Gerry Veenstra

Social capital, SES and health: an individual-level analysis

Stimulated by the finding (Kawachi et al., 1997) that social capital in communities may mediate the relationship between income inequality and health status, this article describes relationships between individual-level elements of social capital--trust, commitment and identity in the social-psychological dimension; participation in clubs and associations and civic participation in the action dimension--and self-rated health status, before and after controlling for human capital (socioeconomic status measured by income and education), using survey data collected in Saskatchewan, Canada (n = 534, 40% response rate). Income (P = 0.001) and education (P < 0.001) were related to health in the expected directions. Both income (P = 0.002) and education (P = 0.004) were related to health among the elderly; education (P = 0.035) to health among the middle-aged; and neither among the youthful respondents. Frequency of socialization with work-mates (P = 0.019) and attendance at religious services (P = 0.034) had the strongest (and positive) relationships with health of the social engagement questions, even after controlling for human capital, and participation in clubs and associations was positively related to health among the elderly (P = 0.009). But for commitment to ones own personal happiness (P = 0.039), trust, commitment and identification of various kinds were not significantly related to health. Civic participation was also unrelated to health. The main conclusion is that little evidence was found for compositional effects of social capital on health. Secondary findings are that the relationship between SES and health was the same for men and women and strongest among the elderly; that socialization with colleagues from work is relevant and that attendance at religious services and participation in clubs are related to health for the elderly.

Social capital and health (plus wealth, income inequality and regional health governance).

This article describes an empirical exploration of relationships among aspects of thirty health districts in Saskatchewan, Canada. These aspects include social capital, income inequality, wealth, governance by regional health authorities and population health, the primary dependent variable. The social capital index incorporated associational and civic participation, average and median household incomes served as proxies for wealth, the degree of skew in the distribution of household incomes assessed income inequality while the model for effective governance by District Health Boards (DHBs) focused on reflection of health needs, policy making and implementation, fiscal responsibility and the integration and co-ordination of services. I found no evidence of a relationship between social capital in health districts and the performance of DHBs. Among the determinants of health, wealth appeared unrelated to age-standardised mortality rates while income inequality was positively and social capital was negatively related to mortality. Income inequality was not as strongly related to age-standardised mortality after controlling for social capital. and vice versa, suggesting the two may be comingled somehow when it comes to population health, although they were not significantly related to one another. Of the predictors of social capital the distribution of age in districts appeared to be the most salient; of the predictors of age-standardised mortality rates the gender composition of a district was most salient.

Loneliness and risk of mortality: a longitudinal investigation in Alameda County, California.

We investigated the prospective impact of self-reported loneliness on all-cause mortality, mortality from ischemic disease and mortality from other cardiovascular diseases. We tested these effects through GEE binomial regression models applied to longitudinal data from the Alameda County Study of persons aged 21 and over arranged into person-years. Controlling for age and gender, the chances of all-cause mortality were significantly higher among respondents reporting that they often feel lonely compared to those who report that they never feel lonely. Frequent loneliness was not significantly associated with mortality from ischemic heart disease but more than doubled the odds of mortality from other ailments of the circulatory system in models controlling for age and gender. Subsequent models showed that physical activity and depression may be important mediators of loneliness-mortality associations. Finally, we find support for the contention that chronic loneliness significantly increases risk of mortality but also find reason to believe that relatively recent changes in feelings of loneliness increase risk of mortality as well.

“Who Do They Think We Are, Anyway?”: Perceptions of and Responses to Poverty Stigma

In this article, we report on qualitative findings pertaining to low-income peoples perceptions of and responses to “poverty stigma,” a key component of social exclusion with important implications for health and well-being. Our findings are drawn from a multimethod study designed to investigate experiences of social exclusion and social isolation among people living on low incomes. We conducted semistructured individual interviews (n = 59) and group interviews (total n = 34) with low-income residents of two large Canadian cities. Data were analyzed using thematic content analysis techniques. Participants overwhelmingly thought that other members of society tend to view them as a burden to society—as lazy, disregarding of opportunities, irresponsible, and opting for an easy life. Low-income people responded to perceived stigma with a variety of cognitive and behavioral strategies that reflected their efforts to reconcile their perceived “social” and “personal” identities. These strategies included confronting discrimination directly, disregarding responses from others, helping other low-income people, withdrawing and isolating themselves from others, engaging in processes of cognitive distancing, and concealing their financial situation.

