Neighborhood context and health: How neighborhood social capital affects individual health

Abstract

Does it matter for my health in which neighborhood I live? The fact is, health is determined not only by individual characteristics but also by the neighborhood in which someone lives. This thesis shows that health clusters in Dutch neighborhoods and that this is not only a composition effect (that people with healthy characteristics cluster into one neighborhood and unhealthy people cluster in another neighborhood) but also a context effect. In addition to traditional explanations for this cluster, this thesis studies mainly the effects and conditions of neighborhood social capital on individual health. Neighborhood social capital can be defined as the access to resources which are generated by relationships between people in a friendly, well-connected and tightly knit community. Is the health of an individual actually affected by neighborhood social capital? If so, under which conditions is health affected most? And how can this association be explained? This dissertation is the first work that tests the effect of neighborhood social capital on individual health in a multilevel design while using data representative for a whole country (The Netherlands) and a number of control variables for both levels. The results of this dissertation showed a stable association between neighborhood social capital and health. The more neighborhood social capital, the better individual health was, independent of control variables for both individual and neighborhood levels of social capital as well as independent of individual-level social capital. Interestingly, people in urban areas report on average worse health and less social capital than people in rural areas; however, the neighborhood social capital does relate to their health, while it is not associated with the health of ‘rural’ people. A main finding of this dissertation is that individual health can be enhanced through neighborhood social capital without contacts with specific others. Furthermore, the results show that neighborhood social capital is especially valuable for people with low non-local individual-level social capital. Next, the results of this dissertation indicated that longer exposure to social capital is not necessarily better – the association is curvilinear. Finally, this dissertation presents one out of five possible health-related behaviors as a significant mediating factor for the association between neighborhood social capital and individual health. Several behaviors were tested: non-smoking, moderate alcohol intake, nutrition habits, sleep habits, and physical activity. Only physical activity significantly attenuated the association between neighborhood social capital and self-rated health. This dissertation aimed to clarify conditions and mechanisms of a health improving factor, with the goal that its results could be used by policymakers and neighborhood workers. These people often have to argue that neighborhood work matters. The difficult part is not only arguing that the context neighborhood matters but also that the people living in the neighborhoods and their interrelation matter