Capital Social y Tercera Via

7/27/2019 Capital Social y Tercera Via

1/18

Social capital and the third way in public health

CARLES MUNTANER* JOHN LYNCH &

GEORGE DAVEY SMITH

*Department of Behavioural and Community Health, School of Nursing, and Department of

Epidemiology and Preventive Medicine, School of Medicine, University of Maryland-

BaltimoreThe Institute for Social Research, University of MichiganDepartment of Social Medicine, University of Bristol

ABSTRACT The construct of social capital has recently captured the interest of researchers in social

epidemiology and public health. We review current hypotheses on the social capital and health link,

and examine the empirical evidence available as well as its implications for health policy. With regard

to theory, we contend that the construct as currently employed in the public health literature, lacks

depth compared to its uses in social science. In addition, social capital presents itself as an alternative

to materialist structural inequalities (class, gender and race) by bringing to the forefront of social

epidemiology an appealing common sense idealist social psychology to which everyone can relate

(e.g., good relations with your community are good for your health). The use of social capital invokes

a romanticized view of communities without social conict (e.g., Neo Tocquevillian nineteenth

century associationalism) and favours an idealist psychology over a psychology connected to both

material resources and social structure. We argue that the evidence on social capital as a determinant

of better health is still scant or ambiguous depending on the definition that is used. Even if

conrmed, social capital hypotheses call for social determinants beyond the proximal realm of social

psychology. We also maintain that social capital is used in public health as an alternative to both

state-centred economic redistribution (e.g., living wage, full employment, and universal health

insurance) and party politics (e.g., gaining control of the executive branch of the government).

Social capital represents a privatization of both economics and politics. Such uses of social capitalmirror recent Third Way policies in Germany, UK and US. If Third Way policies end up losing

support in Europe, its prominence there might be short lived. In the USA, where the working class

is less likely to inuence social policy, interest in social capital could be longer lived or, alternatively,

could drift in the academic limbo like other psychosocial constructs which at one point were heralded

as the nextbig idea.

Within the last few years, we have witnessed the rapid appearance of the concept of

social capital in public health discourse. Before 1995, there was only one referenceto the term social capital in the Medline database and that was in regard to so-called

Critical Public Health,Vol. 10, No. 2, 2000

Critical Public Health ISSN 0958-1596 print/ISSN 1469-3682 online 2000 Taylor & Francis Ltdhttp://www.tandf.co.uk/journals

Correspondence to: Carles Muntaner, Room 655c, UMB, 655 West Lombard Street, Baltimore,

MD 21201-1579, USA. Tel: +1 (410) 706 0889; Fax: +1 (410) 706 0253;

e-mail: Muntaner@son. umaryland.edu
http://www.tandf.co.uk/journals


2/18

family social capital and its effect on educational and occupational aspirations

(Marjoribanks, 1991). Though the basic ideas encapsulated in the current use of

social capital can be traced to the origins of classical sociology and political science,

the appearance of the term itself in the mid 1990s was largely stimulated by Robert

Putnams work on civic participation and its effect on local governance (Putnam et

al., 1993). He popularized this thesis by discussing the decline of social capital usingthe metaphor that America was Bowling alone (Putnam, 1995a) a powerful image

that propelled Putnam to an audience with President Clinton to discuss the fraying

of the social fabric in America. Since then, the concept of social capital has also

appeared in other fields such as sociology (Portes, 1998) and development

economics (Grootaert, 1997; Ostrom, 1999). In these elds, there has been a good

deal of debate about the definition, operationalization, and the theoretical and

practical utility of the concept for improving human welfare, especially in regard to

alleviating poverty and stimulating economic growth in less industrialized countries(Collier, 1998; Knack & Keefer, 1997). In fact, the World Bank sponsors a website

devoted exclusively to the topic of social capital, where information is exchanged

and issues actively debated. Despite all this activity, one of the leading scholars in

this eld, Michael Woolcock,has argued that the concept of social capital . . . risks

trying to explain too much with too little (Woolcock, 1998, p. 155). He says that

the term social capital is being . . . adopted indiscriminately, adapted uncritically,

and applied imprecisely (Woolcock, 1998, p. 196).

Social capital and its use in public health

We believe Woolcocks critique is especially true for many of the ways that the

term social capital has been used in relation to health. To date there has been

very little systematic theoretical, empirical, or practical appraisal of the concept in

the public health literature,although more critical accounts are beginning to appear.

(Muntaner & Lynch, 1999a; Muntaner et al., 1999; Lynch et al., 2000; Hayes &

Dunn, 2000 unpublished observations; Hawe & Shiell, 2000). Nevertheless, theterm has slipped effortlessly into the public health lexicon as if there was a clear,

shared understanding of its meaning and its relevance for improving public health.

The term social capital and its close cousin, social cohesion, have been used as

multi-purpose descriptors for all types and levels of connections among individuals,

within families, friendship networks,businesses and communities (Wilkinson,1996;

Aneshensel & Sucoff, 1996; Kawachi & Kennedy, 1997; Kawachi et al., 1997a, b;

Fullilove, 1998; Baum, 1997, 1999; Kennedy et al., 1999). In addition, it has been

the subject of theme conferences (11th National Health Promotion Conference,

Perth,Australia) and government sponsored discussion papers (Jenson,1998;Lavis& Stoddart, 1999); it has been the topic of million dollar calls for research proposals

funded by the Centers for Disease Control in the US, and on the basis of highly

dubious comparisons between observational studies and clinical trials of such things

as anti-thrombolytic therapy, it has even been proposed as an important avenue of

public health intervention. Lomas has argued that interventions to increase social

108 C. Muntaneret al.


3/18

support and/or social cohesion in a community are at least as worthy of exploration

as improved access or routine medical care. Certainly they are more worthwhile

than public healths traditional risk factor modication approach to cardiovascular

disease (Lomas, 1998, p. 1184). These are impressive, yet completely untested

claims.

Similarly, in a recent book, published by the Health Education Authorityin Britain, the authors state that, There is a consensus in recent literature that the

construct of social capital may be usefully applied to the study of health and

health-related behavior. (Cooper et al., 1999, p. 4). They leave the impression

that we know much more about the theoretical and practical value of social capital

than an examination of the actual evidence would suggest. Furthermore, they go

on to say that, Researchers have measured social capital in terms of the social,

collective, economic, and cultural resources available to a family, neighbourhood

or community. (Cooper et al., 1999, p. 4).There are a myriad of indicators ofsocial, collective, economic and cultural resources across the levels of families,

neighbourhoods and communities are they all markers of levels of social capital?

We are not concerned about the multi-dimensionality of the concept, but we are

concerned that this multi-dimensionality has received so little theoretical exploration

in regard to public health. Consequently it provides little guidance about the

importance of the particular mechanisms that might link these different dimensions

to health. Stated in this undifferentiated way, the laundry list of measurement

strategies outlined above merely suggests that there may be a little something

for everyone in social capital. Hawe & Shiell (2000) have commented that the

health-related applications of social capital have often involved measuring all that

is good in a community. Conating the political, cultural and economic aspectsof a community under the one umbrella of social capital, may mask important

conceptual distinctions as to the origins of those group resources and may obscure

the fact that these dimensions are not necessarily equally important as determinants

of health. It would seem that under this kind of undifferentiated approach to social

capital, establishing an arts festival (the cultural dimension) and a job creation

program (the economic dimension) are both interventions to improve social capital are they likely to have an equal impact on public health? This in no way denies the

importance of improving the cultural life of a community through programmes of

arts and music.The question is whether tossing all these dimensions into the grab

bag of social capital can inform strategies to improve public health.

