, bettering educational systems, and promoting educational access. Policymakers should consider the benefits of such programmes when addressing health outcomes in financially distressed districts.

【 授权许可】

   
2011 Cramm and Nieboer; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Cockerham WC: Medical Sociology. New Yersey: Pearson Education International; 2010.
• [2]WHO: [http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf] webciteClosing the gap in a generation: Health equity through action on the social determinants of health. 2008. Accessed December 2009
• [3]Wilson J: Not so special after all? Daniels and the social determinants of health. J Med Ethics 2009, 35:3-6.
• [4]Idrovo AJ, Ruiz-Rodriguez M, Manzano-Patiño AP: Beyond the income inequality hypothesis and human health: a worldwide exploration. Revista de Saúde Pública 2010, 44(suppl 4):695-702.
• [5]Pronyk PM, Harpham T, Busza J, Phetla G, Morison LA, Hargreaves JR, KIM JC, Watts CH, Porter JD: Can social capital be intentionally generated? A randomized trial from rural South Africa. Soc Sci Med 2008, 67(suppl 10):1559-1570.
• [6]Harvey PW: Social determinants of health - why we continue to ignore them in the search for improved population health outcomes! Aust Health Rev 2006, 30(suppl 4):419-423.
• [7]Mohajer N, Earnest J: Widening the aim of health promotion to include the most disadvantaged: vulnerable adolescents and the social determinants of health. Health Educ Res 2010, 25(suppl 3):387-394.
• [8]Semenza JC: Strategies to intervene on social determinants of infectious diseases. Euro surveill 2010., 15(suppl 27) pii=19611
• [9]Martin G, Bird P, Crichton C: Global health: where are our priorities? Br Med Bull 2009, 91:23-28.
• [10]World Health Organization: [http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf] webciteClosing the gap in a generation: health equity through action on the social determinants of health. 2008. Accessed 22 December 2009
• [11]Kelly MP, Morgan A, Bonnefoy J, Butt J, Bergman V: The social determinants of health: developing an evidence base for political action (measurement and evidence knowledge network). Geneva, Switzerland: World Health Organisation; 2007.
• [12]Setel PW, Macfarlane SB, Szreter S, Mikkelsen L, Jha P, Stout S, AbouZahr C: A scandal of invisibility: making everyone count by counting everyone. Lancet 2007, 370:1569-1577.
• [13]Brassard P, Anderson KK, Menzies D, Schwartzman K, Macdonald ME: Knowledge and perceptions of tuberculosis among a sample of urban Aboriginal people. J Community Health 2008, 33:192-198.
• [14]Mangesho PE, Shayo E, Makunde WH, Keto GBS, Mandara CI, Kamugisha ML, Kilale AM, Ishengoma DR: Community knowledge, attitudes and practices towards tuberculosis and its treatment in Mpwapwa District, central Tanzania. Tanzan health res bull 2007, 9:38-43.
• [15]Subramanian SV, Kawachi I: Whose health is affected by income inequality? A multilevel interaction analysis of contemporaneous and lagged effects of state income inequality on individual self-rated health in the United States. Health Place 2006, 12:141-156.
• [16]Harling G, Ehrlich R, Myer L: The social epidemiology of tuberculosis in South Africa: a multilevel analysis. Soc Sci Med 2008, 66(Suppl 2):492-505.
• [17]Acevedo-Garcia D: Zip code-level risk factors for tuberculosis: neighborhood environment and residential segregation in New Jersey, 1985-1992. Am J Public Health 2006, 91(5):734-741.
• [18]McKay CM, Bell-Ellison BA, Wallace K, Ferron JM: A multilevel study of the associations between economic and social context, stage of adolescence, and physical activity and body mass index. Pediatrics 2007, 119:S84-S91.
• [19]Cramm JM, Koolman X, Møller V, Nieboer AP: Socio-economic status and self-reported tuberculosis: a multilevel analysis in a low-income township in the Eastern Cape South Africa. Journal of Public Health in Africa 2011, 2:e34:143-146.
• [20]Wen M, Browning CR, Cagney KA: Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health. Soc Sci Med 2003, 57:843-860.
• [21]Rose R: How much does social capital add to individual health? A survey study of Russians. Soc Sci Med 2000, 51(9):1421-1435.
• [22]Hyyppä MT, Mäki J: Social participation and health in a community rich in stock of social capital. Health Educ Res 2003, 18(6):770-779.
• [23]Ziersch AM: Health implications of access to social capital: findings from an Australian study. Soc Sci Med 2005, 61(10):2119-2131.
