Individual and contextual social capital is reported to be associated with better health outcomes and lesser risk behaviour. We analyzed representative data of a large scale telephone survey in Germany to examine whether such a relation is present in Germany today.

1. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Effect of individual and contextual social
capital on health status and health
behaviour in Germany
Lars Eric Kroll, PhD Thomas Lampert, DrPH
Robert Koch-Institute, Berlin
The Robert Koch
Institute is a
Federal Institute
within the portfolio
of the Federal
Ministry of Health

2. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Outline
 Background
 Data and Methods
 Contextual social capital and health
 Individual social capital and health
 Comparison of effects of contextual and individual
social capital on general health and smoking.

3. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Several notions of 'Social Capital‘
(cf. i.e. Halpern 2005, Putnam 2000, Bourdieu 1979)

4. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Social Capital and Health (I)
Émile Durkheim‘s „Le Suicide“ (1897) as a starting point
 Hypotheses: Suicide as a result of dysfunctional social integration (idea of ‘social facts’).
 Conclusion: Egoistic suicide a result of less tight social integration of Protestants in
comparison to Catholics in France
 On the other hand Fatalistic/altruistic suicides are seen results of too tight integration in
a community

5. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Social Capital and Health (II)
(Berkman and Glass 2000, Islam et al. 2006)
There are different pathways from social capital to health:
Individual social capital…
…encourages health behaviour (norms, sanctions)
…coping resource (social support, integration)
…social mobility (a form of capital that can be transformed into money)
Contextual social capital…
…leads to a better provision of health relevant common goods
…less stressful or harming environments
…encourages healthy behaviour (norms, sanctions) in communities

6. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Telephone Health Survey 2008/2009
 Representative Health Interview
Survey as a part of nationwide health
monitoring at the Robert Koch-
Institute.
 Method: CATI, RDD-Sample
 Response: RR3 (AAPOR) 29.1%
 Sample size 21.512 aged 18+ yrs
 Regional information provided by
respondents (district level, NUTS3)
 430 of 466 districts in the sample,
49.4 obs per district (mean)

7. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Indicators
Social Capital
 Contextual: Quintiles of Voter participation rate in the Federal
Election of 2005 (official statistic)
Q1 vs. Q2-Q5
 Individual: Oslo 3-Item Social Support Scale (ECHIM-Indicator)
LOW vs. MEDIUM/HIGH
Contextual Health Indicators
 Life expectancy (mean men/women)
Individual Health Indicators
 Self Rated General Health Status (less than 'good')
 Smoking status (current smoking)
 Health awareness (pay attention to own health is important)

8. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Relationship of individual and contextual
Social Capital in our data
Data Source: GEDA 2009, Federal Statistical Office for Germany (2010)
Remark: Only districts with 30 or more respondents in the GEDA sample are shown. After controlling for
unemployment rate and mean household income, significant effect of ≈ 5.5 pct point of low social support
in comparison of 1th and 5th quintile of voter participation. R²=0.12

9. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Contextual Social Capital and Life Expectancy
Data Source: Federal Statistical Office for Germany (2010)
Remark: After controlling for unemployment rate and mean household income, significant difference of ≈ 1 life year in comparison of
1th and 5th quintile of voter participation. R²=0.46

10. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Individual social capital and self-rated health
Data Source: GEDA 2009
OR=2.0 (1.7-2.2) OR=2.3 (2.1-2.6)
Remark: OR‘s of social support are roughly identical in individual and multi-level specification.

11. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Effect of individual and contextual social capital on
health outcomes
Data Source: GEDA 2009, Federal Statistical Office for Germany (2010)
Model 1a, 1b: Controlled for age and gender (separately estimated)
Model 2: Controlled for age and gender (jointly estimated)
Model 3: Controlled for age, gender, income, education,
employment status [and for health behaviour]

12. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Effect of individual and contextual social capital on
health outcomes
Data Source: GEDA 2009, Federal Statistical Office for Germany (2010)
Model 1a, 1b: Controlled for age and gender (separately estimated)
Model 2: Controlled for age and gender (jointly estimated)
Model 3: Controlled for age, gender, income, education,
employment status [and for health behaviour]

13. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Effect of individual and contextual social capital on
health outcomes
Data Source: GEDA 2009, Federal Statistical Office for Germany (2010)
Model 1a, 1b: Controlled for age and gender (separately estimated)
Model 2: Controlled for age and gender (jointly estimated)
Model 3: Controlled for age, gender, income, education,
employment status [and for health behaviour]

14. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Conclusion
 Different conceptualizations of SoC in Public Health,
Sociology, Psychology and Economics
 Positive Association of individual/contextual social
capital and Health and Health Behaviour in Germany
 Individual effect stronger than contextual effect on
health outcomes
 Limitation: Districts (NUTS3) may be to heterogeneous
in terms of Social Capital (alternative: neighbourhoods),
on the other hand, they are politically relevant as smallest
planning areas in Germany

15. SOC and Health Environment and Health EUPHA 2010 L. E. Kroll
Appendix: Oslo-3 Social Support Scale (OSS-3)
Perceived availability of people whom the individual trusts and who make one feel
cared for, loved, esteemed and valued as a person.
 How easy can you get help from neighbours if you should
need it? (Very easy, easy, possible, difficult, very difficult)
 How many people are so close to you that you can count
on them if you have serious problems? (none, 1-2, 3-5, 5+)
 How much concern do people show in what you are
doing? (a lot, some, uncertain, little, no).
The resulting score ranges from 3 to 14.
3-8 ”poor”, 9-11 ”moderate” and 12-14 ”strong” social support.
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Surveys. Amsterdam: IOS Press