The reasons for the easy and almost completely uncritical acceptance of social

capital into public health discourse is of interest in itself. Discussion of the concept

would appear to come from at least three main sources within the public health

community from those concerned with community-based health promotion

(Baum, 1999; Cooper et al., 1999); from those in the social support eld (Cooperet al., 1999;Tijhuis et al., 1995),and from those who have claimed that social capital

and social cohesion are the main mediators of the link between income inequality

and population health (Wilkinson,1996; Kawachi et al., 1997a, b). One factor that

perhaps links these diverse areas of public health research and practice is that they

are all motivated to some extent, by the underlying idea that there is something

Social capital and the third way in public health 109


4/18

about the connections among individuals that is important for public health.Levels

of population health may be more than the arithmetic sum of the health of the

individuals in those populations, and the determinants of population health are

both individual and contextual. In this view there is something inherently social

about improving public health that cannot be reduced to studying and changing

discrete individuals.This idea is not new (Rose, 1985) and there have been manycritiques of an overly individualistic approach to public health research and

intervention (Krieger,1994; Lynch et al., 1997;Muntaner & OCampo, 1993).The

concept and language of social capital has perhaps been seen as offering a new and

exciting way to invigorate supra-individual public health research and to provide

support for a non-individualized, social science approach to improving public health

(Baum, 1999).

Public health and the connections among individuals

The goal of moving beyond individualistic theory and practice in public health is

laudable and as one of us has recently argued, the connections among individuals

are an important and neglected research area in epidemiology and public health.

In that paper, Koopman & Lynch (1999) showed how the different arrangement

of connections among individuals can produce very different patterns of infectious

disease transmission in a population. Infectious disease transmission depends on

who is connected to whom, and it is possible that other disease processes are also

inuenced by the pattern of connections within a population. This disease trans-

mission perspective perhaps provides another language for understanding how socialsupport has sometimes been found to protect against certain poor health outcomes.

High levels of social support block the transmission of the pathogenic agent, in this

case, usually hypothesized as stress.

Populations are not just unrelated heaps of individuals, whose patterns of

connections can be ignored.However, overly simplistic interpretations of the pattern

of connections among people may mask, not reveal determinants of populationhealth.For example, strong links among individuals can both increase and decrease

the risk of certain health outcomes.Tight connections among infants in a day-care

centre may increase their risk of otitis-media. In one context, strong friendship

networks of peers can increase the risk of smoking, drinking or use of illicit drugs,

while in a different situation these same sorts of links may decrease the risk of suicide.

Tight networks among the Maa, neo-Nazi parties, or semi-clandestine business

organizations such as the Trilateral Commission, the WTO or GATT increase health

risks for other members of the population. Scratch beyond a supercial level and

the public health consequences of how individuals and groups are connected rapidlybecomes very complicated.

As we have stated above, we are advocates of the idea that the way individ-

uals and groups get connected to form friendship networks, neighbourhoods,

communities and populations can be important for public health. However, we are

less convinced that the concept of social capital, in its present form, can provide an



5/18

adequate basis to understand how these connections may be linked to population

health.We believe that social capital has been under-theorized in its public health

usage, and that it is time to engage in serious debate about its denition, measure-

ment, and application in public health research and practice.It is within this broader

framework of appreciating how both the formal and informal connections among

individuals, and the connections among population sub-groups are linked topopulation health, that we must critically evaluate the concept of social capital.We

think that some of the issues for public health research and practice are 1) to explore

the sources of the connections among different individuals and groups i.e., what

determines who gets connected to whom? 2) to understand what is transmitted

over those networks that might be plausibly linked to health outcomes; and 3) to

understand how the health relevant aspects of the connections among individuals

and groups can be changed to improve public health.

Theoretical differences with social science

When I use a word, Humpty Dumpty said, in a rather scornful tone, it means just

what I choose it to mean neither more nor less. The question is, said Alice,

whether you can make words mean so many different things. The question is,said

Humpty Dumpty, which is to be the master thats all. (Lewis CarrollsAlice Through

the Looking Glass).

Because the scant empirical literature on social capital and health has been

accompanied by enthusiastic expectations about social capitals future relevance

to public health (Kawachi et al., 1997a, b; Marmot, 1998; Mustard, 1996), socialcapital often conveys the authoritarian arbitrariness of Alices famous exchange with

Humpty Dumpty. Powerful institutions, actors and funding agencies have a lot to

say about what a concept means and what concepts are considered legitimate for

empirical research (Muntaner et al.,1997;Muntaner,1999a,b;Wing,1998).Never-

theless,because public health is a science, and thus has adjacent disciplines, we can

examine the compatibility of its social capital construct with regard to the socialcapital theories that have been developed in contiguous disciplines (e.g., sociology,

demography, and international development). Almost exclusively, the construct of

social capital adopted by public health researchers has been the most psychological,

the communitarian view (Putnam et al., 1993). This conception emphasizes

civic engagement, as in membership in local non-governmental organizations, or

norms of reciprocity and trust among community members.Communitarians, who

often favour minimal government and self-reliance (Etzioni & George, 1999),

present their position as a third way between laissez-faire neoliberalism and social

democracy (Etzioni & George, 1999),and have been supported by the New Labourand New Democrat administrations in the UK and USA (Muntaner & Lynch,

1999a). The small government communitarian view, with its emphasis on civic

organizations (third sector, not for profit institutions, and Non-Governmental

Organizations), not only undermines government intervention in the social

democratic European welfare state; but also undermines political representation,



6/18

since national class-based parties that strive for state control are substituted with

idealized notions of small scale political organizing at the community level

(Muntaner & Lynch, 1999a).Thus, it is possible that in public health, social capital

may function as a health policy alternative to large scale government redistribution

(i.e., dismantling or reducing the post-World War 2 welfare state) (Wainwright,

1996; Muntaner & Lynch, 1999a). In social epidemiology more specically, socialcapital presents a model of the social determinants of health that does not include

any analysis of structural inequalities (e.g., class, gender or racial relations) in favour

of a horizontal view of social relations based on distributive inequalities in income

(Muntaner & Lynch,1999b).As a consequence, class, race or gender-based political

movements are also ignored as explanations for reducing social inequalities in health

(Muntaner & Lynch, 1999a).

In spite of the confusion regarding the referents of social capital (Coleman,

1990; Woolcock, 1998), there is no justication as to why public health scholarsshould restrict their conception of social capital to the communitarian notion

of civic participation and its indicators (e.g., organization membership, newspaper

readership). In social science, in particular in sociology, demography, and devel-

opmental economics, social capital has at least two other conceptualizations that

have a larger sociological content: one is that of network analysis (Granovetter,

1973; Portes, 1998; Woolcock, 1998). This view of social capital derives from

the Weberian tradition in sociology and acknowledges the existence of stratication

as well as the negative effects of strong networks for communities (e.g., in Maa

families). For example, Granovetter showed the differences in the networks

of professionals and non-professionals weak ties among professionals facilitate

access to information about job opportunities. Portes showed the conditions underwhich strong networks among immigrants have facilitated the enrichment of ethnic

businessmen in the US. Another sociological approach to social capital emphasizes

the role of institutions, including the state. Following the seminal work of Evans

(1995) on economic development, this institutional approach considers both

a communities social capital its internal cohesion, ties and networks as well as

the type of relation that the state has with communities (Szreter, 1999).This embed-dedness or institutional support dictates how the state co-operates with civil society

to foster economic development via interaction between private and public

institutions, legal and democratic systems, and citizen rights (Woolcock, 1998). As

we will show below, and have argued earlier (Lynch et al., 1999), this notion of social

capital is the more encompassing and allows the greater explanatory potential and

integration with other sociological traditions in social epidemiology and public

health (e.g., the study of the health effects of class, gender and race relations).

