The national focus on the overhaul of America’s healthcare system has made us forget other viable solutions that could have an immediate and sustainable impact on America’s health. I’m talking about social capital — the scholarly term that describes certain social structures, including ‘interpersonal trust, norms of reciprocity and mutual aid, that serve as resources for individuals and facilitate collective action.’
In other words, social capital is a cheap, accessible way of improving individual health. One way of improving social capital at the local level is through community involvement. According to Harvard political scientist Robert Putnam, civic engagement in America has been in decline over the past several decades, and this has taken a toll on our sense of community.
We must first become more involved within the Penn community and then within the greater West Philadelphia area; this can be done through casual dialogue or direct participation. We should take the time to speak to our colleagues; urge our friends and classmates to buy local fruits and vegetables (even if those classmates always go to Smoke’s while you prefer the low-key dorm gathering); decorously advise our coworkers to change their smoking habits. We should get involved in local volunteer organizations in Philadelphia and take advantage of those Academically Based Community Service classes.
The simplicity and freedom of this course of action — absent of the bureaucracy that defines policy change — is notable. The sovereignty you have in this respect should be fully exploited to increase the social capital of your community.
Depending on the baseline level of cohesion, this may seem odd at first. However, the individuals to whom you are reaching out would not be complete strangers. Plus, the objective of your “intrusion” should be made clear: the community member’s well-being. But why should you, as opposed to your neighbor, be the one to assume such responsibility, or even care in the first place? The answer is reciprocity.
Reciprocity is the shared exchange of positive actions. It is well documented that if you make the first move, your neighbor will ultimately return the favor. Social norms, moreover, are maintained through reciprocal action. By extension, you have the capability to change what is viewed as normal at Penn by increasing the frequency of mutual exchanges. In this manner, social capital is increased.
Many studies have demonstrated tangible health improvements associated with increased social capital. Social scientists John Bruhn and Stewart Wolf have studied “neighbourly behavior” and social connectedness in Roseto, Pa. They found that such behavior improved overall health and decreased the risk of heart disease. These findings were later corroborated by Harvard epidemiologist Ichiro Kawachi, who found that even a minor increase in group membership in organizations such as church and sports groups was associated with a significant decrease in average mortality rates (66.8 deaths per 100,000 population).
If the health benefits of social capital are insufficient incentives to improve community cohesion, perhaps other areas will have more sway. Improvement in social capital will decrease crime, increase collective efficacy and reduce health care costs.
A low-crime neighborhood not only reduces transport expenditures by giving individuals the choice of walking or biking, but it also improves mental health by reducing anxiety and stress related to fear and potential victimization. Community cohesion also boosts civic action. Researchers at the Kaiser Permanente Medical Care Program of Northern California surveyed participants about the installation of a supermarket with fresh and lower-priced food as a direct product of community activism. This was significant because many residents in this low-income neighborhood relied on public transportation to access the nearest supermarket, and their burden was decreased.
In this way, the relationship between social capital and health is dynamic. Improvements in social capital improve health directly and indirectly. In turn, a community with physically and emotionally healthy individuals will increase social capital through cohesiveness and reciprocity, which will inevitably translate to lower health care costs, a decrease in delinquent conduct and an augmented sense of civic duty.
The necessity for healthcare reform is certain. However, even if reform works, it will be decades before America’s health system will be functioning efficiently and equitably. In the meantime, we have the opportunity to successfully complement policy change with community-oriented action that will directly benefit our health. Take a risk and ask your teammate if she’s been conducting her monthly breast selfexam. And, if she gives you a look of curious bewilderment, tell her how (or at least inform her of the benefits).
Jeremy Steglitz is a Penn graduate studying for his Master’s in Public Health at Yale.
