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January 2003, Vol 93, No. 1 | American Journal of Public Health 122-129
© 2003 American Public Health Association

REKINDLING HEALTH CARE REFORM

Is Social Capital the Key to Inequalities in Health?

Neil Pearce, PhD and George Davey Smith, MD, MSc, DSc, FFPHM

Neil Pearce is with the Centre for Public Health Research, Massey University Wellington Campus, Wellington, New Zealand. George Davey Smith is with the Department of Social Medicine, University of Bristol, Bristol, England.

Correspondence: Requests for reprints should be sent to Neil Pearce, PhD, Centre for Public Health Research, Massey University Wellington Campus, Private Box 756, Wellington, New Zealand (e-mail: n.e.pearce{at}massey.ac.nz).

There has been vigorous debate between the "social capital" and "neomaterialist" interpretations of the epidemiological evidence regarding socioeconomic determinants of health. We argue that levels of income inequality, social capital, and health in a community may all be consequences of more macrolevel social and economic processes that influence health across the life course.

We discuss the many reasons for the prominence of social capital theory, and the potential drawbacks to making social capital a major focus of social policy. Intervening in communities to increase their levels of social capital may be ineffective, create resentment, and overload community resources, and to take such an approach may be to "blame the victim" at the community level while ignoring the health effects of macrolevel social and economic policies.




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