Is social capital a useful tool for explaining the politics of public health in the twentieth century city?

Résumé du document

The development of "politics of public health" is historically dated. As Foucault noted, it appeared with the broader emergence of the idea of "population" which provides, in the modern era, the conceptual framework of health policies. The existence of a common concept, however, should not hide the evolution of public health and public health policies during the modern and contemporaneous eras. Indeed, Public health in the twentieth century does not face the same problems as in previous centuries. In the 19th century, infectious diseases were a central problem, closely related to that of cities. Cities were modified for questions of hygiene: Haussman's works in the 1860's in Paris for instance. In the 20th century, we might say to a certain extent that cities do not occupy the same centrality in hygiene questions, for public health issues changed: degenerative diseases are substituted to transmitted infectious diseases. The spatial question is to be taken differently then, for the issues of proximity and contamination largely disappear.

Extraits

[...] I will first present the interest of the use of the concept of social capital, and then explain why its use is necessarily limited II The interest of bonding social capital Materialist theories of health issues tend to focus only on economic and technological determinants of health. Life quality and life expectancy would be more or less the projections of an infrastructure. In opposition to this monocausal explanation, social capital focuses on the subjective dimension of relations between people. Using the foregoing distinction, we might identify three different uses of social capital to identify social logics of health. Health is influenced by bonding social capital, as we will see with the Roseto effect, and by bridging and linking social capital, as demonstrated for instance by Klinenberg. [...]

[...] Navarro's critique that the concept of social capital should be rejected for it promotes the liberal ideas of individualism and above all negates the materialist base of health inequalities and policies is probably right and in any case interesting, but is not sufficient at all, for Navarro's critique is largely based on an a priori ground, the origins of the concept (such as the IMF and the World Bank). Muntaner is very useful here, for he offers a similar critique of the very notion of social capital without remaining on the ground of presupposes. As Muntaner claims, the original problem is not social capital but social inequalities relative to class. [...]

[...] How is this related to politics of public health? Actually the notion of cultural specificity raised here is very present when it comes to political issues. For instance, Klinenberg shows in his study of Chicago's 1995 heat wave that there are significant differences between similar boroughs, for one is occupied by a Hispanic strong community whereas the other is not. Klinenberg clearly relates that to political issues: Chicago's heat wave is a political event since it is the result, on the long and the short terms, of social policies. [...]

[...] Social capital is connected to health outcomes some variation of a direct social support mechanism”. Greater social cohesion would increase life expectancy and quality of life. Belonging to a community is therefore essential. Szreter and Woolcock refer to it as “bonding social capital”, i.e. “trusting and co-operative relations between members of a network who see themselves as being similar” But on the other hand, one can understand social capital slightly differently: social capital can also be integrated in top-down relations, possibly as a mean to achieve ends. [...]

[...] Therefore, what are “politics of public health”? Obviously, we can include the less controversial point, i.e. politics of medical care. But this is not enough: Urbanism for instance is essential in the 19th century. Does it play a role today? More generally, what is the relevant domain of “health policies”? I will include in health policies, every policy inasmuch as it has an impact on life expectancy and quality of life. In that sense nearly every political decision potentially has consequences on health, to the extent that it modifies the social situation of populations. [...]