Testing the association between social capital and health over time: a family-based design

BACKGROUND The past decade has seen a vast increase in empirical research investigating associations between social capital and health outcomes. Literature reviews reveal 'generalized trust' and 'social participation' to be the most robust of the commonly used social capital proxies, both showing positive association with health outcomes. However, this association could be confounded by unmeasured factors, such as the shared environment. Currently, there is a distinct lack of social capital research that takes into account such residual confounding. METHODS Using data from the United Kingdom's British Household Panel Survey (BHPS) (waves thirteen to eighteen, N = 6982), this longitudinal, multilevel study investigates the validity of the association between trust, social participation and self-rated health using a family-based design. As the BHPS samples on entire households, we employed 'mean' and 'difference from the mean' aggregate measures of social capital, the latter of which is considered a social capital measurement that is not biased by the shared environment of the household. We employed Generalized Estimating Equations for all analyses, our two-level model controlling for correlation at the household level. RESULTS Results show that after adjusting for the shared environment of the household over a six year period, the association between social participation and self-rated health was fully attenuated (OR = 0.97 (95% confidence interval 0.89-1.06)), while the association with trust remained significant (OR = 1.11 (1.02-1.20)). Other health determinants, such as being a smoker, having no formal qualifications and being unemployed maintain their associations with poor self-rated health. CONCLUSIONS The association between social capital (specifically trust and social participation) and self-rated health appear to be confounded by shared environmental factors not previously considered by researchers. However, the association with trust remains, adding to existing empirical evidence that generalized trust may be an independent predictor of health.