ARCHIVED – Health Status and Social Capital of Recent Immigrants in Canada: Evidence from the Longitudinal Survey of Immigrants to Canada

Literature review

Defining Social Capital

The term “social capital” is a hybrid notion that “brings together the theoretical and empirical rationale for considering social ties as a potentially important ingredient of well-being and prosperity in society” (PRI 2005b, 37). It is a geographical, political, economic, and sociological concept, and although there is much debate surrounding its definition and conceptualization, it carries with it a “seductive simplicity” (Mohan and Mohan 2002, 191) in that it is “based on the premise that an interpersonal network provides value to its members by giving them access to the social resources available within the network” (Staber 2006, 190). As Putnam explains, “like tools (physical capital) and training (human capital), social networks have value” (2007, 137); “they have value for the people who are in them, and they have, at least in some instances, demonstrable externalities, so that there are both public and private faces of social capital” (2001, 41).

Table 1 identifies some of the various definitions of social capital found within the literature.

Table 1:   Definitions of Social Capital

The characteristics of the social organization such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit Putnam 1995, 67
The sum of the resources, actual or virtual, that accrue to an individual or a group by virtue of possessing a durable network of more or less institutionalized relationships of mutual acquaintance and recognition Bourdieu and Wacquant 1992, 119
The ability of actors to secure benefits by virtue of membership in social networks or other social structures  Portes 1998, 6

Social capital has been linked to positive externalities such as better health, higher employment rates, and increased social interaction (Mohan and Mohan 2002, 193). However, not all the effects of social capital may be positive: “just as the sources of social capital are plural so are its consequences” (Portes 1998, 9). Portes (1998) has identified several negative externalities of social capital including “exclusion of outsiders, excess claims on group members, restrictions on individual freedom and downward levelling norms” (15). As Putnam explains, “although networks can powerfully affect our ability to get things done, nothing guarantees that what gets done through networks will be socially beneficial” (2007, 138). Therefore, “understanding social capital demands an emphasis on the nature of interactions, the meaning of linkages and their potential to enable change, rather than the structural casing and visible connections themselves” (MacKian 2002, 208; italics in original).

The concept of social capital has been found to be particularly relevant to the study of immigrant integration. Research on social capital has emphasized the significance of social networks (both homogenous and heterogeneous) to a variety of outcomes, including employment.  Results from recent analyses of the General Social Survey (GSS) and the Longitudinal Survey of Immigrants to Canada (LSIC) support the importance of social capital to the integration of immigrants to Canada (van Kemenade et al. 2006; Xue 2008). Evidence from both surveys shows that social capital is a major determinant of immigrant health (Zhao 2007a; van Kemenade et al. 2006).

Social capital has been connected to immigrant educational attainments. Ooka and Wellman (2006) found that educational attainment is positively associated with being in heterogeneous friendship networks. The authors found that first generation immigrants with post-secondary education are more likely to be in a heterogeneous network than those with less education. Educational and employment outcomes of immigrants play a role in influencing immigrant health outcomes. Dunn and Dyck (1998) analyzed results from the National Population Health Survey (NPHS 1994-1995). The authors’ findings showed that immigrants with high levels of education and high incomes were more likely to report their health status as very good or excellent. 

Despite a recent “flourishing epidemiologic and public health interest in the investigation of the effects of social capital on physical health outcomes” (Kim et al. 2008,186), the mechanisms that link social capital to health are not yet clearly understood (Kawachi et. al 1999, 1190): “At the individual level, it is not completely established whether good health is the result of social capital or whether social capital is the result of good health and/or other unmeasured personal characteristics that determine both health status and patterns of social engagement” (Kawachi 2006, 992). Despite this major challenge, several researchers including Kawachi et al. (1999), Putnam (2000), and Berkman and Glass (2000) have attempted to identify pathways and mechanisms through which social capital impacts community and individual health outcomes.

Within the literature it is suggested that social networks may influence health outcomes –by serving as a tool that rapidly diffuses health information, therefore improving access to health resources (Kawachi et al. 1999; Berkman and Glass 2000); through the provision of tangible assistance such as “money, convalescent care, and transportation, which reduces psychic and physical stress and provides a safety net” (Putnam 2000, 327); through the reinforcement of health norms (e.g., physical activity) and social influence (networks’ values and norms) (Kawachi et al. 1999; Putnam 2000; Berkman and Glass 2000); and finally, by providing emotional support (Berkman and Glass 2000), which may serve as a “psychological triggering mechanism, stimulating people’s immune systems to fight disease and buffer stress” (Putnam 2000, 327).

