S OCIAL C APITAL , GENDER EQUITY AND H EALTH : E VIDENCE FROM THE WHO - PowerPoint PPT Presentation

S OCIAL C APITAL , GENDER EQUITY AND H EALTH : E VIDENCE FROM THE WHO SAGE S URVEYS Nandita Bhan, GEH authors, Anita Raj Center on Gender Equity and Health (GEH) University of California, San Diego Working Paper Presentation for 30 October 2017

Background • Health and wellbeing predominantly a construction of individual and household determinants • Contextual determinants are neglected • Considered residual in models • Harder to act upon – tailor interventions • Harder to measure • Increasing systematic inquiry into ‘context’ • Recognition that individuals flourish or harmed by their environment • Interventions at collectives, environmental determinants and policies

Conceptualizing Social Capital • Durkeim: anomie - individuals do not feel attached to the collective • Bourdieu – economic, social and cultural capital • Coleman – reciprocity and trust -> insurance • Putnam – decline in social capital • ….. Many of you • However, harder to integrate these ideas in health studies • Level of measurement unclear • Defining the ‘collective’ • Limited understanding of mechanism • Debate on terminology: social capital vs. cohesion?

Definition • Social capital is a form of economic and cultural capital, in which networks are central, transactions are marked by reciprocity, trust and cooperation, and market agents produce goods and services not only for themselves but for a common good. • Resources • Relationships • Impact • Traditionally used to explain why groups do better despite adversity • Reflection of many things – bonding and bridging

Contextualizing ‘Context’ • Industrialization and urbanization transforming social capital in an irreversible way (Durkheim, Simmel, Weber) • Is the conceptualization of social capital from developed countries applicable to LMICs? • How can social capital and contextual transformations be seen from the prism of urbanization in LMICs, including population changes brought on by migration? • Do contextual determinants interact with gender and impact men and women differently?

Study Objective • Investigate the relationships between 4 aspects of social capital in the transitioning context of LMICs and their associations with • Active travel • Recreation • Depression • Are they outcomes of social capital or are they manifestations of societal breakdown?

Why are these outcomes important? • Rising burden of chronic conditions linked to both physical inactivity and depression. • Physical activity is the 4 th leading risk factor; but offers the largest range of interventions • Individual (recreation) and systems (systems for active travel) level • Recreation • Mechanistic links – social capital drives agency or determines engagement, thereby influencing these outcomes directly • Growing evidence that these outcomes linked to urbanization • Is urbanization driving the social change or part of it? • Urbanization includes infrastructure, norms and relationships

Markers of Social Capital Perception of Connectedness Safety Participation Perception of to create trust on others change

Data and Sample • WHO Study on Global AGEing and Adult Health (SAGE) (Wave 1, 2007-10) • 6 LMICs: China, Ghana, India, Mexico, Russia and South Africa. • 50+ sample, with sub-samples of sample of younger 18 – 49 years • Data collected through standardized survey instrument and training protocols. • Response rates : China (93%), Ghana (81%), India (68%), Mexico (53%), Russia (83%) and South Africa (75%) • Ethical clearance Sample • n=47,443 adult persons; China: 15,050; India: 12,198; Mexico: 5448; Russia: 4947, South Africa: 4227; Ghana: 5573).

Dependent Variables • Active Travel: physical activity in getting to and from places. • “ Do you walk or use a bicycle (pedal cycle) for at least 10 minutes continuously to get to and from places? ”. • Recreational Activity: involvement in leisure or fitness (moderate to vigorous) • “ Do you do any vigorous intensity sports, fitness or recreational (leisure) activities that cause large increases in breathing or heart rate [like running or football], for at least 10 minutes continuously” or “Do you do any moderate-intensity sports, fitness or recreational (leisure) activities that cause a small increase in breathing or heart rate [such as brisk-walking, cycling or swimming] for at least 10 minutes at a time? ” • Depression: problems related to feeling sad, low or depressed over the last 30 days

Measures for Social Capital Social Connectedness Visited by friends, been to a different neighborhood, socialized with co-workers outside of work, attended religious services or went out of home to attend social meetings or events. Trusting neighbors “great extent”, “neither great nor small” and “small extent”. Trusting co-workers “great extent”, “neither great nor small” and “small extent”. Trusting strangers Classified as to a “great extent”, “neither great nor small” and “small extent”. Social participation Attended public meetings, met with a community leaders, attended groups or clubs, and worked to fix or improve something. Perception of safety “ In general, how safe from crime and violence do you feel at home when you are alone at home?” : “very safe”, “slightly safe” and “unsafe”. Perception of safety “ How safe do you feel when walking down your street on the street alone after dark ?”: “very safe”, “slightly safe” and “unsafe”.

