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Social Connectedness and Health Amongst Older Adults

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Abstract

Australia is experiencing a "structural ageing" of its population; by 2044 approximately 25% of adults will be aged 65 years and over, leading to a corresponding increase in need for aged health and community care provisions. Older adults have been shown to be more vulnerable to social isolation than the rest of the populace. Socially isolated older adults have more ill health and less well being than those who are socially connected. Social connection appears to provide a protective effect against ill health and mortality in the aged. It is likely that those who are socially connected will, therefore, have less need to access health and community care services than those who are socially isolated. Based on a qualitative study of older adults within a local Melbourne municipality, I argue that increasing social connectedness amongst the elderly could have important beneficial impacts, not only on health, but also on government budgetary requirements and service allocations and, at a social capital level, on all of society. I also argue that, to date, programs that promote social connectedness amongst older adults are limited in their ability to access those who are truly socially isolated.
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Social Connectedness and Health Amongst Older Adults
Sue Malta
Sociology, Faculty of Life and Social Sciences, Swinburne University of Technology
smalta@swin.edu.au
Abstract
Australia is experiencing a “structural ageing” of its population; by 2044
approximately 25% of adults will be aged 65 years and over, leading to a
corresponding increase in need for aged health and community care provisions. Older
adults have been shown to be more vulnerable to social isolation than the rest of the
populace. Socially isolated older adults have more ill health and less well being than
those who are socially connected. Social connection appears to provide a protective
effect against ill health and mortality in the aged. It is likely that those who are
socially connected will, therefore, have less need to access health and community care
services than those who are socially isolated. Based on a qualitative study of older
adults within a local Melbourne municipality, I argue that increasing social
connectedness amongst the elderly could have important beneficial impacts, not only
on health, but also on government budgetary requirements and service allocations and,
at a social capital level, on all of society. I also argue that, to date, programs that
promote social connectedness amongst older adults are limited in their ability to
access those who are truly socially isolated.
Introduction
This paper considers issues of social connection amongst older adults arising from a
study of a local Melbourne municipality. First a brief differentiation between the
effects of the two concepts, social isolation and social connection is given, along with
a discussion of their differing impacts on health and wellbeing. Second, the social
capital thesis is postulated as providing an explanatory basis for why social
connection should be promoted in today’s society. Finally, results from my study into
social connectedness and the elderly are provided as evidence that truly isolated older
adults are not being accessed by existing social connection programs. If, as Putnam
argues, social connectedness is one of the “most powerful determinants of our
wellbeing” (Putnam, 2000a: 326), then this finding raises important questions for the
social capital thesis in particular and for community life in general.
Research has shown that social isolation amongst older adults is a problem of growing
concern (see Findlay 2003). Older adults who have limited or no contact with others,
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and who perceive those contacts to be inadequate in some way, are considered to be
socially isolated (Findlay 2003: 648). Older adults are more vulnerable to loneliness
and social isolation than the rest of the population (World Health Organization
(WHO) 2002: 28) due, in part, to a loss of physical mobility, a lack of transport
options and the loss of life partners and friends (Findlay and Cartwright 2002: 6-7;
McKinnon 2003: 10; Strang and Pearson 2000: 2). Older adults who are socially
isolated have been shown to be more depressed, more disabled, to be in poorer health
and to have less well-being than those who are socially connected (WHO 2002: 28;
WHO 2003: 22). Indeed, a recent meta review of existing empirical research
undertaken by the National Heart Foundation of Australia identified social isolation
and a lack of quality social support as independent psychosocial risk factors for the
occurrence of coronary heart disease across various age groups (Bunker et al. 2003:
272). Prevalence rates for social isolation vary, with a recent review estimating the
rate in Britain at between two and 20% of people aged 65 years and over (Victor et al.
2000: 410). Research in Australia suggests that, in the veteran community at least,
approximately 10% are socially isolated, with a further 12% at risk of social isolation
(Gardner et al. 1999: 5).
Socially connected adults, on the other hand, have a greater chance of successfully
recovering from a heart attack and have lower rates of coronary heart disease (WHO
2003: 22) than socially isolated individuals. Social connection, that is, social
participation, social support and social networks have been shown to contribute to
seniors’ overall health and wellbeing (National Advisory Council on Ageing 1993: 3).