Idealist social psychology Bowling with de Tocquevilleand other exaggerations

Social capital in public health is coined in terms of a lay/common sense social

psychology that has great appeal in the US and elsewhere (Cooper et al., 1999;

Baum, 1998; Kawachi et al., 1997b). Who would oppose the notion that civic



7/18

participation, trust in communities,good neighbourly relations are good for health?

In the US,the mom and apple pie idea that good community relations are desirable

is part of the collective wisdom among communitarians, liberals and social conser-

vatives alike (Putnam, 1995a, b; Etzioni & George, 1999).

Behind this conventional aspiration for achieving healthy communities also

lies an idealized view of past community life that is seldom-warranted (Lynch &Kaplan, 1997). A particular form of historical imprecision is the selective reading

of Alexis de Tocqueville, a French aristocrat, known for his observations on the high

degree of civic participation in American communities during his nineteenth century

journey in the US (e.g., Kawachi et al., 1997a,b; Kawachi & Berkman, 2000).

Leaving aside the contradictions in Democracy in America (Elster, 1993),

de Tocqueville displayed a sharp critical view, for example, when reecting on the

individualism and self-sufciency that is so dear to communitarians: Individualism

is a calm and considered feeling which disposes each citizen to isolate himself fromthe mass of his fellows and withdraw into the circle of family and friends; with this

little society formed to his taste and leaves the greater society to look after himself

(de Tocqueville, 1835/1969). This sentence highlights the perils of narrow

associationism, or a negative effect of social capital which is largely absent

from current public health and social policy writings on the subject (Muntaner &

Lynch, 1999a). A negative appraisal of vibrant, local associationism in the US is

not new, however. Multiple local interest group associations are part ofAmerican

Exceptionalism (Muntaner, 1999a) and these strongly localized associations may

be seen as both potential barriers and supports to creating public policies aimed to

improve population health. For example, the failure of creating a broad working

class political party capable of establishing a strong welfare state, including thelack of universal access to health care (Navarro, 1994), has been a barrier to

improvements in public health in the US. Furthermore, a recent analysis of voter

participation data in American cities circa 1880 lends no support to the social capital

perspective whereby civic associations would have beneficial impact on broad-

based political participation (Kaufman, 1999). Rather, these analyses reveal that

civic associations functioned as powerful interest groups that lobbied for specicparty platforms that were not necessarily in the broader public interest (Kaufman,

1999).

Another inaccuracy of the received wisdom in current public health accounts

of social capital is the uncritical acceptance of Putnams Bowling alone thesis on

the decline of social capital in the US (Kawachi et al., 1997a; Kawachi & Kennedy,

1997; Kawachi et al., 1999;Wilkinson et al., 1998a,b).The available evidence in the

US suggests that there has not been a decline in associations over the last two

decades (Smith, 1997; Paxton, 1999). Furthermore, older forms of civic partici-

pation that have perhaps declined have been transformed over time (Fukuyama,1999; Skocpol, 1999). In addition, Putnams analysis of social capital as the key

factor underlying economic development in several Italian regions (e.g., Emilia-

Romagna) has also been challenged (e.g., the neglect of class relations or 19th

century socialist and catholic political traditions in the creation of contemporary

social capital; Warren, 1994). The notion that social capital drives political and



8/18

economic performance has been refuted with new analyses of data from Italian

regions and other industrial democracies (Jackman et al., 1996). Our overall point

here is that the discourse around social capital in public health has tended to focus

on its upside. We believe a more complete reading of the literature relevant to

understanding the likely health effects of social capital reveals that the concept has

been portrayed narrowly and has focused on more optimistic appraisals of itsrelevance to population health.

Communitarians of the world unite! Ignoring the class, gender and race

structure

Given the scant support for the social capital hypotheses reviewed above, one

would expect that policy makers and researchers alike would be more sanguine intheir approach to the subject. At least, some acknowledgement of alternative

mechanisms driving the political,economic and health performance of nations (e.g.,

political movements, and class relations) might be expected from objective scholars.

Unfortunately, in the enthusiastic entourage of social capital, this is not the case (e.g.,

Kawachi et al., 1997a).The eld is indeed inundated with paradoxes and omissions.

For example, although communitarians such as Vaclav Havel accept the end of the

nation-state (Havel, 1999), that is, of its welfare policies (universal health care,

public education, subsidized housing, poverty relief, unemployment compensation,

etc.), they are often accepting of international military interventions under the

umbrella of powerful nation states (e.g., NATOs war in the former Yugoslavia;

Chomsky, 1999a).Even the most erudite scholars seem to dismiss competing alternatives to social

capital. For example, in the elds of comparative political sociology and economic

development, dependency and world-system theories are far from exhausted,

contrary to what Woolcock claims in his exhaustive review and integration of social

capital studies (Woolcock, 1998). The early Dependency (e.g., Andre Gunder-

Frank, Fernando-Henrique Cardoso) and world-system theories (e.g., ImmanuelWallerstein, Christopher Chase-Dunn), which were a spin-off of the Marxian

tradition in sociology, have de facto evolved into stronger research programs that

retain some of their ideas. This has happened for several reasons, including, 1)

in recent years there has been a number of empirical articles on these theories in

the leading sociological journals (American Journal of Sociology, American Sociological

Review); 2) hypotheses arising from these theories of development (e.g., that

receiving aid from the International Monetary Fund and the World Bank is

associated with increased income inequality) have been conrmed by researchers

coming from different perspectives (e.g., Boswell, who comes from the Marxiantradition, and Nielsen, who does not; see Muntaner & Lynch, 1999a); and 3)

controversies in this eld have reached such a degree of sophistication that the issue

is less whether IMF or WB aid is associated with increases in a nation s income

inequality (it is), but rather the timing of these income inequalities (Dixon & Boswell,

1996; Kentor, 1998; Alderson & Nielsen, 1999). In other areas of social science,



9/18

social capital has been integrated with research on social inequalities (e.g., class,

gender and race). For example, in historical sociology, Gould explains social class

mobilization in the Paris Commune with network analysis and pre-existing levelsof social cohesion (Gould,1991, 1993).Another area of integration between strati-

cation and social capital is the sociology of gender. Brines (1999) for example,has shown how earnings equality among cohabiting couples reinforces cohesion

and stability, making couples more likely to remain together than in conditions

where one of the members of the couple (most notably the woman in heterosexualcouples) earns more than her male partner.In addition to class and gender (Erikson,

1996; Muntaner et al., 1999; Persell et al., 1992; Zweigenhaft, 1993), racial andethnic segregation has also been linked to social capital (Borjas, 1992). Contrary to

the law and order view of social capital often portrayed in public health, Pattillo(1998) has showed the difficulty of separating networks of law abiding and

criminal residents in cohesive African American neighbourhoods characterized bydense networks. Recently, researchers have also found that educational networks

(Colemans original notion of social capital) are class and racially segregated(Schneider et al., 1997).

Thus, in social science the elds of class, gender and race/ethnic inequalities

are often integrated with social capital (mostly its network and institutionalversions). However, with few exceptions (Matthews et al., 1999) the mostly

communitarian approach to social capital in public health shies away from thesemechanisms (Muntaner & Lynch, 1999a, 1999b).

Familiar health policy implications The importance of subjectivity

One implication of social capital in public health is the role of individual subjectivityin mediating the relation between inequality and health (Wilkinson, 1996, 1999).