Results

Prevalence (%) of active travel, recreation and depression across study countries Active Travel Recreation Moderate to (none) (yes) severe Depression China 30.17 17.8 3.9 India 23.81 15.7 22.03 Mexico 40.43 8.58 19.92 Russia 29.94 11.67 16.78 South Africa 60.19 9.51 22.73 Ghana 24.75 15.13 19.41 <0.001 <0.001 <0.001

Patterning of Connectedness by Country and Gender 80 Low High 70 60 50 40 % 30 20 10 0 Men Women Men Women Men Women Men Women Men Women Men Women China India Mexico Russia South Africa Ghana Degree of Social Connectedness

Patterning of feeling unsafe on the street by country and gender 60 Slightly Unsafe Unsafe 50 40 30 % 20 10 0 Men Women Men Women Men Women Men Women Men Women Men Women China India Mexico Russia South Africa Ghana Feeling Unsafe on the Street

Patterning of feeling unsafe at home by country and gender 60 Slightly Unsafe Unsafe 50 40 30 % 20 10 0 Men Women Men Women Men Women Men Women Men Women Men Women China India Mexico Russia South Africa Ghana Feeling unsafe at home

Patterning of Trust on strangers and neighbors by country and gender 100 Strangers - Small Extent Neighbor- Small Extent 90 80 70 60 50 % 40 30 20 10 0 Men Women Men Women Men Women Men Women Men Women Men Women China India Mexico Russia South Africa Ghana

Patterning of social participation by country and gender 80 Low High 70 60 50 40 % 30 20 10 0 Men Women Men Women Men Women Men Women Men Women Men Women China India Mexico Russia South Africa Ghana

Regression results: Outcome - Moderate to High Depression Levels of social Connected Participation connectedness and participation to create change Medium 1.07 (0.83,1.37) 1.21 (0.93,1.56) Low 2.29* (1.78,2.96) 1.99* (1.56,2.55) Female 1.5* (1.35,1.67) 1.55* (1.38,1.74) Medium*Female 0.99 (0.85,1.15) 0.91 (0.78,1.07) Low*Female 0.82* (0.71,0.95) 0.78* (0.67,0.90) Urban 0.86* (0.80,0.92) 0.85* (0.80,0.91) • Adjusted for age, country and education • R2 for the participation models twice that of connectedness

Gender inequities in perception of safety At home In the street Slightly unsafe Unsafe Slightly unsafe Unsafe (%) (%) (%) (%) Male 23.03 4.16 33.1 8.45 Female 30.5 5.96 41.2 14.3

Regression results for all outcomes by perception of safety At home In the streets Active Recreation Depression Active Travel Recreation Depression Travel 1.48* 0.89 2.09* 1.38* 0.93 1.69* Slightly unsafe (1.25,1.75) (0.72,1.11) (1.68,2.61) (1.17,1.62) (0.77,1.13) (1.35,2.11) 1.58* 0.83 2.21* 1.65* 0.71 2.18* Unsafe (1.12,2.22) (0.50,1.36) (1.49,3.29) (1.28,2.13) (0.49,1.02) (1.60,2.97) 1.36 0.70* 1.56* 1.46* 0.68* 1.54* Female (1.29,1.44) (0.66,0.75) (1.44,1.69) (1.37,1.55) (0.63,0.74) (1.41,1.68) 0.87* 1.1 0.75* 0.82 1.09 0.81* Slightly (0.79,0.96) (0.97,1.26) (0.66,0.85) (0.75,0.90) (0.97,1.23) (0.71,0.92) unsafe *female 0.77* 1.17 0.85 0.72* 1.25* 0.82* Unsafe*femal e (0.63,0.94) (0.88,1.57) (0.68,1.06) (0.62,0.83) (1.01,1.54) (0.69,0.97) 1.06* 2.09* 0.87* 1.07* 2.09* 0.86* Urban (1.01,1.12) (1.96,2.23) (0.81,0.92) (1.02,1.12) (1.96,2.23) (0.80,0.92)