Access to health care and community social capital

Health Services Research, Feb, 2002 by Michael S. Hendryx, Melissa M. Ahern, Nicholas P. Lovrich, Arthur H. McCurdy

The National Association for City and County Health Officials 1997 National Profile of Local Health Departments was used for data on public health collaborations and public health service provision. Surveys were mailed to all local health departments nationwide in 1996-97 and were completed by local health department officials. The response rate was 88 percent, and no metropolitan areas represented in the CTS were lost because of nonresponse to this survey. For this study, we included only local health departments that matched a CTS site. The 1997 National Profile of Local Health Departments was funded through a Centers for Disease Control and Prevention cooperative agreement with the National Association of County and City Health Officials.

Two variables were derived from the profile for this study: The first is the number of collaborations or partnerships with other state or community organizations, including other local health departments, state health departments, other state agencies or units of government, community health centers, migrant health centers, health care providers, insurance companies, nonprofit/voluntary organizations, the faith community, and others. This variable is a count of the number of collaborations and ranges potentially from 0 to 13. This is a conceptual measure of public health collaborations, and the internal consistency reliability of the measure is 0.92. The second is the number of services the health department provided, contributed resources to, or contracted for, including adult immunizations, behavioral health, case management, child health, chronic disease treatments, dental health, home health care, maternal and prenatal care, primary care, substance abuse services, sexually transmitted disease services, a nd others. The variable is a count ranging potentially from 0 to 12.

The multicity broadcast media marketing database is a combination of citizen survey data and published sources of MSA statistics, made available as a gift to our university by Leigh Stowell and Associates, Inc. (Seattle, WA). The measure of general social capital used in this analysis represents a contextual variable developed for each MSA. It is a composite variable of six individual elements pertaining to the level of interpersonal trust, reciprocity sentiments, sense of personal efficacy, sense of personal safety, voting behavior, and civic engagement in each MSA. This range of elements reflects well the type of broader social context that scholars such as Putnam (1993) and McKnight (1995) view as essential for the development and sustenance of effective families, neighborhoods, and communities. The published sources include statistics on crime reported to the police, used as a surrogate for sense of personal safety, taken from the FBI Uniform Crime Reports for 1996. Crime is measured as 100,000 minus the crime rate per 100,000; thus, a higher score indicates higher personal safety. Voting rates in 1996 were used as one surrogate measure for civic engagement. A second civic engagement indicator is a 1 to 4 rating of each MSA on the level of activity of fraternal orders, based on their number and membership size (Weiss 1994). Annual 1996 per capita contributions to the United Way were used as a surrogate of reciprocity, entered into the database from the annual August report of The Chronicle of Philanthropy.