For instance, in a study of elderly Americans, Glass et al. (1999) found that
participation in social activities such as social groups, playing cards, games or bingo,
visiting cinemas and so on, lowered the risk of mortality in adults aged 65 years and
older (1999: 278,480). Moreover, a recent longitudinal study found that, in Australian
adults aged 70+ years, involvement in social networks with friends and confidants,
excluding family, provided “significant protective effects against mortality over a 10
year follow-up period” (Giles et al. 2005: 577).
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Why is social isolation / social connection an issue?
Increases in life expectancy and a sustained decline in fertility have led to a
“structural ageing” of Australia’s population (Australian Bureau of Statistics (ABS)
1999: [3]). In 2001, 12.4% of the population of Australia was aged 65 years and over;
by 2044-45 this figure is estimated to be almost 25% (Productivity Commission 2005:
339). This so-called “greying” of the population is of particular concern to all levels
of government because of the perceived dependency of this age group (WHO 2002: 9)
and the corresponding blow-out in costs associated with an increased need for aged
health services and community care programs (ABS 1999: [1,5]). The predicted
increase in future need, will place significant pressure on Australian governmental
budgeting arrangements, service provisions, and personnel, program and
infrastructure allocations (Productivity Commission 2005: 293,299). This will be
especially relevant at the local government level, where many programs and services
associated with aged and community care are implemented (Australian Local
Government Association 2005: 16-20; Productivity Commission 2005: 293,299).1
The anticipated increase in the elderly population means, potentially, a subsequent
increase in the number and proportion of socially isolated individuals, who, given the
foregoing evidence, will be more vulnerable to ill health than the rest of the
population. This increase in older citizens in poor health will only serve to augment
the strain on aged health services and community care programs. In contrast,
empirical studies show that socially connected older adults have better health and
wellbeing and, by implication, may have less need to access health and community
care services than those who are socially isolated. Consequently, it seems both
socially and fiscally advantageous to ensure that older adults within local
communities are socially connected. This is in line with the World Health
Organization’s pronouncement that policies and programs that promote social
connection “are as important as those that improve physical health status” (WHO
2002: 12).
1 Explaining the provision of services for the elderly in Australia is difficult. It is complicated by the
fact that aged care and health care services are funded as separate entities and by differing levels of
contributions from all three levels of government.
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“Social Capital” - a framework for social connectedness
At an individual level, promoting social connectedness amongst older adults has
obvious health benefits and, at a macro level, may well have beneficial financial and
policy implications. However, at a community level the advantage of encouraging
social connection amongst older adults has not been made altogether clear. A
framework that may help contextualize the intricacies and benefits of social
connectedness is the theory that social capital is related to our health and wellbeing.
Social capital refers primarily to connections and relations among individuals, with
the central premise being that social networks have value (Putnam 2000a: 18-19).
Putnam describes social capital as “features of social organization, such as networks,
norms and trust that facilitate coordination and cooperation for mutual benefit”
(Putnam 1993: [1]).
School performance, public health, crime rates, clinical depression, tax
compliance, philanthropy, race relations, community development, census
returns, teen suicide, economic productivity, campaign finance, even
simple human happiness – all are demonstrably affected by how (and
whether) we connect with our family and friends and neighbours and co-
workers. (Putnam 2000b)
Further, Putnam sees social capital as being composed of two dimensions: bridging or
bonding. Bridging capital is “inclusive”, it promotes broader identities and a more
outward looking focus; whereas bonding capital is “exclusive” and has a tendency to
reinforce identities and promote homogeneous groups with strong boundaries (Putnam
2000a: 22).