The breakdown in social cohesion occurs because individuals perceive their relative

position in the social distribution of income, which creates anxiety and other

psychosocial injuries which, in turn, affect health (Wilkinson, 1999). As no expla-

nations for the causes of income inequalities are provided, this psychosocialmechanism becomes the central explanation of social cohesion models in publichealth (Muntaner & Lynch, 1999b; Lynch et al., 1999). This is not surprising as

individuals look for explanations and they hold to those that are offered (Muntaner& Lynch, 1999b). The move towards psychosocial explanations on the effects ofsocial cohesion (e.g., the culture of inequality;Wilkinson, 1996, 1999) is rather

surprising, as just a few years ago the eld of social inequalities in health was stillmaterialist (Kaplan, 1995). Even researchers that had been relatively sympathetic

to materialist explanations such as social class and working conditions (Marmot &Theorell, 1988), seem suddenly convinced by social capital/psychosocial environ-

ment explanations for health inequalities (Marmot, 1998).The culture of inequality mechanism underlying the social capital health

association is not, however, all that innovative. For example, the culture of povertyhypothesis popularized by Oscar Lewis (1998/1963) is strikingly similar to the social

capital/social cohesion formulations by Wilkinson and colleagues, albeit more



10/18

psychologically reductionist and victim blaming than the latter (Muntaner& Lynch, 1999a).The culture of poverty states that some poor communities bring

poverty onto themselves because of few community ties and little communityheritage (i.e., social capital). Perceptions and subjectivity are all important, as it is

not objective inequalities that ultimately determine the well being of populations butthe subjective response to those inequalities.

One of the implications of the social capital/social cohesion hypothesis for

public health is that communities may be seen as responsible for their crime rates

(Sampson et al., 1997) or aggregated health rates, an idea that nicely justifies

the privatization of health services, such as managed care (Stoto, 1999). Another

possible direction for public health may be that we take a step back from the

structural sources of health inequalities (the importance of subjectivity,Wilkinson,

1999) after all, if they are not an integral part of our theories of health inequalities

and are so difcult to change, then perhaps an achievable alternative is to retreat tomass psychotherapy for the poor to change their perceptions of place in the social

hierarchy (e.g.,Proudfoot & Guest, 1997).Again, this idea is not new. In the 1960sthe functionalist sociologist Warner revealed his hopes for his book called Social

Class in AmericaThe lives of many are destroyed because they do not understand

the workings of social class. It is the hope of the authors that this book will provide

a corrective instrument which will permit men and women better to evaluate their

social situations and thereby better adapt themselves to social reality and t their

dreams and aspirations to what is possible. (Warner, 1960, p. 5). Elsewhere, we

have labelled this new set of public health implications associated with the idea ofa loss of social capital blaming the community (Muntaner & Lynch, 1999a).The

problem with subjectivity as an explanation for health inequalities is not only that

it has little empirical support but also that it may yield anti-egalitarian public health

policies (Muntaner & Lynch, 1999a, 1999b). Such anti-egalitarian public policy

outcomes are not desired by any of the proponents of the social capital/psychosocial

environment approach to health inequalities, or for that matter, anyone in the

broader public health community.This is because social egalitarianism constitutes

one of public healths core values (Muntaner, 2000).The perceptions of relative inequality approach implies a psychophysical

dualism that is at odds with scientific psychology since Sechenov and Pavlov

(Muntaner & Lynch, 1999a).The culture of inequality view implies that culture is

non-material (a subjective invention of peoples minds that is not tied to the material

world), while economics is material (Wilkinson, 1999). There is no basis for thisassumption in modern science: ideology, technology, and art are as material as

political representation or production of goods and services.The process of writing

an article on anarchism is a cultural activity, selling it is an economic activity and

censoring it because of its content is a political activity all of them materialprocesses,as they take part in a social system,which is a material, albeit not physical,

system (Muntaner & Lynch, 1999a).



11/18

Can social capital be saved from shallowness?

Why now? Explaining the growing interest in social capital

The literature on different approaches to social capital (e.g., communitarian,

network, institutional) has been growing for the last three decades, from Loury,Bourdieu and Coleman, to Portes, Evans and Putnam (Coleman, 1990; Putnam,

1995b). However, not until the 1990s has the concept of social capital/social

cohesion gained popularity in public health (e.g.,Wilkinson, 1996) and development

studies (Woolcock, 1998).

To understand the timely emergence of social capital from a psychosocial

construct in the sociology of education (Coleman, 1990) to the next research

paradigm in developmental economics at the World Bank (Stiglitz, 1996, 1997),

we need to understand the difcult position of international lending institutions inthe current decade. After the demise of the Soviet Union, the so-called Washington

Consensus rhetoric of minimal governments, austerity measures, debt repay-

ment, and neo-classical (e.g., rational choice) economics pervaded unchallenged

(Chomsky, 1999b). Maybe the clearest example of this attitude is the now famous

1991 Memorandum attributed to Lant Pritchett and Larry Summers, currently US

Secretary of Treasury and then chief economist at the World Bank. This unique

historical document provides a testimony of the policies of the Banks ideology that

has been replaced by the language of social capital at the end of the decade (e.g,

Stiglitz, 1996,1997;Woolcock, 1998). Following Summers:

Dirty Industries: Just between you and me, shouldnt the World Bank be

encouraging MORE migration of the dirty industries to the LDCs (LessDeveloped Countries)? I can think of three reasons: 1) The measurements

of the costs of health impairing pollution depends on the foregone earnings

from increased morbidity and mortality. From this point of view a given

amount of health impairing pollution should be done in the country with

the lowest cost, which will be the country with the lowest wages. I thinkthe economic logic behind dumping a load of toxic waste in the lowest

wage country is impeccable and we should face up to that. 2) The costs of

pollution are likely to be non-linear as the initial increments of pollution

probably have very low cost. Ive always thought that under populated

countries in Africa are vastly UNDER-polluted, their air quality is probably

vastly inefciently low compared to Los Angeles or Mexico City. Only the

lamentable facts that so much pollution is generated by non-tradable

industries (transport, electrical generation) and that the unit transport

costs of solid waste are so high prevent world welfare enhancing trade inair pollution and waste. 3) The demand for a clean environment for

aesthetic and health reasons is likely to have very high income elasticity.

The concern over an agent that causes a one in a million change in the odds

of prostate cancer is obviously going to be much higher in a country where

people survive to get prostate cancer than in a country where under 5



12/18

mortality is 200 per thousand. Also, much of the concern over industrial

atmosphere discharge is about visibility impairing particulates. These

discharges may have very little direct health impact. Clearly trade in goods

that embody aesthetic pollution concerns could be welfare enhancing.

While production is mobile the consumption of pretty air is a non-tradable.

The problem with the arguments against all of these proposals for morepollution in LDCs (intrinsic rights to certain goods, moral reasons, social

concerns, lack of adequate markets, etc.) could be turned around and used

more or less effectively against every Bank proposal for liberalization.

(Summers, as cited in Valette, 1999)

This economic logic that if applied to interpersonal, rather than international

relations, would be considered psychopathic, had to change once a series of

economic crises in part fuelled by IMF and WB policies started to creep up aroundthe globe (e.g., Mexico, Russia, Brazil, and East Asia; Galbraith, 1999). Criticism

of IMF austerity policies escalated (Kolko, 1999) even at WB headquarters where

the Banks new chief economist began using a more social democratic language

where a positive role for governments was acknowledged, including references to

social capital as a key factor in economic development (Stiglitz, 1996, 1997).The

Banks interest in social capital thus marked a departure from economic imperialism,

rational choice and public choice models, and a growing attention to integrating

economics with sociology (Woolcock, 1998; World Bank, 1999a). Recent annual

reports from the Bank also include the social dimension of economic development,

including the need for government intervention in reducing international inequal-

ities in science and technology (Stiglitz, 1997;World Bank, 1999b).Sceptical observers argue that economic development happens precisely when

countries do not follow IMF policies (Chomsky, 1999b); that countries that receive

IMF and WB suffer increases in social inequalities (Kentor, 1998); and that social

democracy has already been successfully tested in some European countries during

part of the World War 2 period, without need for social capital explanations.

