Social participation, trust and self-rated health: A study among ageing people in urban, semi-urban and rural settings
Introduction
Self-rated health is an important measure of a person's health status in general (Idler and Benyamini, 1997). Core aspects of social capital, such as trust and social participation, (Putnam, 1995) have been found to have health protective effects. High levels of trust have been shown to be associated with better self-rated health in cross-sectional studies (Barefoot et al., 1998; Kawachi et al., 1999; Subramanian et al., 2002; Hyyppä and Mäki, 2001) and in a follow-up study with a variety of indicators of good health and survival (Barefoot et al., 1998). An association between self-rated health and social participation or social engagement has also been found. Those people reporting higher levels of participation and volunteering have been found to have better self-rated health (Kawachi et al., 1999; Morrow-Howell et al., 2003; Veenstra, 2000), and cultural activity as a form of social participation associates with better chances of survival (Konlaan, 2001).
To our knowledge relatively few studies have examined the relationships between participation or trust and community characteristics such as urbanity and rurality. According to Greiner et al. (2004), social participation in the USA was highest in rural areas while trust (in terms of self-reported community ratings) was at a relatively low level among rural residents. As well, the risk of poor health may be higher especially in densely populated rural areas (Greiner et al., 2004). In Finland, by reason of demographic and labour market structures, self-rated health has been found to be the poorest in sparsely populated countryside areas. This is because rural areas are populated more by ageing persons and the unemployed. Social participation, organisational activities and neighbour relationships are highest in sparsely populated countrysides (Heikkilä et al., 2002). However, trust in politicians (Heikkilä et al., 2002) and the material standard of living (Kainulainen et al., 2001) are lowest there as well.
Income inequality is strongly associated with trust and group membership. High-income inequality lowers the level of participation and trust, which may have a negative influence on health (Kawachi et al., 1997). There is also evidence that separated or divorced people, people of lower socio-economic status, and younger persons report more often a lower level of trust (Subramanian et al., 2003). Conversely, demographic and socio-economic factors have not been associated with trust among the elderly, but participation seems to be associated with age and education. Overall high trust may give better emotional, financial and logistical resources to older individuals. Higher participation may also promote physical and mental activity (Pollack and von dem Knesebeck, 2004).
There is a close association between trust and social participation or engagement. However, social participation in its traditional forms has been partly compensated by new single-issue organisations or movements (Putnam, 1995). According to Fukuyama (1999), the increasing number of ideologically, religiously or programmatically new forms of social participation is no longer a precondition for generalised trust in other people. Shared values indicate the strong community and the high level of generalised social trust. However, people increasingly share norms and values in ways that link them with smaller and more flexible communities and groups. The types of groups have shifted to smaller radius, i.e. the circle of people can be trusted is narrowed, and the interest focuses on a single topic and is less authoritative. Therefore the type of groups people join has shifted, but people join groups and organisations in even large numbers. Growing individualism means that sense of community must be found elsewhere from smaller and flexible groups, because of the good things like mutual recognition and identity. This new phenomenon of low trust and high social participation has been called “the miniaturisation of community”. Trust has decreased in the USA since the 1960s among new birth cohorts (Fukuyama, 1999). This seems to be true also in Sweden. Low trust in other people is more common in younger than in older age groups. Elderly people may have maintained their trust in other people, but they nowadays participate less than when they were younger. As a contrast to “the miniaturisation of community” this might be a sign of traditionalism. Thus, high trust and participation do not need to mutually enhance each other (Lindström, 2004a).
Theoretically, trust and participation can exist in four different combinations (Fig. 1). According to Lindström (2004a), high trust and high participation characterise a group with high social capital, whereas low trust and low participation define a group with low social capital. High trust combined with low participation might be an indication of traditionalism, whereas high participation/low trust indicates “the miniaturisation of community” (Lindström, 2004a).
Social participation may promote unhealthy behaviours in low trust social contexts (Lindström, 2004a). The miniaturisation of community has been shown to be associated with such unhealthy behaviour as intermittent cigarette smoking (Lindström, 2003) and cannabis smoking (Lindström, 2004b) as well as patient dissatisfaction (Lindström and Axen, 2004), among others. The association between the miniaturisation of community and self-rated health has rarely been studied. However, a previous study from Scania in southern Sweden found that poor self-rated health was more common among those in the miniaturisation category than in the high-social capital category (Lindström, 2004a).
According to Lindström (2004a), the miniaturisation of community looks a credible phenomenon in the USA, but its existence in Europe is less certain. There are no published research results in Finland relating to changes of trust in other people over time (Ruuskanen, 2002). However, membership in associations in Finland has not diminished. More likely is that associational membership has undergone transformations. Membership in political organisations and peace movements has declined over the past decade whereas membership has increased most clearly in sports clubs, study groups, art groups and organisations for environmental protection (Siisiäinen, 1999). Among the elderly, pensioners’ organisations, religious organisations and social and health organisations are the most popular voluntary organisations. Organisational activities, especially voluntary religious activity and parish work, are more common among the ageing than among younger age groups in Finland (Niemi, 2002).
The first aim of this study was to describe the distributions of the combination of individual level social participation and trust in different residential areas. The second aim was to investigate which of the four different combinations of participation and trust associates most strongly with good self-rated health among ageing people in different residential areas.
Section snippets
Study population
The study examined data from a survey conducted in 2002 in the Päijät-Häme hospital district in southern Finland in the context of the “Good Ageing in Lahti region” (GOAL) project. The aim of the project is to promote the welfare of ageing people in the region. The demographic and social structures have changed very rapidly in Finland during the last decades. Current health threats are no longer the same as before and nowadays local actors are needed to promote health. Based on these changes,
Results
The proportion of respondents in both low and high social capital groups was about one quarter in all areas (Table 1). Most (about 40%) of the participants belonged to the traditionalist group (low participation/high trust). Conversely, the proportion of respondents in the miniaturisation of community group was only about 9%.
According to Table 2, good self-rated health was the most common (p<0.05) among respondents with high social capital in all areas (58–60%). In contrast, good self-rated
Main findings
The study showed that different combinations of participation and trust were divided rather evenly between the areas described. The most prevalent combination in all living areas was traditionalism (about 40%). Approximately a quarter of the people from the different areas belonged to the low or high social capital groups. The category of miniaturisation remained low in all areas (about 9%). In the urban area the traditionalist group had a higher prevalence of good self-rated health than the
Conclusion
In this study, both the independent and the dependent variables were self-reported. However, self-rated health has been found to be a good measure of a person's health status in general (Idler and Benyamini, 1997). A good deal of discussion on social capital has been going on, but a consensus for a definition of the concept has not been found. Thus the concept of social capital needs clarifying, even though this is not an easy task. Social capital might differ among countries and cultures.
Acknowledgements
The Ministry of Social Affairs and Health supported the study. The authors also gratefully acknowledge the co-operation of the Päijät-Häme hospital district, Ikihyvä study group, and all the municipalities involved in this study.
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