Social capital is both productive and cumulative so that, as people work together
building connections and trust, they create a network of links that benefit communities
and result in the increased possibility of collective action (ABS 2002: 4). Behaviours
such as singing in the local choir, saying hello to someone in the street, voting, being
involved in the local computer club, gossiping with neighbours, reading newspapers
and so on, are all examples of “civic engagement” and, as such, can be seen to create
social capital solidarity and collaboration at a community level (Putnam 1993: [2-3];
Putnam 2000a: 93). To illustrate, in the USA, strong correlations have been found
between high levels of social capital and neighbourhood vitality, lower crime rates,
and tolerance for others (Putnam 2000a: 308-309,356). Putnam has cautioned,
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however, that social capital can have a downside, whereby it can be used negatively
by “power elites” for antisocial purposes, such as “sectarianism, ethnocentrism (and)
corruption” (Putnam, 2000a: 22).
In keeping with the findings reported earlier, Putnam asserts that social connectedness
has been proven “beyond reasonable doubt” to be one of the “most powerful
determinants of our wellbeing” (Putnam 2000a: 326). A series of longitudinal studies
in the USA showed that “people who are socially disconnected are between two and
five times more likely to die from all causes, compared with matched individuals who
have close ties with family, friends and the community” (Berkman and Glass 2000;
cited in Putnam 2000a: 327). Furthermore, in a study that used survey data from
approximately 170,000 people in the USA, a strong relationship between poor health
and low social capital was found, even when individual risk factors were accounted
for (Kawachi et al. 1999: 1187). However, the reasons why social networks and
social cohesion are beneficial for health have yet to be elucidated (Putnam 2000a:
327,331), although it has been postulated that social capital may act as a trigger to
arouse the immune system to fight off disease and stress (Putnam 2000a: 327).
These results mirror those found earlier for older adults. Thus the social capital thesis
appears to offer an empirical association as to why health outcomes in older adults are
bound up with social connectedness. The emphasis on social networks and social
involvement helps create a sense of social cohesion which bolsters and sustains social
capital and which has, in turn, flow-on effects on community health outcomes. These
results have implications for ensuring that social connection initiatives for older adults
are provided in an ongoing community context.
Local governments and social isolation / connection
Local governments have a relationship with local communities that is missing from
other tiers of Government (Commonwealth of Australia 2003: 8). Further, the
Australian Local Government Association maintains that local government is a “key
player in public health and community welfare” (ALGA 2005a: [5]) and the
Municipal Association of Victoria claims that local government is increasingly being
identified as “responsible for community care” (MAV 2004: 4).
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Given the proposition that socially connected older adults need fewer health and
community care services, local area governments have a vested interest in sponsoring
social connection amongst the aged. In addition, the evidence that social connection
fosters and promotes social capital which, in turn, influences health and wellbeing,
cannot be ignored. It seems especially appropriate then that local governments, which
are in a unique position to advocate on behalf of the community, implement programs
to actively encourage social connection and thereby, social capital. However, much
of the local government research to date has focused on social isolation in older adults
rather than social connection per se (see for example: Knox City Council 2002 The
Social Isolation Pilot Project). The work that this paper is based on was undertaken
in an attempt to address this lack.
Despite the gap in the research, programs designed to promote social connection and
alleviate social isolation in the aged do exist. However, ongoing research by Cattan
and her colleagues suggests that, thus far, these programs have evolved to “meet the
needs of current participants”, thereby excluding truly isolated individuals (Cattan et
al. 2003: 20). This limitation will need to be borne in mind, as it poses significant
problems for the development and implementation of programs in this area in the
future.
The study
This study was undertaken as an Honours project investigating social connectedness
amongst older adults from a local Melbourne municipality. This paper reports
qualitative findings from in-depth interviews with older adults. Eight social club
organizers (who were also older adults) and eight older adults were interviewed (16 in
total). Of the 16 respondents, 10 were females (62.5%) and six were male (37.5%).
Ages ranged from 65 – 92 years and the median age was 75 years. Questions were
asked about various aspects of social connection and social isolation. The interviews
were analysed thematically.
The study had two objectives. The first objective was to determine whether existing
programs and initiatives within the municipality helped promote social connection
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amongst older adults. Furthermore, as research by Cattan et al. (2003) suggests that
services provided for socially isolated older adults do not actually get through to those
in most need, an additional objective was to ascertain whether socially isolated older
adults were actually being accessed by these programs.