On close scrutiny, now that communism and big bureaucratic states cannot beblamed, social capital allows for a different kind of criticism of debtor countries

(e.g.,Woolcock,1998). Social capital allows for the characterization of countries as

corrupt or developmental according to the character of the ties between state,

private sector,and civil society (Evans, 1995). For example, after the crisis of 1997,

South Korea, a country formerly praised for its Asian values and Confucian

capitalism, became an example ofcrony capitalism, while the role of the deregu-

lation of Korean nancial markets in the crisis was ignored (Galbraith, 1999).

In the case of Russia, the economic policy dictated by Harvard and the IMF

(Wedel, 1998) are not to blame for its failure to develop, it is Russian corruption(The Economist, 1999).Thus, in the WBs post-Washington Consensus documents,

the interpretation of what happened to Russia in the 1990s is thought of as capitalism

without proper social capital (i.e., decient governmental regulation), rather than

communisms inevitable heritage (World Bank, 1999a, b). Russian events such as

the 30% GDP decline and unregulated monopolies are explained as the outcome



13/18

of a deliberate hurry to privatize before any institutional capability to regulate could

be put in place. Russian events are used as an example of social capital failure that

provides a rationale for the Banks retreat from neo-liberalism and its attempt to

build a new development theory. Social capital is used to inform a supposedly new

comprehensive and participatory approach to development, which avoids small

government and authoritarian top-down neo-liberalism (Stiglitz, 1997;Woolcock,1998).The underlying notion is that with adequate levels of social capital (proper

civil and state guidance and regulation), the internationalization of markets and

private property are optimal for the welfare of nations (World Bank, 1999a,b).Social

capital thus represents a leaner version of previous proposals on various degrees

of state intervention in capitalist economies. There is thus a correspondence

between the WBs approach to social capital and its public health applications

(less state interventions, emphasis on civic life, blaming the community, sharing

responsibility with the community).This should not be surprising as there is a stronginterdependence between the WB and the US government (Left Business Observer,

1999).

What is not to be done: a third wayfor comparative health research

Social capital has been explicitly associated with Third Way social policies in the

US and in the EU as well (Szreter, 1999).The Third Way, as in the New Labour

or New Democrat governments and their intellectuals (Robert Reich, Anthony

Giddens) has been associated with the reduced role of the state, privatization

of social services, labour market exibility, non-governmental organizations, modernphilanthropy and the demise of the welfare state (Muntaner & Lynch, 1999a).

Critics of the Third Way have argued that instead of representing a new set of policies

by social-democratic parties, it represents a capitulation to the political right that

leads to greater social inequalities (Albo & Zuege,1999;Muntaner & Lynch,1999a,

1999b). Albo & Zuege have argued that the failures of European social democracy

in the seventies (e.g.,Swedens Meidner plan) and early eighties (e.g.,MitterrandsU turn) sent them into a path of retreat, accommodation and confusion from

which they still have to recover.The Third Way rhetoric, more often dened by what

it is not than by what it is (Giddens,1994), would be part of a search for a big idea

that would ensure a durable political base for social-democratic parties in the new

European capitalism. It is this potential role for social capital in public health that

we think should be avoided (Muntaner & Lynch, 1999b).

In the wake of recent elections in Europe, some analysts are arguing that

support for Third Way policies is fading, most notably in Germany (Singer, 1999).

If that were to be the case, the fortunes of social capital in public health could follow,at least in the EU where governments have been more responsible to egalitarian

pressures from working class parties (Navarro, 1999).This is less likely to occur in

the US where government is more insulated from egalitarian working class politics

(Navarro, 1994).Within public health, rather than discarding structural inequalities

such as gender, race and class as outmoded materialism, in favour of psychosocial



14/18

constructs such as social cohesion (Wilkinson, 1999), a much more fruitful strategywould be to seize the opportunity that social capital brings to integrate sociology

and economics into the field of social inequalities in health. For example, theMarxian tradition of class inequality (Wright, 1997) could be integrated with the

Weberian tradition of institutional social capital (Evans, 1995). The institutionalview of social capital stresses how states operate: some states are efficient or

inefcient,others are strong or weak.The role of political institutions such as parties,

the judicial system, how the executive and legislative branches of governmentsoperate (e.g., the rationalization of state bureaucracies) become central to under-

standing how states are formed (Evans, 1995). From a Marxian perspective on theother hand, class inequality guides the analysis of the state. How does the capitalist

class inuence the legislative, administrative and executive branches of government?What are the class alliances (capitalist vs. working class) and splits among different

segments of the capitalist class (financial vs. industrial) that affect governmentfunction or the relationship between the capitalist class and state elites? (Kadushin,

1995). At least the institutional approach to social capital favoured by Woolcock(1998) seems to be open to this kind of integration (e.g., Evans, 1995). But then,

as public health scholars and activists, should we place false hopes on initiativesheralded by institutions (Amin, 1997) that have helped generate the health

inequalities that we want to eliminate?

References

Albo, G. & Zuege, A. (1999) European capitalism today: between the Euro and the third way,

Monthly Review, 51(3), pp. 100119.

Alderson, A. S. & Nielsen, F. (1999) Income inequality, development, and dependence: a

reconsideration,American Sociological Review, 64(4), pp. 606631.

Amin, S. (1997) Capitalism In the Age of Globalization: The Management of Contemporary Society

(Atlantic Highlands, NJ, Zed Books).

Aneshensel, C. S. & Sucoff, C. A. (1996) The neighborhood context of adolescent mental health,

J Health & Soc Behaviour, 37, pp. 293310.

Baum, F. (1997) Public health and civil society: understanding and valuing the connection, Aust

J Public Health, 21, pp. 673675.

Baum, F. (1999) Social capital: is it good for your health? Issues for a public health agenda,

J Epidemiol Community Health, 53, pp. 195196.

Borjas, G. J. (1992) Ethnic capital and intergenerational mobility, The Quarterly Jounal of Economics,

107(1), pp. 123150.

Brines, J. (1999) The ties the bind: principles of cohesion in cohabitation and marriage, American

Sociological Review, 64(3), pp. 333355.

Carroll, L. (1999) The Complete Works of Lewis Carrol(Harmondsworth, Penguin).

Chomsky, N. (1999a) The new military humanism: lessons from Kosovo, In These Times, 23(21),

pp. 711.

Chomsky, N. (1999b) Prot Over People: Neoliberalism and Global Order(New York, Seven Stories

Press).

Coleman, J. (1990)Foundations of Social Theory (Cambridge, MA, Harvard University Press).

Collier, P. (1998) Social Capital and Poverty (Washington, DC, The World Bank, Social Capital

Initiative).

Cooper, H., Arber, S. & Ginn, J. (1999) The Inuence of Social Support and Social Capital on

Health (London, Health Education Authority).

http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0003-1224^28^2964:3L.333[aid=58494,csa=0003-1224^26vol=64^26iss=3^26firstpage=333]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0003-1224^28^2964:3L.333[aid=58494,csa=0003-1224^26vol=64^26iss=3^26firstpage=333]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/1326-0200^28^2921L.673[aid=58492,csa=1326-0200^26vol=21^26iss=7^26firstpage=673,nlm=9489177]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0003-1224^28^2964:3L.333[aid=58494,csa=0003-1224^26vol=64^26iss=3^26firstpage=333]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0143-005X^28^2953L.195[aid=58493,csa=0143-005X^26vol=53^26iss=4^26firstpage=195]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/1326-0200^28^2921L.673[aid=58492,csa=1326-0200^26vol=21^26iss=7^26firstpage=673,nlm=9489177]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0003-1224^28^2964:4L.606[aid=58491,csa=0003-1224^26vol=64^26iss=4^26firstpage=606]


15/18

Dixon, W. J. & Boswell, T. (1996) Dependency, disarticulation, and denominator effects: another

look at foreign capital penetration,American Journal of Sociology, 102, pp. 54362.

