Social capital , class gender and race conflict , and population health : an essay review of Bowling Alone ‘ s implications for social epidemiology

Robert Putnam’s Bowling Alone (henceforth BA)1 serves as justification and support for one of the most influential hypotheses in contemporary social epidemiology, namely that the primary explanation for health inequalities in wealthy countries lies in low levels of social capital or social cohesion. For example, the major textbook of the sub-discipline2 includes two chapters on this topic. Putnam, and most social epidemiology, defines social capital as the norms of reciprocity and trustworthiness that arise from social connections among individuals.1 Although the social capital concept lacks closure and varies with authors and disciplines,3–6 Putnam uses a consistent set of indicators that have been readily adopted in epidemiology.1,7 Among these indicators we find community organization membership (clubs, civic or social organizations), engagement in public affairs (voting, town or school public meeting attendance), volunteering (number of non-profit organizations), informal sociability (entertaining, visiting friends), and norms of social trust. Here we present an overview of Putnam’s claims, their supporting evidence, and we draw several consequences of the BA hypothesis for epidemiology and public health. We argue that the omission of class, race and gender relations and political variables from research on community trust and norms of reciprocity limits the usefulness of social capital as framework for social epidemiology. Next, we link the current theoretical emphasis on social cohesion to earlier social science attempts at advancing the beneficial effects of lack of conflict in Europe and the US. An appraisal of Bowling Alone