Social Capital and Communication in Health

The concept of social capital dates back more than 100 years and has intrigued academics, policymakers, and activists interested in understanding intergroup relations and social change in a variety of fields including communication, public health, sociology, and political science (Portes 1998). It has been seen as a promising way to examine how interaction and association among people and groups could influence public health, politics, economics, and overall comity and cohesion among disparate social groups. Despite substantive disagreements about the definition, utility, and appropriate measurement of social capital, there is broad agreement that social capital grows out of relationships between and among individuals and organizations and facilitates social action. Dimensions of social capital are generally understood to include norms of reciprocity, interpersonal trust, solidarity, and cooperation that seem to depend on social networks and civic engagement. Social capital is usually regarded as a positive phenomenon, although it can have negative effects when ties hinder positive action or serve to exclude segments of the population from key resources.

Definition Of Social Capital

Coleman (1988) defined social capital by its function, as a “variety of entities” that facilitate actions by social actors. Social capital helps in explaining different outcomes of actions of individuals as well as connecting them to larger structural changes. Thus, according to Coleman, social capital, although a property of the social structure, is fungible and used by individuals to accomplish goals.

In contrast, Putnam (1993, 35–36) put a more collective spin on the concept and defined social capital not by its function, but rather as the “features of social organizations, such as networks, norms, and trust, that facilitate action and cooperation for mutual benefit.” Thus the benefits of social capital accrue more markedly at the community, rather than individual, level. Certainly social capital benefits individuals, because individuals form connections that benefit their own interests. However, the connections themselves affect the wider community, so that not all the benefits of social connections will belong to the individual, but rather can contribute to well-being at the group level.

In public health, definitions of social capital that favor the communitarian approach seem to have prevailed. The utility of social capital in examining group-level differences in health, above and beyond the well-established benefits of social support for individuals, is the novel contribution of social capital to understanding public health (Kawachi et al. 2004). Groups enjoying higher levels of social capital have demonstrated lower levels of stressful conditions, risky behaviors, poor health, and mortality.

Putnam (2000) elaborated two key forms of social capital, “bridging” and “bonding,” to which Szreter and Woolcock (2004) added “linking.” Briefly, bonding social capital tends to reinforce homogeneous groups; developing reciprocity and mobilizing solidarity. Bonding social capital often occurs in the context of dense networks such as families, churches, and ethnic enclaves. Bridging social capital, in contrast, tends to be more inclusive, connecting people of greater diversity, and can generate broader identities and reciprocity. Finally, linking social capital is a particular form of bridging social capital, and links people across power or authority gradients in society.

Communication And Social Capital

An understanding of the relationship between social capital and communication requires careful attention to both the appropriate level and cross-level analyses (Viswanath in press). For example, a widely viewed television program mass communication may lead to discussions among co-workers, interpersonal communication, cementing relationships with a potential for trust and reciprocity, two dimensions of social capital. Accordingly, communication at both interpersonal and mass levels may lead to an increase (or in some cases a decrease) in social capital.

Communication may also be a key to understanding how different variants of social capital – bonding, bridging, and linking – are related to each other. From the point of view of health, communication facilitates diffusion of new information, reinforces social norms, mobilizes people for collective action, and creates social support, thus providing the base for understanding how social capital may impact public health. For individuals, communication plays a role in integrating people into cohesive communities by helping to support and maintain social ties and in promoting interpersonal trust. Interpersonal communication within social networks sustains trust, reciprocity, expectations, and information exchange, all critical dimensions of social capital. In addition, social capital, through interpersonal communications, may reinforce, moderate, and contradict information people are exposed to in mass media.

Mass media communications also play a role in community integration and cohesion, critical elements of social capital (Viswanath in press). A dimension of social capital membership in local organizations and institutions is related to local and national media use (Rothenbuhler et al. 1996; Stamm & Weis 1986; Viswanath et al. 1990). This wellestablished finding of local media use and community ties is important in understanding exposure to information of all kinds, including health information in the local media. “Media effects” on audience awareness, knowledge, opinions, attitude about health, and health behaviors assume exposure to media content, which is a necessary antecedent to effects. Community ties may enhance the opportunities for such exposure. Another way community ties may influence media exposure is through social priming (Demers 1996). Interaction with interpersonal networks and with members of local associations may “prime” audiences to attend to health information and act as a source of information.