Economist(1999) Fueling Russias economy. Online:

http://www.economist.com/editorial/justforyou/19990828/1d6020.html.

Elster, J. (1993) Political Psychology (New York, Cambridge University Press).

Erikson, B. H. (1996) Culture, class and connections,American Journal of Sociology, 102, pp.217251.Etzioni, A. & George, R. P. (1999) Virtue and the state: a dialogue between a commmunitarian and

a social conservative, The Responsive Community, 9(2), pp. 5456.

Evans, P. (1995) Embedded Autonomy (Princeton, NJ, Princeton University Press).

Fullilove, M. T. (1998) Promoting social cohesion to improve health,Journal Am Med Womens Assoc,

53(2), pp. 7276.

Galbraith, J. K. (1999) The Crisis of Globalization. Dissent, Spring, pp. 1319.

Giddens, A. (1994) Beyond Left and Right(California, Stanford University Press).

Gould, R. V. (1991) Multiple networks and mobilization in the Paris commune, 1871,American

Sociological Review, 56, pp. 716729.

Gould, R. V. (1993) Trade cohesion, class unity, and urban insurrection,American Journal of Sociology,

98, pp. 721754.

Granovetter, M. (1973) The strength of weak ties,American Journal of Sociology, 78, pp. 13601380

Grootaert, C. (1997) Social Capital: The Missing Link? In Expanding the Measure of Wealth: Indicators

of Environmentally Sustainable Development. Environmentally Sustainable Development Studies and

Monographs Series No. 7(Washington, DC, The World Bank).

Havel, V. (1999) Beyond the nation-state, The Responsive Community, 9(3), pp. 2633.

Hawe, P. & Shiell, A. (2000) Social capital and health promotion: a review, Social Science and Medicine,

51, pp. 871885.

Hayes, M.V. & Dunn, J.R. (2000) On the currency of social capital in health inequalities. Simon

Fraser University, unpublished paper.

Jackman, R. W. et al. (1996) A renaissance of political culture,American Journal of Political Science,

40(3), pp. 632659.

Jenson J. (1998)Mapping Social Cohesion: The State of Canadian Research (Ottawa, ON, Canadian

Policy Research Networks).

Kadushin, C. (1995) Friendship among the French nancial elite,American Soc Rev, 60, pp. 202221.

Kaplan, G. A. (1995) Where do shared pathways lead? Some reflections on a research agenda,

Psychosomatic Medicine, 57, pp. 208212.

Kaufman, J. (1999) Three views of associationalism in 19th century America: an empirical

examination,American Journal of Sociology, 104(5), pp. 12961345.

Kawachi, I. & Berkman, L. (2000) Social cohesion, social capital and health. In: Berkman L. F.,

& Kawachi, I. (eds.) Social Epidemiology (New York, Oxford University Press).Kawachi, I., Kennedy, B.P. & Wilkinson, G. (1999) Crime: social disorganization and relative

deprivation, Social Science & Medicine, 48, pp. 719731.

Kawachi, I., Kennedy, B. & Pothrow-Smith, D. (1997a) Social capital, income inequality, and

mortality,American Journal of Public Health, 87(9), pp. 14911498.

Kawachi, I., Kennedy, B. & Lochner, K. (1997b) Long live community. Social capital as public health.

American Prospect, NovDec 97, pp. 5659.

Kawachi, I., & Kennedy, B. (1997) Health and social cohesion: why care about income inequality?,

BMJ, 314, pp. 10371039.

Kennedy, B. P., Kawachi, I, & Brainerd, E. (1999) The role of social capital in the Russian mortality

crisis.WorldDevelopment, 26(11), pp. 20292043.Kentor, J. (1998) The long-term effects of foreign investment dependence on economic growth,

19401990,American Journal of Sociology, 103, pp. 10241046.

Knack, S. & Keefer, P. (1997) Does social capital have an economic pay off? A cross-country

investigation, Quarterly Journal of Economics, 112, pp. 12511288.

Kolko, G. (1999) Ravaging the poor: the international monetary fund indicted by its own data,

International Journal of Health Services, 29(1), pp. 5157.

http://www.economist.com/editorial/justforyou/19990828/1d6020.html.http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/1053-0754^28^299:2L.54[aid=58497,csa=1053-0754^26vol=9^26iss=2^26firstpage=54]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/1053-0754^28^299:2L.54[aid=58497,csa=1053-0754^26vol=9^26iss=2^26firstpage=54]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0002-9602^28^2998L.721[aid=58500,csa=0002-9602^26vol=98^26iss=4^26firstpage=721]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0002-9602^28^2998L.721[aid=58500,csa=0002-9602^26vol=98^26iss=4^26firstpage=721]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0090-0036^28^2987:9L.1491[aid=58507,csa=0090-0036^26vol=87^26iss=9^26firstpage=1491,nlm=9314802]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0092-5853^28^2940:3L.632[aid=58503,csa=0092-5853^26vol=40^26iss=3^26firstpage=632]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0277-9536^28^2951L.871[aid=58502,doi=10.1016/S0277-9536^2800^2900067-8,nlm=10972431]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0002-9602^28^2998L.721[aid=58500,csa=0002-9602^26vol=98^26iss=4^26firstpage=721]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0003-1224^28^2956L.716[aid=58499,csa=0003-1224^26vol=56^26iss=6^26firstpage=716]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0098-8421^28^2953:2L.72[aid=58498,csa=0098-8421^26vol=53^26iss=2^26firstpage=72,nlm=9595899]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0020-7314^28^2929:1L.51[aid=58512,csa=0020-7314^26vol=29^26iss=1^26firstpage=51,nlm=10079397]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0033-5533^28^29112L.1251[aid=58511,cw=1]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0002-9602^28^29103L.1024[aid=58510,csa=0002-9602^26vol=103^26iss=4^26firstpage=1024]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0305-750X^28^2926:11L.2029[aid=58509,doi=10.1016/S0305-750X^2898^2900094-1]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0959-8138^28^29314L.1037[aid=58508,csa=0959-8138^26vol=314^26iss=7086^26firstpage=1037,nlm=9112854]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0090-0036^28^2987:9L.1491[aid=58507,csa=0090-0036^26vol=87^26iss=9^26firstpage=1491,nlm=9314802]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0277-9536^28^2948L.719[aid=58506,csa=0277-9536^26vol=48^26iss=6^26firstpage=719,doi=10.1016/S0277-9536^2898^2900400-6,nlm=10190635]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0002-9602^28^29104:5L.1296[aid=58505,csa=0002-9602^26vol=104^26iss=5^26firstpage=1296]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0033-3174^28^2957L.208[aid=58504,csa=0033-3174^26vol=57^26iss=3^26firstpage=208,nlm=7652121]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0092-5853^28^2940:3L.632[aid=58503,csa=0092-5853^26vol=40^26iss=3^26firstpage=632]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0277-9536^28^2951L.871[aid=58502,doi=10.1016/S0277-9536^2800^2900067-8,nlm=10972431]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0002-9602^28^2998L.721[aid=58500,csa=0002-9602^26vol=98^26iss=4^26firstpage=721]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0003-1224^28^2956L.716[aid=58499,csa=0003-1224^26vol=56^26iss=6^26firstpage=716]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0098-8421^28^2953:2L.72[aid=58498,csa=0098-8421^26vol=53^26iss=2^26firstpage=72,nlm=9595899]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/1053-0754^28^299:2L.54[aid=58497,csa=1053-0754^26vol=9^26iss=2^26firstpage=54]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0002-9602^28^29102L.217[aid=58496,csa=0002-9602^26vol=102^26iss=1^26firstpage=217]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0002-9602^28^29102L.543[aid=58495,csa=0002-9602^26vol=102^26iss=2^26firstpage=543]http://www.economist.com/editorial/justforyou/19990828/1d6020.html.


