Social capital: is it good for your health? Issues for a public health agenda.

For two decades governments around the world have put economic issues at the top of their policy agendas. As a result the search for economic growth has become our holy grail in the final decades of this millennium. The assumption has been that if it's good for the economy then it must be good for the rest of society. Ironically, in public health policy in recent years there has been an increasing acceptance that the determinants of health and well being are complex and reflect a mix of economic, environmental, social, biological, and genetic factors. 1 Perhaps as a reaction to the overwhelming dominance of economic considerations in public policy debates, there has been a growing emphasis on social determinants of health and well being. This emphasis is to be welcomed but it also challenges the public health community to grapple with the complex way in which social factors interact with economic ones. Pursuing a social agenda in a world dominated by neo-liberal assumptions about the primacy of the needs of the economy has not proved easy for health advocates. However, the emergence of widespread interest in the notion of social capital oVers some hope. This interest, in itself, reflects disillusionment with economic dominance in public policy decision making. The dominance is perceived as having contributed to social dislocation and disharmony in many countries, as expressed in rising crime rates, increased social tension between groups, growing inequi-ties, a decline in the quality of relations between citizens, growing mistrust in civic institutions, and a general decline in community spirit. The increased interest in social capital provides an opportunity for the public health community to advance social agendas that have been evident in public health for some time but have not captured popular or political imaginations as much as would be desirable. It is also a means of challenging the individualistic agendas of medicine and neo-liberalism. Seizing the opportunity will require a development of epidemiological and theoretical thinking about the links between social capital, economic development, and health. A fundamental issue is defining and understanding social capital. The term can easily become a cliched one that people use uncritically without due regard to the underlying ideological and theoretical implications of its use. Despite this, it is possible to discern a broad agreement in the burgeoning literature that social capital concerns the levels of social and civic trust, the presence of both thick …