Social Capital and Health

Putnam (2000) states that “of all the domains in which I have traced the consequences of social capital, in none is the importance of social connectedness so well established as in the case of health and well-being” (326). The relationship between social capital and health outcomes has been explored in both empirical and theoretical research. Social capital has been connected to a variety of health outcomes such as access to health care, binge drinking, leisure time, physical inactivity, food security, child behaviour problems, walking activity, violent crime and homicide, life expectancy, tuberculosis case rates, life satisfaction, and suicide rates (Kawachi et al. 2004).

Ecological studies have found that social capital is associated with lower rates of suicide and higher levels of life satisfaction (Helliwell 2003). Fisher et al. (2004) found that cohesive communities rich in trust are characterized by increased levels of physical activity, and results from Hendryx et al. (2002) suggest that community social capital is associated with better access to health care. Research in this area has also concluded that for neighbourhoods with higher social capital, members report better individual and self-rated health (Wen et al. 2003).

Self-rated health status, increasingly used as a measure of overall health, has been found within the literature to be linked to a variety of individual level measures of social capital (Kim et al. 2008). For example, research has found that self-rated health status is linked to longevity and functional ability (Idler and Kasl 1995; Idler et al. 1999) and social trust (Lavis and Stoddart 1999), as well as involvement in formal and informal networks (Rose 2000).

Immigrant Social Capital and Health

There is limited research that looks directly at the ways in which social capital affects the health outcomes of immigrant populations. However, the work of Deri (2005), Newbold (2009), van Kemenade et al. (2006) and Zhao (2007a) provides some insight into this area. 

Deri (2005) used data from the Canadian National Population Health Survey (CNPHS) to examine if and how social networks impact the health care utilization patterns of immigrants whose mother tongue is neither English nor French. Following Bertrand et al. (2000), she measures social networks by the extent of linguistic concentration in an area of Census sub-divisions. Deri’s findings suggest that social networks play an important role in influencing health care utilization behaviours. She found that “for high utilizing language groups, living in areas of high concentration of the language group increases access. Conversely, for low utilizing groups, living in areas of high concentration of the language group decreases access” (Deri 2005, 1079). 

Newbold (2009) used the LSIC to estimate health transitions of recent immigrants. According to Newbold, recent immigrants “who noted monthly social interactions with family or friends (relative to less than monthly social interactions), were less likely to transition to poor health. Otherwise, the degree of social interaction was unimportant” (329-30). However, the author’s findings also indicate that having family or friends close in proximity and involvement in a social group do not appear to have any impact on health transitions.

Using the General Social Survey (GSS), van Kemenade et al. (2006) found that “having access to close networks of people from the same cultural origin – as well as to programs that support these networks – is associated with the social and economic integration of immigrants in the host county and with their well being” (19). Results indicate that (1) “there is a positive association between the size of networks of strong ties and reported good health among immigrants”; (2) “there is also a positive association between the number of ties with organizations and immigrants’ self-reported health. Immigrants with a high number of ties to organizations perceive their health to be good”; (3) “immigrant women who say they had at least one reciprocal support relationship within their social networks were more likely to say they are in good health than their peers without such a relationship”; and (4) “immigrant men who volunteered in the year preceding the survey are more than twice as likely to say they are in good health as their peers who had not participated in volunteer activity” (19).

Zhao (2007a) conducted a duration analysis of the LSIC in an attempt to gain further insight into the health outcomes and socio-economic determinants of health among Canada’s recent immigrants. According to Zhao (2007a), immigrants who had frequent interaction with friends in Canada, who spoke at least one of the official languages, who were not in low income families, and who owned a home rather than rented had a decreased risk of a decline in health status. Zhao also found that “immigrants with a social network and social support were more likely to visit doctors” (42). This reflects that immigrants with a social network and social support had fewer problems accessing health care services but possibly had more health issues. However, social capital effects were not the main interests in Zhao (2007a). The main differences between that paper and the present work are: (1) we categorize social networks into three types, i.e., kinship, friendship and organizational networks; (2) for each type of networks, we also look at its size, diversity, and density, etc; and (3) we apply a panel data model to take into account unobserved individual characteristics, such as differences in genes, lifestyle, and attitudes towards physical activities.

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