Older adults’ social club organizers
Members of this target group were older adults who were involved in various
organizing capacities as volunteers at older adults’ social and activity groups. They
were all on the Committee of Management as President, Secretary, Treasurer, and so
on. These social activity groups sponsor a variety of structured weekly events, such
as cards, craft, indoor bowling, dancing, bingo and day trips. New group members are
recruited primarily via word-of-mouth referrals from existing social club members or
sometimes through advertisements in local newspapers. Initial contact with new
members is usually by a telephone call and is sometimes followed up by a home visit.
This is undertaken by a committee member who is often designated as the “Welfare /
Welcoming Officer”.
Results from the interview data suggest that some clubs make a concerted effort to
welcome new members, and to actively promote an atmosphere of inclusiveness.
They generate social connectedness through the group activities, either large or small,
and through shared interests and peer support. In these clubs, many of the organizers
endeavour to connect with isolated people in their surrounding neighbourhoods, in an
effort to encourage them to be involved:
I visit many people in my area to ask them to come along (to the club)….. I
don’t like to think that older people might be stuck at home and might
never leave the house; it makes me sad. [Nick, Social Club Organizer]
Other clubs are cliquey and inadvertently (or otherwise) create an atmosphere of
exclusion, as evidenced by waning numbers. In these cases, club officials maintain a
power structure reminiscent of in-group and out-group dynamics (Tajfel 1982 cited in
Taylor et al. 2000: 190) and are far more restrained in their attitudes to those whom
they know to be isolated. For instance, many of these social club organizers consider
those who are truly socially isolated as “too much hard work” or “too much trouble”.
This means they are not really interested in helping to recruit new members from this
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subsection of the population, or in going out of their way to help them, as this quote
attests: “We don’t like to push them; if they want to come, they’ll come” [Rudy,
Social Club Organizer].
These results fit neatly into the social capital thesis which sees social capital as
composed of two dimensions: bridging or bonding. Social groups that were
welcoming to newcomers and promoted an atmosphere of “inclusiveness”, could be
classed as being high in bridging capital; whereas those social groups that were not so
welcoming and could, at times, be “exclusionary”, could be viewed as high in
bonding capital (see Putnam 2000a: 22).
Older adults
This group of respondents were drawn from two sub-groups: (i) older adults who were
active members of social activity groups; or (ii) older adults who were not taking part
in any social activity groups. Results suggest that those older adults who are involved
are usually involved in more than one group. Many learn about social activity groups
via word-of-mouth, that is, from their friends or neighbours and most had received a
phone call or a personal visit from a designated club officer, such as the “Welfare /
Welcoming” Officer, before attending for the first time. Once involved, older adults
became socially connected through involvement in social activities, befriending others
and giving and receiving social support, particularly those involved in “inclusive”
groups. Programs and activities provide older adults with a feeling of connection to
their peers and to the wider community:
I feel that I have made many friends through my club. I see those friends
outside of the club. I think it is very important to be connected to friends
and the community, and being part of a club has made it possible for me.
[Frank, Older Adult]
Our club always visits people when they are sick in hospital. It makes you
feel good. It’s good to have someone else, not just from your family, to
have someone your own age….. you can rely on them if you need them.
[Jenny, Older Adult]
Whilst some older adults were willing to help those who were socially isolated to
become connected others, however, would not go out of their way to help. Reflecting
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the results obtained from the social organizers, it seems these older adults feared the
commitment of helping others on an ongoing basis, reiterating the sentiments stated
above that it was “too much hard work” or “too much trouble”.
Nevertheless, for the most part, social club organizers and social club participants
found socially isolated older adults in the community extremely difficult to identify.
There is no registry of isolated older adults, nor any way of determining who is
socially isolated except through sporadic referrals from families, friends or neighbours
and, in most cases, health care workers. Furthermore, privacy laws constrain direct
contact with an isolated older person without first obtaining permission from the
person themselves. This creates an invidious “Catch 22” situation and can leave
many people who could benefit from increased social contact and participation,
unconnected. Whilst the objective of privacy laws may well be to enhance trust
within the community, in this instance, they only served to maintain social isolation in
the aged by inhibiting social connectedness.
