Social determinants of health – A question of 
social or economic capital? Interaction effects 
of socioeconomic factors on health outcomes

Johanna Ahnquis, arah P. Wamala, Martin 
Lindstrom. Social determinants of health – A 
question of social or economic capital? 
Interaction effects of socioeconomic factors on 
health outcomes. Social Science & Medicine. 74(6):930-939. March 2012.

Abstract

Social structures and socioeconomic patterns are 
the major determinants of population health. 
However, very few previous studies have 
simultaneously analysed the “social” and the 
“economic” indicators when addressing social 
determinants of health. We focus on the relevance 
of economic and social capital as health 
determinants by analysing various indicators. The 
aim of this paper was to analyse independent 
associations, and interactions, of lack of 
economic capital (economic hardships) and social 
capital (social participation, interpersonal and 
political/institutional trust) on various health 
outcomes. Data was derived from the 2009 Swedish 
National Survey of Public Health, based on a 
randomly selected representative sample of 23,153 
men and 28,261 women aged 16–84 year, with a 
participation rate of 53.8%. Economic hardships 
were measured by a combined economic hardships 
measure including low household income, inability 
to meet expenses and lacking cash reserves. 
Social capital was measured by social 
participation, interpersonal (horizontal) trust 
and political (vertical/institutional trust) 
trust in parliament. Health outcomes included; 
(i) self-rated health, (i) psychological distress 
(GHQ-12) and (iii) musculoskeletal disorders. 
Results from multivariate logistic regression 
show that both measures of economic capital and 
low social capital were significantly associated 
with poor health status, with only a few 
exceptions. Significant interactive effects 
measured as synergy index were observed between 
economic hardships and all various types of 
social capital. The synergy indices ranged from 
1.4 to 2.3. The present study adds to the 
evidence that both economic hardships and social 
capital contribute to a range of different health 
outcomes. Furthermore, when combined they potentiate the risk of poor health.

Highlights

We analysed independent associations, and 
interactions, of lack of economic capital (i.e., 
economic hardships) and social capital at the 
individual level on various health outcomes in 
Sweden. Findings add to the evidence that both 
economic hardships and social capital at the 
individual level contribute to a range of 
different health outcomes. When economic 
hardships and social capital are combined they 
potentiate the risk of poor health.

Keywords

Social determinants; Social capital; Economic 
hardships; Self-rated health; Sweden

http://www.sciencedirect.com/science/article/pii/S0277953612000238

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