Open Access Open Badges Research article

Testing the association between social capital and health over time: a family-based design

Giuseppe N Giordano1*, Juan Merlo2, Henrik Ohlsson1, Maria Rosvall34 and Martin Lindström35

Author affiliations

1 Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden

2 Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden

3 Unit for Social Medicine and Health Policy, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden

4 Department of Public Health and Environment, Region Skåne, Malmö, Sweden

5 Centre for Economic Demography, Lund University, Lund, Sweden

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Citation and License

BMC Public Health 2013, 13:665  doi:10.1186/1471-2458-13-665

Published: 17 July 2013



The past decade has seen a vast increase in empirical research investigating associations between social capital and health outcomes. Literature reviews reveal ‘generalized trust’ and ‘social participation’ to be the most robust of the commonly used social capital proxies, both showing positive association with health outcomes. However, this association could be confounded by unmeasured factors, such as the shared environment. Currently, there is a distinct lack of social capital research that takes into account such residual confounding.


Using data from the United Kingdom’s British Household Panel Survey (BHPS) (waves thirteen to eighteen, N = 6982), this longitudinal, multilevel study investigates the validity of the association between trust, social participation and self-rated health using a family-based design. As the BHPS samples on entire households, we employed ‘mean’ and ‘difference from the mean’ aggregate measures of social capital, the latter of which is considered a social capital measurement that is not biased by the shared environment of the household. We employed Generalized Estimating Equations for all analyses, our two-level model controlling for correlation at the household level.


Results show that after adjusting for the shared environment of the household over a six year period, the association between social participation and self-rated health was fully attenuated (OR = 0.97 (95% confidence interval 0.89-1.06)), while the association with trust remained significant (OR = 1.11 (1.02-1.20)). Other health determinants, such as being a smoker, having no formal qualifications and being unemployed maintain their associations with poor self-rated health.


The association between social capital (specifically trust and social participation) and self-rated health appear to be confounded by shared environmental factors not previously considered by researchers. However, the association with trust remains, adding to existing empirical evidence that generalized trust may be an independent predictor of health.

Self-rated health; Social capital; Trust; Multilevel; Longitudinal; Family-based design; United Kingdom