• [24]Lochner K, Kawachi I, Brennan RT, Buka SL: Social capital and neighborhood mortality rates in Chicago. Soc Sci Med 2003, 56:1797-1805.
• [25]Requena F: Social capital, satisfaction, and quality of life in the workplace. Soc Indic Res 2003, 61(Suppl 3):331-360.
• [26]Putnam RD: Bowling Alone. The Collapse and Revival of American Community. London: Simon and Schuster; 2000.
• [27]Kawachi I, Berkman L: Social cohesion, social capital and health. In Social epidemioology. Edited by Kawachi I, Berkman L. NewYork: Oxford University Press; 2000:174-190.
• [28]Rogers EM: Diffusion of innovations. 5th edition. New York: The Free Press; 2003.
• [29]Cramm JM, Nieboer AP: The relationship between (stigmatizing) ideas and the lay public preferences regarding tuberculosis treatment in the Eastern Cape, South Africa. Int J Equity Health 2011, 10(Suppl 1):2.
• [30]Møller V, Erstad I, Cramm JM, Nieboer AP, Finkenflügel H, Radloff S, Ndoro T, Kwizera SA: Delays in presenting for TB treatment: Fears related to learning one is HIV positive. Afr J AIDS Res 2011, 10(Suppl 1):25-36.
• [31]Cramm JM, Finkenflügel HJM, Møller V, Nieboer AP: TB treatment initiation and adherence in a South African community influenced more by perceptions than by knowledge of tuberculosis. BMC Public Health 2010, 10(Suppl 72):1-8.
• [32]Cramm JM, van Exel J, Møller V, Finkenflügel HJM: Patient views on determinants of compliance with tuberculosis treatment in the Eastern Cape, South Africa: an application of Q-methodology. Patient 2010, 3(Suppl 3):159-172.
• [33]Kim D, Kawachi I: U.S. state-level social capital and health related quality of life: multilevel evidence of main, mediating, and modifying effects. Ann Epidemiol 2007, 17(Suppl 4):258-269.
• [34]Poortinga W: Do health behaviors mediate the association between social capital and health? Prev Med 2006, 43:488-493.
• [35]Winkelman R: Unemployment, social capital, and subjective well-being. J Happiness Stud 2009, 10(Suppl 4):421-430.
• [36]Camfield L, Skevington SM: On subjective well-being and quality of life. J Health Psychol 2008, 13:764-775.
• [37]Cramm JM, Møller V, Nieboer AP: Improving subjective well-being of the poor in the Eastern Cape. J Health Psychol 2010, 15(7):1012-1019.
• [38]Forbes A, Wainwright SP: On the methodological, theoretical and philosophical context of health inequalities research: a critique. Soc Sci Med 2001, 53:801-816.
• [39]Møller V, Erstad I: Stigma associated with tuberculosis in a time of HIV/AIDS: narratives from the Eastern Cape, South Africa. South African Review of Sociology 2007, 38:103-119.
• [40]Noble M, Barnes H, Wright G, Roberts B: Small area indices of multiple deprivation in South Africa. Soc Indic Res 2010, 95:281-297.
• [41]Møller V: Living in Rhini. A 2007 update on the 1999 social indicators report. Institute of Social and Economic Research, Research Report Series No. 14; 2007.
• [42]Nemeth R: [http://www.math.uni-klu.ac.at/stat/Tagungen/Ossiach/Nemeth.pdf] webciteRespondent selection within the household - A modification of the Kish grid.
• [43]Lopez R: Income inequality and self-rated health in US metropolitan areas: A multi-level analysis. Soc Sci Med 2004, 59:2409-2419.
• [44]Baron-Epel O: Self-reported health. Encyclopedia of health and behavior. Edited by Anderson NB. Sage CA, Thousand Oaks; 2004.
• [45]Israel BA, Krieger J, Vlahov D, Ciske S, Foley M, Fortin P, Guzman JR, Lichtenstein R, McGranaghan R, Palermo A-G, Tang G: Challenges and facilitating factors in sustaining community-based participatory research partnerships: lessons learned from the Detroit, New York City and Seattle urban research centers. J Urban Health 2006., 83(Suppl 6)
• [46]Farquhar SA, Michael YL, Wiggins N: Building on history and social capital to create change in two urban communities. Am J Public Health 2005, 95(4):596-601.
• [47]Völker B, Flap H, Lindenberg S: When are neighborhoods communities? Community in Dutch neighborhoods. Eur Sociol Rev 2007, 23(Suppl 1):99-114.
• [48]Uphoff N, Wijayaratna CM: Demonstrated Benefits from Social Capital: The Productivity of Farmer Organizations in Gal Oya, Sri Lanka. World Dev 2000, 28:1875-1890.