This article aims at contributing to the discussion on the features of public health systems consistent with the broader definition of health--broader than the strictly bio-medical one--which is currently accepted in the related literature. The questions it raises are on how social capital influences well-being, and on whether and how it can be recognized and cultivated as a basic resource for health, and integrated into the health systems.
In the first part, research literature on the ways health conditions are correlated with both poverty and social capital is briefly discussed. In the second part, several cases on health prevention and rehabilitation programs are analysed in some detail, as they appear to improve the health conditions of a community by investing in its 'social capital'. The main insights are on how to combine social protection with individual agency.
Introduction: Rethinking Public Health Systems
It is well known that people's health conditions do not solely depend on advances in science and the medical professions but are also greatly influenced by social factors of well-being. The case of tuberculosis is a classic example in this respect. As the historical literature on this epidemic and the present research on its reappearance both show, (WHO 2000) the biomedical knowledge of this disease and of its cure, the penicillin vaccine, is a crucial but in itself insufficient factor to successfully fight the epidemic: more important have been and continue to be the battle against social inequalities and the improvement in living conditions and educational levels of the poorest sections of the population (Farmer 1999). Above all, as Bloom argues (2001), public health, and society's commitment to a TB-free environment as a 'public good', more than biomedical science, have been and still are crucial factors in the eradication of this epidemic. As the TB example shows, the degree of social well-being of individuals, social groups and populations influences both their health needs and the effectiveness of health professional performance, both in terms of demand and supply (Bloom 2001).
On the one hand the cultural, economic and social conditions of social groups and populations influence their health needs. This influence has been described and widely documented by the research literature, above all in the case of health conditions in developing countries. The health conditions of a population are, in this respect, an inseparable aspect of a more general state of well-being. The basic indicators of health conditions, such as morbidity and mortality rates, and life-expectancy at birth show a strong correlation not only with indicators related to aggregate socioeconomic conditions (income, employment, nutrition, etc.) but also with indicators related to other indirect variables of well-being. For instance, education, especially women's education, rates have a significant impact on human development indicators, such as the life expectancy at birth rates. (1) Equally significant is the correlation between political variables--such as the presence of democratic institutions, the degree of participation in public life--and the population's conditions of well-being, of which, as we mentioned above, health is an important component. (2)...