16/18

Koopman, J. S. & Lynch, J. W. (1999). Individual causal models and population systems models in

epidemiology,American Journal of Public Health, 89, pp. 11701175.

Krieger, N. (1994) Epidemiology and the web of causation: has anyone seem the spider?, Social Science

and Medicine, 39, pp. 887903.

Lavis, J. N. & Stoddart, G. L. (1999)Social Cohesion and Health (Toronto, Canada: Canadian Institute

for Advanced Research, Program in Population Health).Left Business Observer(1999) Money. The Holy Trinity: Rubin, Greenspan, Summers, 90, pp.67.

Lewis, O. (1998) The culture of poverty, Society, 35, pp. 79.

Lomas, J. (1998) Social capital and health: implications for public health and epidemiology. Soc

Sci Med, 47, pp. 11811188.

Lynch, J. W. & Kaplan, G. A. (1997) Wither studies on the socioeconomic foundations of population

health?,Am. J Public Health, 87, pp.14091411.

Lynch, J. W., Kaplan, G. A. & Salonen, J. T. (1997) Why do poor people behave poorly? Variations

in adult health behaviour and psychosocial characteristics, by stage of the socioeconomic

lifecourse, Soc Sci Med, 44, pp. 809820.

Lynch, J. W., Due, P., Muntaner, C. & Davey Smith, G. (2000) Social capital: is it a good investment

strategy for public health?Journal of Epidemology and Community Health, 54, pp. 404408.

Marjoribanks, K. (1999) Family human and social capital and young adults educational attainment

and occupational aspirations, Psychological Reports, 69(1), pp. 237238.

Marmot, M. & Theorell T. (1988) Social class and cardiovascular disease: the contribution of work,

International Journal of Health Services, 18(4), pp. 659674.

Marmot, M. (1998) Improvement of the social environment to improve health. The Lancet, 351,

pp. 5760.

Matthews, S., Stansfeld, S. & Power, C. (1999) Social support at age 33: the inuence of gender,

employment status and social class, Social Science and Medicine, 49, pp. 133142.

Muntaner, C. & OCampo, P. (1993) A critical appraisal of the Demand/Control model of the

psychosocial work environment: epistemological, social, behavioral and class considerations,

Social Science and Medicine, 36, pp. 15091517.

Muntaner, C. (1999a) Teaching social inequalities in health: barriers and opportunities.Scandinavian

Journal of Public Health, 27, pp. 161165.

Muntaner, C. (1999b) Invited commentary: social mechanisms, race and social epidemiology,

American Journal of Epidemiology, 150(2), pp. 121126.

Muntaner, C. (2000) Applied epidemiology,Journal of Public Health Policy, 21(1), pp. 99102.

Muntaner, C. & Lynch, J. (1999a) Income inequality and social cohesion versus class relations: a

critique of Wilkinsons neo-Durkheimian research program, International Journal of Health

Services, 29, pp. 5982.

Muntaner, C. & Lynch, J. (1999b) The social class determinants of income inequality and socialcohesion Part I: further comments on Wilkinsons reply,International Journal of Health Services,

29(4), pp. 699715.

Muntaner, C., Nieto, J. & O Campo, P. (1997) Additional clarication re: on race, social class, and

epidemiologic research,American Journal of Epidemiology, 146(7), pp. 607608.

Muntaner, C., Oates, G. & Lynch, J. (1999) The social class determinants of income inequality and

social cohesion Part 2: presentation of an alternative model, International Journal of Health

Services, 29(4), pp. 715732.

Mustard, J. F. (1996) Health and Social Capital in Health and Social Organization: Towards a Health

Policy for the 21st Century, (New York, Routledge).

Navarro, V. (1994) The Politics of Health Policy (Amityville, NY, Baywood).Navarro, V. (1999) The political economy of the welfare state in developed capitalist countries,

International Journal of Health Services, 29, pp. 150.

Ostrom, E. (1999) Revisiting the commons: local lessons, global challenges, Science, 284,

pp. 278282.

Pattillo, M. E. (1998) Sweet mothers and gangbangers: managing crime in a black middle-class

neighborhood, Social Forces, 76(3), pp. 747774.

http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0147-2011^28^2935L.7[aid=58515,csa=0147-2011^26vol=35^26iss=2^26firstpage=7]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0090-0036^28^2987L.1409[aid=58517,csa=0090-0036^26vol=87^26iss=9^26firstpage=1409,nlm=9314787]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0020-7314^28^2918:4L.659[aid=58520,nlm=3235250]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0277-9536^28^2949L.133[aid=58521,csa=0277-9536^26vol=49^26iss=1^26firstpage=133,nlm=10414846,doi=10.1016/S0277-9536^2899^2900122-7]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0002-9262^28^29146:7L.607[aid=58526,csa=0002-9262^26vol=146^26iss=7^26firstpage=607,nlm=9326442]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0036-8075^28^29284L.278[aid=8655,nlm=10195886,doi=10.1126/science.284.5412.278]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0020-7314^28^2929:4L.699[aid=58525,csa=0020-7314^26vol=29^26iss=4^26firstpage=699,nlm=10615570]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0020-7314^28^2929L.59[aid=58524,csa=0020-7314^26vol=29^26iss=1^26firstpage=59,nlm=10079398]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0140-6736^28^29351L.57[aid=6378,csa=0140-6736^26vol=351^26iss=9095^26firstpage=57,nlm=9433438,doi=10.1016/S0140-6736^2897^2908084-7]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0277-9536^28^2939L.887[aid=58514,csa=0277-9536^26vol=39^26iss=7^26firstpage=887,nlm=7992123]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0037-7732^28^2976:3L.747[aid=58529,csa=0037-7732^26vol=76^26iss=3^26firstpage=747]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0036-8075^28^29284L.278[aid=8655,nlm=10195886,doi=10.1126/science.284.5412.278]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0020-7314^28^2929L.1[aid=58528,csa=0020-7314^26vol=29^26iss=1^26firstpage=1,nlm=10079396]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0002-9262^28^29146:7L.607[aid=58526,csa=0002-9262^26vol=146^26iss=7^26firstpage=607,nlm=9326442]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0020-7314^28^2929:4L.699[aid=58525,csa=0020-7314^26vol=29^26iss=4^26firstpage=699,nlm=10615570]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0020-7314^28^2929L.59[aid=58524,csa=0020-7314^26vol=29^26iss=1^26firstpage=59,nlm=10079398]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0002-9262^28^29150:2L.121[aid=58522,csa=0002-9262^26vol=150^26iss=2^26firstpage=121,nlm=10412956]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0277-9536^28^2936L.1509[aid=24888,csa=0277-9536^26vol=36^26iss=11^26firstpage=1509,nlm=8511639]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0277-9536^28^2949L.133[aid=58521,csa=0277-9536^26vol=49^26iss=1^26firstpage=133,nlm=10414846,doi=10.1016/S0277-9536^2899^2900122-7]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0140-6736^28^29351L.57[aid=6378,csa=0140-6736^26vol=351^26iss=9095^26firstpage=57,nlm=9433438,doi=10.1016/S0140-6736^2897^2908084-7]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0020-7314^28^2918:4L.659[aid=58520,nlm=3235250]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0033-2941^28^2969:1L.237[aid=58519,csa=0033-2941^26vol=69^26iss=1^26firstpage=237,nlm=1961801]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0090-0036^28^2987L.1409[aid=58517,csa=0090-0036^26vol=87^26iss=9^26firstpage=1409,nlm=9314787]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0147-2011^28^2935L.7[aid=58515,csa=0147-2011^26vol=35^26iss=2^26firstpage=7]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0277-9536^28^2939L.887[aid=58514,csa=0277-9536^26vol=39^26iss=7^26firstpage=887,nlm=7992123]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0090-0036^28^2989L.1170[aid=58513,csa=0090-0036^26vol=89^26iss=8^26firstpage=1170,nlm=10432901]


17/18

Paxton, P. (1999) Is social capital declining in the United States? A multiple indicator assessment,

American Journal of Sociology, 105(1), 88127.

