Enabling pathways to health equity: developing a framework for implementing social capital in practice

Abstract

BackgroundMounting evidence linking aspects of social capital to health and wellbeing outcomes, in particular to reducing health inequities, has led to intense interest in social capital theory within public health in recent decades. As a result, governments internationally are designing interventions to improve health and wellbeing by addressing levels of social capital in communities. The application of theory to practice is uneven, however, reflecting differing views on the pathways between social capital and health, and divergent theories about social capital itself. Unreliable implementation may restrict the potential to contribute to health equity by this means, yet to date there has been limited investigation of how the theory is interpreted at the level of policy and then translated into practice.MethodsThe paper outlines a collaborative research project designed to address this knowledge deficit in order to inform more effective implementation. Undertaken in partnership with government departments, the study explored the application of social capital theory in programs designed to promote health and wellbeing in Adelaide, South Australia. It comprised three case studies of community-based practice, employing qualitative interviews and focus groups with community participants, practitioners, program managers and policy makers, to examine the ways in which the concept was interpreted and operationalized and identify the factors influencing success. These key lessons informed the development of practical resources comprising a guide for practitioners and briefing for policy makers.ResultsOverall the study showed that effective community projects can contribute to population health and wellbeing and reducing health inequities. Of specific relevance to this paper, however, is the finding that community projects rely for their effectiveness on a broader commitment expressed through policies and frameworks at the highest level of government decision making. In particular this relationship requires long term vision, endorsement for cross-sectoral work, well-developed relationships and theoretical and practical knowledge.ConclusionsAttention to the practical application of social capital theory shows that community projects require structural support in their efforts to improve health and wellbeing and reduce health inequities. Sound community development techniques are essential but do not operate independently from frameworks and policies at the highest levels of government. Recognition of the interdependence of policy and practice will enable government to achieve these goals more effectively.

How Engaged Are Family Physicians in Addressing the Social Determinants of Health? A Survey Supporting the American Academy of Family Physician's Health Equity Environmental Scan

“…The questionnaire was developed based on a literature review about clinical and population-based interventions to address the SDoH (referred to as clinical actions and populationbased actions from this point forward). 12,13,16,17,[24][25][26][27][28][29] Input from 16 family physicians was also used from the AAFPs Subcommittee on Health Equity. The outcomes of interest were clinical and populationbased actions that were separated because of their distinct research threads.…”

Exploring the Relationship between Perceptions of Neighbourhoodresources, Sense of Coherence and Health for Different Groups in a Norwegian Neighbourhood

“…21,22 However, the health-promoting influence of resources can be diminished or even reversed through unsuitable design or internal organization. 13,17 Additionally, neighbourhoods are embedded in a broader societal and geographical context, which might support or hazard the health-promoting aspect of resources and interventions within the setting 23 . Social groups relate to the neighbourhood-context differently.…”

How people with type two diabetes in England learn about digital health technologies, and what are the barriers to access and motivators for use? A qualitative study

“…Bridging is the connections that link people across different networks or social groupings (such as ethnicity, occupational class, or religion), which are responsible for the transmission of information and resources [33][34][35][36]. Bridging occurred through diabetes support groups, involvement in research groups and online forums.…”

“…These measures did not account for the importance of membership to social groups (e.g. diabetes groups, research groups and online forums) and how these supported access to knowledge about technology, provided shortcuts to accessing new and helpful innovations, and support to overcome issues with usability (tech buddies) [33][34][35][36]41]. Research into health inequalities should consider the important role of social and community assets in the access and use of health interventions.…”