Conclusion
The results presented in this paper are necessarily brief. Nevertheless, they provide
some answers to the research objectives. A number of local government initiatives
aimed at promoting social connection in the aged do appear to be effective. Those
older adults who are involved in social activity groups report feeling connected to
their peers and to the wider community. However, the majority of the people
involved in these programs are not the socially isolated individuals that the programs
were originally designed for. This has previously been established by Cattan et al.
and my small study supports her findings (2003: 20). I was able to demonstrate that
socially isolated older adults – those who were most in need of social connection –
were difficult to access due to structural and social impediments. Accordingly,
programs that specifically target this cohort are needed, together with a greater
awareness in the wider community of the negative implications of social isolation in
older adults.
Social connection in the aged provides a powerful protective effect against ill health
and an equally protective effect against mortality. In general, older adults who are
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socially connected may have less need to access health and community services.
Given this, and the anticipated blow-out in aged and community care costs, it makes
sense for Governments, at all levels, to promote any program or method that enhances
social connection amongst the aged. Further, the social capital thesis suggests that
increasing social connectedness at a community level, is beneficial for all of society.
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... It comprises the interaction with siblings, associates, age mates, and neighbors, as well as networks that individuals create by means of working to earn a living, entertainment and other forms of relaxation, or through unpaid work or communal service. Social interaction is considered a form of defence against morbidity and mortality during old age (Malta, 2005). Adults with strong societal networks appear to have possible likelihoods of effectively recuperating from cardiac arrest, as well as reduced incidences of coronary heart diseases (WHO, 2003). ...
... The effect of loneliness on health can occur irrespective of the demographic characteristics of the individual, but the major consequences often happen among the aged. On a social basis, the elderly who are lonely are affected by diseases and are less likely to experience wellbeing (Malta, 2005). Thus, the elderly who are detached from society become sad, develop poor health, and have poor wellbeing (WHO, 2002). ...
... At the biologic predisposition, genetics had been reported a major attribution to depression, especially to major depression [7,8]. In terms of person's social and internal psyche, there are many factors indicated having association with depression: Physical activities, medical illness, quality of life, social connectedness, drug and alcohol [9][10][11][12][13][14][15][16][17][18][19]. Although depression is not a normal part of aging, it is a true and treatable medical condition, but older adults still are at an increased risk for experiencing depression. ...
... At the biologic predisposition, genetics had been reported a major attribution to depression, especially to major depression [7,8]. In terms of person's social and internal psyche, there are many factors which indicated having association with depression: physical activities, medical illness, quality of life, social connectedness, drug, and alcohol [9][10][11][12][13][14][15][16][17][18][19]. Although depression is not a normal part of ageing, it is a true and treatable medical condition, but older adults still are at an increased risk for experiencing depression. ...
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... The initial premise on which we developed our pilot research included the position statement that participation by older women with informal craft activities could ameliorate the need for engagement with formal social services. The focus for this inquiry grew out of recognition that social connection and subjective wellbeing appear to provide protective effects against ill-health and mortality in the aged (Malta, 2005;Reynolds, 2010), while at the same time noting that the impact of participation in the arts on wellbeing has been comprehensively ignored (Michalos, 2005). Given our own observations of the large numbers of older women participating in some form of craft venture we were curious to explore the curative, restorative and protective factors these activities appeared to offer. ...
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While the social work literature is broader and more holistic than many disciplines, we undoubtedly still limit the knowledge we draw upon in ways that stifle our creativity in conceptualising and attempting to facilitate wellbeing, which flows on to limit our teaching. In particular, the significance to wellbeing of place and social space, the value of informal networks to generate support and opportunities for reciprocity, and the inherent therapeutic value of creative activity appears to be neglected. In this paper we draw upon a small Australian research study around older women and craftmaking to explore how learning from diverse disciplines, such as critical gerontology and textile making, can illuminate our understanding of wellbeing. We relate this discussion to examining notions of ageing that go beyond a focus on illness and deterioration, to enhance positive and diverse concepts of health in the context of everyday life. We then discuss the implications for social work education, with particular emphasis on ageing, and argue that by engaging with a diverse range of disciplines, we are able to think about, teach and advocate for wellbeing in more expansive and useful ways. <br /
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Emotional well being is one of two aspects of personal well-being that can be measured in quality of life assessments, and is a critical part of a senior citizen to help them age gracefully and remain independent as well as integrated with society. In order to improve the emotional well being of the elderly in the era of looming ageing population crisis, in this paper the authors report on design and a field trial of Matilda, a human-like assistive communication assistive robot in Australian residential care and home-based care facilities. The work demonstrates that by marrying the embodiment of care with artificial intelligence, emotion measuring techniques and positive emotion generation in its design and applications, Matilda has the ability to improve emotional well being of the elderly.