Persell, C. H., Catsambis, S. & Cookson, P. W. (1992) Differential asset conversion: class and

gendered pathways to selective colleges, Sociology of Education, 65(3), pp. 208225.

Portes, A. (1998) Social capital: its origins and applications in contemporary sociology, Annual

Review of Sociology, 24, pp. 124.Proudfoot, J. & Guest, D. (1997) Effect of cognitive behavioural training on job-nding among

long-term unemployed people, Lancet, 350 (9071), pp. 96100.

Putnam, R. (1995a) Bowling alone: Americas declining social capital,Journal of Democracy, 6(1),

pp. 6578.

Putnam, R. (1995b) The prosperous community: social capital and public life, The American

Prospect, Spring, pp. 2740.

Putnam, R., Leonardi, R. & Nanetti, R. (1993)Making Democracy Work: Civic Traditions in Modern

Italy (Princeton, Princeton University Press).

Rose, G. (1985) Sick individuals and sick populations, International Journal of Epidemiol, 14,

pp. 3238.

Sampson, R. J., Raudenbush, S. W. & Earls, F. (1997) Neighborhoods and violent crime: a

multilevel study of collective efcacy, Science, 277, pp. 918924.

Schneider, M. et al. (1997) Networks to nowhere: segregation and stratication in networks of

information about schools,American Journal of Political Science, 41(4), pp. 12011223.

Singer, D. (1999) Third way dead end? (Editorial), The Nation, July 5.

Skocpol, T. (1999) Associations without members, The American Prospect, 45, pp. 6673.

Smith, T. (1997) Factors relating to misanthropy in contemporary American society, Social Science

Research, 26, pp. 170196.

Stiglitz, J. (1996) Some lessons from the East Asian miracle, The World Bank Research Observer, 11,

pp. 151178.

Stiglitz, J. (1997) An agenda for development for the twenty-rst century. In: Pleskovic, B. &

Stiglitz, J. (eds) Annual Bank Conference on Development Economics 1997 (Washington, DC,

The World Bank).

Stoto, M. A. (1999) Sharing responsibility for the public s health, Public Health Reports, 114,

pp. 231235.

Szreter, S. (1999) A new political economy for New Labour The importance of social capital,

Renewal, 7, pp. 3044.

de Tocqueville, A. (1969) Democracy in America (New York, Anchor Books). First edition 1835.

The World Bank Group (1999a) Social Capital for Development.

The World Bank Group (1999b) World Bank Calls for a Narrowing of the Knowledge Gap between Rich

and Poor.Tijhuis, M. A., Flap, H. D. Foets, M. & Groenewegen, P. P. (1995) Social support and stressful

events in two dimensions: life events and illness as an event, Soc Sci Med, 40, pp. 15131526.

Valette, J. (1999). Larry Summers War Against the Earth. On-line:

http//:www.counterpunch.org/summers.html.

Wainwright, D. (1996) The political transformation of the health inequalities debate, Critical Social

Policy, 16, pp. 6782.

Warner, W. L. (1960) Social Class in America (New York, Harper and Row).

Warren, M. R. (1994) Exploitation or cooperation? The political basis of regional variation in the

Italian informal economy, Politics & Society, 22(1), p. 89.

Wedel, J. R. (1998) Collision and Collusion. The Strange Case of Western Aid to Eastern Europe19891998(London, St. Martin Press).

Wilkinson, R. G. (1996) Unhealthy Societies: The Afictions of Inequality (Routledge, London).

Wilkinson, R.G. (1999) Income inequality, social cohesion, and health: clarifying the theory a

reply to Muntaner and Lynch, International Journal of Health Services, 29, pp. 525543.

Wilkinson R. G, Kawachi, I. & Kennedy, B. (1998a) Mortality, the social environment, crime and

violence,Sociol Health and Illness, 20(5), pp. 578597.

http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0038-0407^28^2965:3L.208[aid=58530,csa=0038-0407^26vol=65^26iss=3^26firstpage=208]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0140-6736^28^29350:9071L.96[aid=58532,csa=0140-6736^26vol=350^26iss=9071^26firstpage=96,nlm=9228961,doi=10.1016/S0140-6736^2896^2909097-6]http://www.counterpunch.org/summers.htmlhttp://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0261-0183^28^2916L.67[aid=58541,era=96W/476]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0033-3549^28^29114L.231[aid=58539,csa=0033-3549^26vol=114^26iss=3^26firstpage=231,nlm=10476992]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0049-089X^28^2926L.170[aid=58537,csa=0049-089X^26vol=26^26iss=2^26firstpage=170,doi=10.1006/ssre.1997.0592]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0300-5771^28^2914L.32[aid=58533,nlm=3872850]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0360-0572^28^2924L.1[aid=58531,csa=0360-0572^26vol=24^26iss=^26firstpage=1]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0141-9889^28^2920:5L.578[aid=58543,csa=0141-9889^26vol=20^26iss=5^26firstpage=578]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0020-7314^28^2929L.525[aid=58542,csa=0020-7314^26vol=29^26iss=3^26firstpage=525,nlm=10450545]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0261-0183^28^2916L.67[aid=58541,era=96W/476]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0033-3549^28^29114L.231[aid=58539,csa=0033-3549^26vol=114^26iss=3^26firstpage=231,nlm=10476992]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0049-089X^28^2926L.170[aid=58537,csa=0049-089X^26vol=26^26iss=2^26firstpage=170,doi=10.1006/ssre.1997.0592]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0092-5853^28^2941:4L.1201[aid=58535,csa=0092-5853^26vol=41^26iss=4^26firstpage=1201]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0036-8075^28^29277L.918[aid=58534,nlm=9252316,doi=10.1126/science.277.5328.918]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0300-5771^28^2914L.32[aid=58533,nlm=3872850]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0140-6736^28^29350:9071L.96[aid=58532,csa=0140-6736^26vol=350^26iss=9071^26firstpage=96,nlm=9228961,doi=10.1016/S0140-6736^2896^2909097-6]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0360-0572^28^2924L.1[aid=58531,csa=0360-0572^26vol=24^26iss=^26firstpage=1]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0038-0407^28^2965:3L.208[aid=58530,csa=0038-0407^26vol=65^26iss=3^26firstpage=208]http://www.counterpunch.org/summers.html


18/18

Wilkinson, R. G., Kawachi, I. & Kennedy, B. (1998b) Morality, the social environment and

violence. In: Bartley, M., Blane, D., Davey Smith G. (eds.) The Sociology of Health Inequalities

(Oxford: Blackwell Publishers).

Wing, S. (1998) Whose epidemiology, whose health?, International Journal of Health Services, 28(2),

pp. 241252.

Woolcock, M. (1998) Social capital and economic development: a critical review, Theory andSociety, 27, pp. 151208

Wright, E. O. (1997) Class Counts. Comparative Studies in Class Analysis (New York: Cambridge

University Press).

Zweigenhaft, R. L. (1993) Accumulation of cultural and social capital, Social Spectrum, 13,

pp. 365376.

http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0020-7314^28^2928:2L.241[aid=58544,nlm=9595342]http://pinkerton.catchword.com/nw=1/rpsv/cgi-bin/linker?ext=a&reqidx=/0020-7314^28^2928:2L.241[aid=58544,nlm=9595342]

Documents

Capital Social y Tercera Via