Social capital, class gender and race conflict, and population health: an essay review of Bowling Alone‘s implications for social epidemiology

‘The bull session buzz about “participatory democracy” and “all power to the people” seemed to augur ever more widespread engagement in community affairs.' Robert D Putnam (ref. 1, p.18) Robert Putnam's Bowling Alone (henceforth BA)1 serves as justification and support for one of the most influential hypotheses in contemporary social epidemiology, namely that the primary explanation for health inequalities in wealthy countries lies in low levels of social capital or social cohesion. For example, the major textbook of the sub-discipline2 includes two chapters on this topic. Putnam, and most social epidemiology, defines social capital as the norms of reciprocity and trustworthiness thatarise from social connections among individuals.1 Although the social capital concept lacks closure and varies with authors and disciplines,3–6 Putnam uses a consistent set of indicators that have been readily adopted in epidemiology.1,7 Among these indicators we find community organization membership (clubs, civic or social organizations), engagement in public affairs (voting, town or school public meeting attendance), volunteering (number of non-profit organizations), informal sociability (entertaining, visiting friends), and norms of social trust.