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To examine any association between social, productive, and physical activity and 13 year survival in older people. Prospective cohort study with annual mortality follow up. Activity and other measures were assessed by structured interviews at baseline in the participants' homes. Proportional hazards models were used to model survival from time of initial interview. City of New Haven, Connecticut, United States. 2761 men and women from a random population sample of 2812 people aged 65 and older. Mortality from all causes during 13 years of follow up. All three types of activity were independently associated with survival after age, sex, race/ethnicity, marital status, income, body mass index, smoking, functional disability, and history of cancer, diabetes, stroke, and myocardial infarction were controlled for. Social and productive activities that involve little or no enhancement of fitness lower the risk of all cause mortality as much as fitness activities do. This suggests that in addition to increased cardiopulmonary fitness, activity may confer survival benefits through psychosocial pathways. Social and productive activities that require less physical exertion may complement exercise programmes and may constitute alternative interventions for frail elderly people.
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This book covers the lifelong importance to health of determinants such as poverty, drugs, working conditions, unemployment, social support, good food and transport policy. It provides a discussion of the social gradient in health, and an explanation of how psychological and social influences affect physical health and longevity. The focus is on the role that public policy can play in shaping the social environment and on structural issues such as unemployment, poverty and the experience of work. Each of the chapters contains a brief summary of what has been established by research, followed by some implications for public policy. [Country: Europe]
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Introduction The context for the review of loneliness and social isolation in later life is that of ‘successful aging’ and ‘quality of life’. The term ‘quality of life‘ includes a broad range of areas of life and there is little agreement about the definition of the term. Models of quality of life range from identification of ‘life satisfaction’ or ‘social wellbeing’ to models based upon concepts of independence, control, and social and cognitive competence. However, regardless of how the concept of quality of life is defined, research has consistently demonstrated the importance of social and family relationships in the definition of a ‘good quality of life’.
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The commissioned study into the ageing of Australia’s population was released April 2005. The Commission found that one quarter of Australians will be aged 65 years or more by 2044-45, roughly double the present proportion. This gives rise to significant policy challenges. The Commission maintains that policy responses would have to be broad and at all levels of government. Policy measures will be needed to reduce the fiscal pressure from ageing and/or to finance the fiscal gap. Reforms would be needed in key human service areas, such as health and aged care, where the pressures of an ageing population will impact most. The resulting fall in labour force participation would also need to be addressed. The Commission shows that raising labour force participation and productivity can partly offset the impacts of an ageing population. These would enhance income growth, helping to sustain economic growth and living standards, and increase the capacity to ‘pay’ for the costs of ageing, as well as through taxation.
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Social capital consists of features of social organization--such as trust between citizens, norms of reciprocity, and group membership--that facilitate collective action. This article reports a contextual analysis of social capital and individual self-rated health, with adjustment for individual household income, health behaviors, and other covariates. Self-rated health ("Is your overall health excellent, very good, good, fair, or poor?") was assessed among 167,259 individuals residing in 39 US states, sampled by the Behavioral Risk Factor Surveillance System. Social capital indicators, aggregated to the state level, were obtained from the General Social Surveys. Individual-level factors (e.g., low income, low education, smoking) were strongly associated with self-rated poor health. However, even after adjustment for these proximal variables, a contextual effect of low social capital on risk of self-rated poor health was found. For example, the odds ratio for fair or poor health associated with living in areas with the lowest levels of social trust was 1.41 (95% confidence interval = 1.33, 1.50) compared with living in high-trust states. These results extend previous findings on the health advantages stemming from social capital.