Social environments and health: cross sectional national survey

Researchers are increasingly interested in studying the effects of the social environment on health.¹ The concept of social capital has been put forward as one explanation for why some communities work better than others, with benefits for the whole of the local population.² Social capital is applied to those features of a community that promote cohesion and a sense of belonging and that enable its members to cooperate. Similarly, criminologists have argued that the level of social organisation in a neighbourhood, or the degree to which residents are able to realise common goals and exercise social control, links the social composition of a neighbourhood and rates of deviant behaviour.³ We investigated how individual's reports of social capital and social disorganisation are associated with health outcomes among men and women aged 16 to 54 from a representative cross section of British households.

Methods and results

The British Household Panel Study is an annual survey of a representative cross section of British households.⁴ The first wave of interviews took place between September and December 1991. Our analysis is based on surveys in 1998 and 1999. Respondents were asked eight questions about their neighbourhood. We summed responses and divided them into low, medium, high, and very high levels of social capital. We also summed responses to eight questions about various community problems and divided them into low, medium, high, and very high levels of social disorganisation. We assessed psychiatric morbidity using the 12 item general health questionnaire.⁵ People scoring 3 or more were classified as cases. We also analysed reported physical health problems related to arms, legs, or hands (including arthritis); chest or breathing; and heart or blood pressure.

We used logistic regression analysis to examine the relative influence of social capital and perceived disorganisation on health after controlling for other factors. Separate models were computed for men and women.

The table shows the number of men and women with poor health outcomes for each level of social capital and social disorganisation. Men in the lowest category of social capital were more likely to report psychiatric morbidity than men in the highest category (odds ratio 1.96, 95% confidence interval 1.39 to 2.75). Men in the lowest quartile of social disorganisation were less likely to report chest or breathing problems than men in the highest category (0.59, 0.36 to 0.97). Psychiatric morbidity was more common among women in the lowest categories of social capital compared with women in the highest category (1.80, 1.36 to 2.38). Women in the lowest category of social disorganisation had lower rates of psychiatric (0.72, 0.52 to 0.99) and heart or blood pressure problems (0.52, 0.21 to 0.91) than those in the highest category. These associations were independent of individual age, education, smoking, material deprivation, marital status, social support, and economic activity.

Comment

We found that people in the lowest categories of social capital had increased risk of psychiatric morbidity and that those in the lowest categories of social disorganisation had lower rates of some health problems. This research adds to the evidence on the influence of social environments on health.

Social relationships lead to the development of norms of trust and reciprocity that have spillover effects within neighbourhoods as a whole. Resources are potentially available to everyone within the neighbourhood, not just those who invest in maintaining relationships. Likewise, conditions that lead to social disorganisation are not associated just with individual victims but are detrimental to the health of all members of society. Understanding the ways in which the social environment affects health is important to improve our knowledge of how health inequalities arise and how they can potentially be reduced.

Questionnaires and further details about the British Household Panel Study are available at www.iser.essex.ac.uk/bhps

Table 1.

Effect of social capital and social disorganisation on risk of poor health

	Total No	Psychiatric morbidity			Problems with arms, legs, or hands			Problems with chest or breathing			Problems with heart or blood pressure
		No of cases	Odds ratio (95% CI)		No of cases	Odds ratio (95% CI)		No of cases	Odds ratio (95% CI)		No of cases	Odds ratio (95% CI)
Men
Social capital:
Low	575	137	1.96 (1.39 to 2.75)		116	1.36 (0.98 to 1.88)		60	1.05 (0.69 to 1.60)		31	1.60 (0.88 to 2.92)
Medium	505	74	1.08 (0.75 to 1.57)		80	1.02 (0.72 to 1.44)		44	0.98 (0.63 to 1.53)		31	1.86 (1.03 to 3.36)
High	481	70	1.08 (0.74 to 1.58)		86	0.94 (0.67 to 1.33)		49	1.13 (0.73 to 1.73)		31	1.36 (0.76 to 2.44)
Very high	512	68	1*		97	1		47	1		23	1
Social disorganisation:
Low	358	59	0.85 (0.58 to 1.25)		63	0.93 (0.64 to 1.36)		27	0.59 (0.36 to 0.97)		16	0.90 (0.46 to 1.76)
Medium	680	110	0.82 (0.59 to 1.14)		117	0.86 (0.62 to 1.19)		55	0.65 (0.43 to 0.97)		46	1.28 (0.75 to 2.18)
High	563	83	0.69 (0.49 to 0.97)		96	0.82 (0.59 to 1.15)		57	0.83 (0.56 to 1.23)		26	0.85 (0.47 to 1.53)
Very high	472	97	1		103	1		61	1*		28	1
Women
Social capital:
Low	500	157	1.80 (1.36 to 2.38)		102	1.31 (0.96 to 1.80)		70	1.34 (0.92 to 1.94)		33	0.75 (0.47 to 1.20)
Medium	542	121	1.11 (0.84 to 1.48)		101	1.00 (0.74 to 1.36)		63	1.13 (0.78 to 1.65)		31	0.60 (0.38 to 0.96)
High	571	132	1.17 (0.89 to 1.54)		96	0.83 (0.61 to 1.13)		59	1.03 (0.71 to 1.50)		38	0.65 (0.42 to 1.00)
Very high	759	151	1*		158	1		74	1*		70	1
Social disorganisation:
Low	396	78	0.72 (0.52 to 0.99)		75	1.03 (0.73 to 1.47)		40	0.87 (0.57 to 1.31)		20	0.53 (0.31 to 0.91)
Medium	681	147	0.78 (0.60 to 1.02)		118	1.00 (0.74 to 1.36)		65	0.81 (0.56 to 1.15)		40	0.66 (0.42 to 1.02)
High	640	146	0.78 (0.60 to 1.01)		132	1.10 (0.81 to 1.48)		75	0.97 (0.69 to 1.37)		49	0.73 (0.48 to 1.10)
Very high	655	190	1*		132	1		86	1		63	1*

^*Trend test: P<0.05. 

Models were additionally adjusted for age, education, social support, deprivation, low income, marital status, smoking, and economic activity.