Understanding the relationship between community involvement and health : Is social capital important?

Local authorities and their partners are increasingly required to involve communities within decision making (DETR, 1998; 2000a). Community involvement, and the subsequent creation of networks, has been presented within national policy documentation as a means to tackle social exclusion and associated multiple deprivation (DETR, 2000a; SEU, 2001). Similarly, increased levels of societal integration have long been associated with improved health outcomes (e.g. Durkheim, 1952; Egolf et al, 1992). More recently, social capital, in its various interpretations, has been portrayed as an important resource for public health (Kawachi et al, 1997). Here, the relationship between community involvement and health has been explored and the value of social capital in advancing understanding of this relationship determined. Theories of social capital and well being interpretations of health informed the development of a qualitative methodology. In the first stage of research, a local authority case study was selected to examine the translation of policies into a new strategic framework for community involvement. Qualitative interviews and analysis of key documentation determined interpretations of community involvement. In the second stage, observations and interviews were conducted with a newly formed community group to explore experiences of involvement and their potential influence upon health. This approach enabled the investigation of bonding, bridging and linking forms of social capital (Szreter and Woolcock, 2002). Reflecting the extensive changes taking place within the local authority, the new strategic approach to involvement centred upon a model of engagement, yet the value attached to community development perspectives diverged across the sectors. Investigation of the involvement activities of the community group revealed that their limited capacity inhibited interaction with the newly created involvement structures. Capacity, in turn, determined the perceived levels of control and influence held by communities. In the absence of the capacity to respond to the challenges presented by involvement, community group membership yielded predominantly negative health related outcomes. It is concluded that community involvement can potentially influence health through two primary mechanisms; the development of resources and the facilitation of collective action. Therefore uncritical acceptance of community involvement as a positive resource for public health does not reflect the complexity of the relationship. Instead, the relationship is shaped by the heterogeneous nature of bonding, bridging and linking forms of social capital. Reflecting this, it is concluded here that Bourdieu's (1997) interpretation of social capital as interdependent with cultural and economic resources presents a valuable framework for the implementation of involvement.