Perceptions of genetic discrimination among people at risk for Huntington’s disease: a cross sectional survey

Objective To assess the nature and prevalence of genetic discrimination experienced by people at risk for Huntington’s disease who had undergone genetic testing or remained untested. Design Cross sectional, self reported survey. Setting Seven genetics and movement disorders clinics servicing rural and urban communities in Canada. Participants 233 genetically tested and untested asymptomatic people at risk for Huntington’s disease (response rate 80%): 167 underwent testing (83 had the Huntington’s disease mutation, 84 did not) and 66 chose not to be tested. Main outcome measures Self reported experiences of genetic discrimination and related psychological distress based on family history or genetic test results. Results Discrimination was reported by 93 respondents (39.9%). Reported experiences occurred most often in insurance (29.2%), family (15.5%), and social (12.4%) settings. There were few reports of discrimination in employment (6.9%), health care (8.6%), or public sector settings (3.9%). Although respondents who were aware that they carried the Huntington’s disease mutation reported the highest levels of discrimination, participation in genetic testing was not associated with increased levels of genetic discrimination. Family history of Huntington’s disease, rather than the result of genetic testing, was the main reason given for experiences of genetic discrimination. Psychological distress was associated with genetic discrimination (P<0.001). Conclusions Genetic discrimination was commonly reported by people at risk for Huntington’s disease and was a source of psychological distress. Family history, and not genetic testing, was the major reason for genetic discrimination.

Home is where the governing is: social capital and regional health governance.

The relationship between the civic nature of a community and effective political governance by regional health boards in Canada is explored. A model is proposed that identifies components of social capital such as trust, commitment and identity, associationalism, civic participation and collaborative problem-solving. These concepts are then theoretically linked to effective governance, in particular to reflection of health needs, policy implementation, population health, fiscal responsibility and administrative efficiency. The generalizability of this model is discussed, as are current research directions and policy implications for governments. The conclusion is that governments might want to incorporate a dual perspective encompassing both the political institutions and the community structure.

Poverty, Sense of Belonging and Experiences of Social Isolation

This article compares experiences of social isolation and perceptions of belonging between lower-income and higher-income people. We conducted individual interviews with 60 higher-income and 59 lower-income study participants and six group interviews with 34 low-income participants from two Canadian cities. Subsequently, a representative sample of 1,671 lower- and higher-income participants was surveyed by telephone. Income was a consistent predictor of measures of isolation and sense of belonging to the community: lower-income people experienced greater isolation and a lower sense of belonging than did higher-income people. Poverty shaped low-income peoples perceptions and experiences of stigmatization and isolation.

Beyond the patient: The broader impact of genetic discrimination among individuals at risk of Huntington disease†‡

We aimed to address gaps in current understanding of the scope and impact of discrimination, by examining a cohort of individuals at‐risk for Huntington disease (HD), to describe the prevalence of concern for oneself and ones family in multiple domains; strategies used to mitigate discrimination; and the extent to which concerns relate to experiences. We conducted a cross‐sectional survey of 293 individuals at‐risk for HD (80% response rate); 167 respondents were genetically tested and 66 were not. Fear of discrimination was widespread (86%), particularly in the insurance, family and social settings. Approximately half of concerned individuals experienced discrimination (40–62%, depending on genetic status). Concern was associated with “keeping quiet” about ones risk of HD or “taking action to avoid” discrimination. Importantly, concern was highly distressing for some respondents (21% for oneself; 32% for relatives). Overall, concerned respondents with high education levels, who discovered their family history at a younger age, and those who were mutation‐positive were more likely to report experiences of discrimination than others who were concerned. Concerns were rarely attributed to genetic test results alone. Concern about genetic discrimination is frequent among individuals at‐risk of HD and spans many settings. It influences behavioral patterns and can result in high levels of self‐rated distress, highlighting the need for practice and policy interventions.

A relational approach to health practices: towards transcending the agency-structure divide

Many health scholars find that Pierre Bourdieus theory of practice leaves too little room for individual agency. We contend that, by virtue of its relational, field-theoretic underpinnings, the idea of leaving room for agency in Bourdieus theory of practice is misguided. With agency manifested in interactions and social structures consisting of relations built upon relations, the stark distinction between agency and structure inherent to substantialist thinking is undermined, even dissolved, in a relational field-theoretic context. We also contend that, when treated as relationally bound phenomena, Bourdieus notions of habitus, doxa, capital and field illuminate creative, adaptive and future-looking practices. We conclude by discussing difficulties inherent to implementing a relational theory of practice in health promotion and public health.

Capital relations and health: mediating and moderating effects of cultural, economic, and social capitals on mortality in Alameda County, California.

Inspired by Bourdieus theories on various forms of capital, conversions among them, and the fields (social spaces) delineated by possession of them, the authors investigate distinct and interconnected effects of cultural, economic, and social capitals on risk of mortality. Using 35 years of longitudinal data from the Alameda County Study (n = 6,157), they created discrete-time hazard models to predict all-cause mortality from educational attainment (institutionalized cultural capital), household income (economic capital), and different forms of personal ties (social capital). The results show that education, income, having three or more close friends, regularity of church attendance, and participation in social/recreational groups were all negatively and significantly associated with risk of mortality. Income mediated a significant portion of the education effect. None of the personal ties variables mediated the effects of education or income. Relative composition of the sum total of education and income did not have an effect. Lastly, examination of statistical interactions between capitals determined that protective effects of church attendance and participation in community betterment groups applied only to non-wealthy people. These findings speak to the structure of the U.S. social space within which health-delimiting relationally defined social classes may be made manifest.