Structural Social Capital and Population Health: Exploring Health Outcomes by Racial Groups

Context: Preventable gaps in health care access and health outcomes persist in the United States, linked to a range of complex, multilevel factors. Social capital is often considered a health-promoting resource that can facilitate improved health outcomes across communities. However, critiques of social capital highlight potential drawbacks, including unequal benefits across groups. Objective: This research examines the relationship between social capital and health outcomes across 2 racial groups within the same communities in the United States. Design: This research leverages a unique county-level dataset to analyze how social capital may be associated with divergent health outcomes across different racial groups within the same counties. We estimate our models using ordinary least squares regression with errors clustered by state. For 2 different health outcomes, we compare regression coefficients across the Black and White models using the seemingly unrelated post-estimation procedure. Setting: Our dataset includes county-level data on social capital, health outcomes, and socioeconomic factors from more than 1000 US counties where aggregated health data are reported by racial subgroup. Main Outcome Measures: We analyze whether social capital is health-protective for both Black and White populations, considering 1 health behavior (influenza vaccination) and 1 health outcome (life expectancy). Results: Our findings suggest that county-level structural social capital is associated with higher White influenza vaccination rates and higher life expectancy. However, the same levels of social capital within a county are not associated with higher Black influenza vaccination rates or higher life expectancy. Conclusions: Our analysis suggests that the current conceptualization of structural social capital captures health-promoting resources for White populations but not for Black populations. Addressing disparate impacts of social capital requires both acknowledging unequal levels of structural social resources and reconceptualizing social capital to better capture resources Black individuals leverage for health.