Social capital and self-rated health in Colombia: The good, the bad and the ugly

Abstract

Although there is increasing evidence supporting the associations between social capital and health, less is known of potential effects in Latin American countries. Our objective was to examine associations of different components of social capital with self-rated health in Colombia. The study had a cross-sectional design, using data of a survey applied to a nationally representative sample of 3025 respondents, conducted in 2004–2005. Stratified random sampling was performed, based on town size, urban/rural origin, age, and sex. Examined indicators of social capital were interpersonal trust, reciprocity, associational membership, non-electoral political participation, civic activities and volunteering. Principal components analysis including different indicators of social capital distinguished three components: structural-formal (associational membership and non-electoral political participation), structural-informal (civic activities and volunteering) and cognitive (interpersonal trust and reciprocity). Multilevel analyses showed no significant variations of self-rated health at the regional level. After adjusting for sociodemographic covariates, interpersonal trust was statistically significantly associated with lower odds of poor/fair health, as well as the cognitive social capital component. Members of farmers/agricultural or gender-related groups had higher odds of poor/fair health, respectively. Excluding these groups, however, associational membership was associated with lower odds of poor/fair health. Likewise, in Colombians with educational attainment higher than high school, reciprocity was associated with lower odds of fair/poor health. Nevertheless, among rural respondents non-electoral political participation was associated with worse health. In conclusion, cognitive social capital and associational membership were related to better health, and could represent important notions for health promotion. Human rights violations related to political violence and gender based discrimination may explain adverse associations with health.

Introduction

Although increasing empirical evidence from the last decade supports the link between social capital, defined as “the features of the social organization, such as the density of civic associations, levels of interpersonal trust, and norms of reciprocity, that facilitate collective action” (Kennedy, Kawachi, & Brainerd, 1999, p. 262) and health (Kawachi et al., 2008a, Kawachi et al., 2008b), less is known about plausible associations in Latin American countries, where the effects could vary according to socio-political and economical characteristics (Kawachi & Kennedy, 2002) and different disease distributions (Kim et al., 2008, Krieger et al., 2010). Particularly in Latin America, strengthening social capital could enhance policies or interventions aimed to reduce poverty and inequalities. By the same token, central notions of social capital like social cohesion, community participation and civic engagement could be relevant strategies in health promotion (Sapag & Kawachi, 2007). Despite this potential, however, research on social capital and health in the Latin American region, and particularly in Colombia, remains limited. A recent review of the scientific literature from the region (Kripper & Sapag, 2009) showed that most studies have been conducted at the communitarian (Brune and Bossert, 2009, Harpham et al., 2006, Poblete et al., 2008, Sapag et al., 2008), or the ecological level (Idrovo, 2006, Idrovo and Ruiz-Rodríguez, 2007), with no research yet at the national level.

Besides expanding social capital research in Latin American public health, identifying differential components of social capital is a crucial task in order to gain clearer understanding of the pathways by which social capital could causally be related to health. Harpham (2008), for example, distinguishes two components: 1) structural social capital, pertaining to behaviors (e.g. membership in associations, political participation) which could facilitate access and influence of networks that provide social support or other resources that could be beneficial for health; and 2) cognitive social capital that refers to perceptions or expectations in social behaviors, which could provide sense of community belonging and safe and stable representation of reality. Likewise, Putnam and Goss (2002) make a distinction between formal (e.g. organizations with structured procedures) and informal (e.g. spontaneous interactions with relatives, neighbors, colleagues or friends), two forms of social capital where reciprocity can be developed in networks to obtain benefits, either public or private.

In terms of measurement, some authors recommend the use of composite measures to capture different conceptual components of social capital, instead of single-item indicators (Harpham, 2008, Lochner et al., 1999). In this regard, Principal Component Analysis (PCA) is a frequently used statistical technique (Akçomak & ter Weel, 2009), since it allows simplification and reduction of data variability by grouping several observable indicators of social capital into a new independent component or index (Jolliffe, 2002). PCA is often used also because it facilitates the interpretation of latent constructs such as social capital, by considering how different observable indicators are clustered into a new component (Sabatini, 2009). In Latin America this measurement approach to derive independent social capital features has been applied in studies in Chile (Sapag et al., 2008) and Colombia (Harpham, Grant, & Rodriguez, 2004).

Research on social capital in Colombia has a cardinal relevance because the Political Constitution of 1991 mandates civic and political participation and demands the State to encourage the formation and promotion of civic associations. Moreover, civil society has played an important role in several public policies, especially the pursuit of peace and the end of political violence. As an illustration, civic organizations have been key actors in former and ongoing negotiations for the demobilization of armed illegal groups and their reinsertion to public and civic life (Romero, 2002). Sudarsky has led the research on social capital in Colombia (Kalmanovitz, 2000). Based on the World Values Survey (Inglehart, 1997), Sudarsky developed an instrument, the Barometer of Social Capital, (BARCAS in Spanish), adding relevant items pertaining to forms of political and civic participation and political culture in Colombia (Sudarsky, 1999). The BARCAS was first used in 1997 (Sudarsky, 2001) and 2005 (Sudarsky, 2007), having a nationally representative sample on both occasions. Results from these studies highlighted the salience of associational membership, non-electoral political participation and higher educational attainment as predictors of social capital (Sudarsky, 2007).

In addition, Colombian research has inquired about the negative implications or the downsides of social capital. Some authors have concluded that these adverse effects are more than low stock of social capital, but rather collective organizations and actions that promote and reward antisocial behaviors. In this context, concepts like perverse social capital refer to social and economical incentives to engage in illegal activities (Rubio, 1997). In Colombia, an example of this concept is the rise of drug cartels, which fed upon pre-existing networks of institutions and social groups, whose power relations and informal norms of behaviors facilitated their spread across society, not only confined to marginalized populations but to privileged sectors as well. Some other authors have documented barriers to civic participation in Colombia. For example, an extensive qualitative study case regarding community budgeting and urban planning in low income neighborhoods in Bogotá, the capital city, revealed that citizen’s participation was discouraged because resource allocation and priorities were decided by local government officials regardless of resident’s consensus. Another barrier for communitarian participation was leadership issues, where some community spokespersons failed to sustain citizens’ involvement. In addition, neighborhood associations were perceived as corrupted or useless (Hataya, 2007). Finally, political violence has been identified as an additional complexity in social capital investigations. Apart from being a threat for associational membership and collective civic actions, political violence destroys common bonds and erodes societal values, like decreasing rejection of the use of the violence as a mean to an end (Moser and McIlwaine, 2004, World Bank, 2000).

Regarding research on social capital and health in Colombia, only ecological (Idrovo, 2006, Idrovo and Ruiz-Rodríguez, 2007) or community specific (Harpham et al., 2004, Harpham et al., 2005) research has been conducted, but no initiatives yet at the national level. These studies have shown low to moderate positive associations between community disorganization and cancer mortality (Idrovo, 2006), interpersonal trust with life expectancy (Idrovo & Ruiz-Rodríguez, 2007) and lower prevalence of mental illnesses (Harpham et al., 2004).

Considering the need to provide evidence about social capital and health in developing countries and methodological indications regarding testing differential and independent components of social capital, the objective of our study is to analyze the associations between social capital and health in Colombia, having a valid outcome such as self-rated health (Idler & Benyamini, 1997). To our knowledge, this is the first study on this topic conducted in Colombia and Latin America that uses a nationally representative sample.