The way media are used may also influence the formation of social capital. Media used for information are much more likely to contribute to social capital than media used for entertainment (Shah et al. 2001). News media may provide greater opportunity for exposure to mobilizing information as well as arguments, opinions, and frames that could promote engagements with civic affairs.

It is well documented that mass media are agents of both change and social control (Tichenor et al. 1980). The agendas of organized social groups may be amplified, potentially contributing to bridging and linking social capital. Organized efforts to promote public health, such as public health communication campaigns, often use mass media as powerful advocates. Conversely, when the media are not amplifying the agenda of organized social groups, which is more likely to occur when the groups desire changes that threaten fundamental power structure in the social system, groups may engage in media advocacy. Media advocacy may be more likely to occur in communities with high levels of social capital where members are able to work together and benefit from collective action (Kawachi & Berkman 2000).

The structure of a community – its size, economic base, ethnic, racial, and social class diversity, and centralization or decentralization of power among others – also influences the availability of information, how media cover information, diversity of media choices, and how people use the mass media. Heterogeneous networks facilitate the distribution and dissemination of new information (bridging social capital) and collective mobilization (linking social capital) compared to more closely aligned networks of family and friends (bonding social capital). Thus, social capital may also provide a way to examine communication inequalities that potentially contribute to social disparities (Viswanath 2006). Communication inequality – i.e., differences among social classes in the generation, manipulation, and distribution of information at the group level, and differences in access to and ability to take advantage of information at the individual level – may spring in part from differences among communities in social capital. People who participate in voluntary associations are, in general, from a higher socio-economic position than those who do not, and participation in such associations both contributes to social capital and may potentially provide an opportunity for individuals to access and act on information. In short, it is intriguing to explore whether the nature of social capital may influence what people may learn or do not learn from communications and whether that varies by social class, exacerbating inequalities.

Measurement Of Social Capital

Measuring social capital is challenging for three reasons (Woolcock & Narayan 2000): (1) the multidimensional nature of most definitions of social capital include different levels and units of analysis; (2) social capital can change over time as the relative importance of informal organizations and formal institutions shifts; and (3) in the initial development of the concept no standard approach for measurement was developed, and no longstanding surveys have been implemented to measure social capital across time and place.

In most studies researchers have used data from a variety of sources to compile indices of social capital. Indices generally include items related to structural and cultural aspects of social capital and are constructed either from aggregated micro-level data (such as social survey items assessing trust) or macro-level data (such as number of voluntary organizations or crime rates). Large-scale studies examining social capital and health at the national or state level have tended to use a few items to assess social capital (often unavoidable because few items may be available given the data sources), while smallerscale studies have been able to measure social capital with more comprehensive measures (Harpham et al. 2002). Examples of larger-scale studies include work by Kawachi et al. (1999) based on secondary data from general social surveys, using indices that included per capita membership in voluntary groups, interpersonal trust aggregated, and perceived norms of reciprocity. Other examples include work in Australia by Bullen and Onyx (1998), the Social Capital Community Benchmark Survey directed by Putnam (Saguaro Seminar 2001), and work for use in developing countries by the World Bank (Krishna & Shrader 1999).

Future Research

A more rigorous, systematic, and through understanding of the relationship between health communication and social capital could be valuable in improving public health and reducing inequities among different social classes.

While communication is clearly essential to the formation and maintenance of social capital of all types, the relationships between each form of social capital and health communication should be considered. Health communications to inform people or to persuade or motivate them to change behaviors to improve their health often result in differential levels of knowledge across groups. Knowledge gaps are a perennial problem, and lower levels of health knowledge have often been found among the same groups that suffer from health disparities (Institute of Medicine 2002). Understanding aspects of social structure that are likely to shape how information flows through populations is critical to advancing health communication. Social capital theory, which facilitates analyses of micro-to-macro transitions, has potentially great utility for the study of social factors affecting health communication. Social capital, in each of its forms, is likely to structure the communications that reach the individual by influencing the key components of communication.

In the area of interpersonal communications, social capital, and health, it is too early to predict the impact of the Internet and the world wide web. Nonetheless, their unique characteristics are likely to heavily impact the nature of social interactions and, consequently, trust, reciprocity, and dimensions of health communication.

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