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Promoting health equity through social capital in deprived communities: a natural policy experiment in Trieste, Italy.

ABSTRACT: The Trieste Habitat Micro-area Programme (HMP), an innovative social-health service policy, has offered a natural experiment to empirically evaluate the social mechanisms through which social capital may have an impact on health inequalities. To date, literature clarifying this causal chain is scanty. This empirical study tested the following hypotheses: H1) innovative social-health practices can activate social mechanisms intentionally and systematically so as to generate social capital; H2) such social mechanisms increase specific properties of social capital, in particular those influencing more vulnerable individuals' relationships; H3) investing in these properties can enhance capabilities and, consequently, control over the health of more vulnerable individuals. The study was carried out during 2016-2018 and used both qualitative and quantitative methods. The qualitative part investigated the field experience of the HMP through interviews, focus groups and workshops with HMP professionals. The quantitative part assessed the effect HMP might have on these properties and the capacity to face health risks of more vulnerable individuals. Three samples, each of 200 individuals, residing in the target and in control areas were interviewed using a semi-structured questionnaire. One control sample was matched to the 200 treated subjects using a Propensity Score Matching. The results of the study suggest that the HMP intervention stimulated the development of empowerment, collaboration and interdependence among vulnerable people. This produced an increase in their social capital under several aspects, including enhanced trust, network extension and participation, cooperation and reciprocal help with neighbours, as well as improving their judgement on quality, timing and efficacy of the help received from institutions, relatives or friends. These findings show that socially shared relationships can create innovative local models of a universalistic generative welfare system, which would be both inclusive and able to enhance individual capabilities. These models could be disseminated and carried over to other contexts.

SUBMITTER: Di Monaco R

PROVIDER: S-EPMC7585153 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Promoting health equity through social capital in deprived communities: a natural policy experiment in Trieste, Italy.

Di Monaco Roberto R Pilutti Silvia S d'Errico Angelo A Costa Giuseppe G

SSM - population health 20201009

The Trieste Habitat Micro-area Programme (HMP), an innovative social-health service policy, has offered a natural experiment to empirically evaluate the social mechanisms through which social capital may have an impact on health inequalities. To date, literature clarifying this causal chain is scanty. This empirical study tested the following hypotheses: H1) innovative social-health practices can activate social mechanisms intentionally and systematically so as to generate social capital; H2) su ...[more]

PMID: 33134475

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Project description:BackgroundThe Alberta Immunization Program offers a vaccine against the Human Papillomavirus (HPV) free of charge to all girls in Grades 5 and 9. The vaccine is provided in two different service delivery models depending upon the acceptance of the program by the local school board. Vaccinations may be provided "in-school" or in "community" through appointments at Public Health Clinics. The purpose of this study was to determine whether there was a difference in vaccine uptake in Calgary between the two service delivery models, "in-school" and "community", and to examine if socioeconomic status (SES) was a contributing factor.MethodsIndividual data from the Calgary Zone Public Health vaccination database for all grade 5 and 9 girls in Calgary for school years 2008-2011 were analyzed using descriptive statistics. These data included vaccination records for 35,592 girls. Logistic regression was used to examine the effect of delivery system and SES status on being vaccinated, controlling for school type.ResultsHPV vaccination completion rates were 75% (95% confidence interval = 74.7%, 75.8%) for girls with an "in-school" compared to 36% (95% confidence interval = 35.3%, 37.2%) for girls in schools with a "community" service delivery model. A girl's neighbourhood SES was related to the likelihood of being HPV vaccinated depending on the service delivery model available to her. For girls attending a Public school with an "in-school" delivery model, the proportion completing vaccination increased as SES decreased (high SES = 79%; medium SES = 79%; low SES = 83%; p-value<0.001). For girls attending Calgary Catholic School District schools with the "community" delivery model there was a decrease in immunization rates from high and mid to low SES (high SES = 41%; medium SES = 42%; low SES = 34%; p-value<0.001). These results show that those with lower SES were differentially disadvantaged by not having access to an "in-school" vaccination delivery model.ConclusionService delivery models make a difference in HPV vaccination completion rates and create inequities for health protection and disease prevention based on socioeconomic status.

Dataset Information

Promoting health equity through social capital in deprived communities: a natural policy experiment in Trieste, Italy.

Publications

Promoting health equity through social capital in deprived communities: a natural policy experiment in Trieste, Italy.

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