1. The espousal of social capital in Oral health care
Author: Dr. Shoeb Ahmed Ilyas BDS, MPH, EMSRHS, M.Phil. (HHSM), MHRM, MS (PSY), MS
(BIOTECH), PGDMLE, FHTA.
Health Care Quality Management Consultant
Ruby Med Plus, Telangana State, India.
Oral health is projected to be affected by the environment; to provide an understanding to this,
the concept of social capital can be used. Social networking appears to be the rational in social
capital in which there is ‘connections’ among individuals, a social network guided by a set of
values and norms of trustworthiness and reciprocity among peoples’, groups, communities etc of
the network. Putnami
(1995) defines social capital as “coordination and co- operation for mutual
benefit”. Hence it is not only a way of describing social relationships within a group or society,
but also adds a social dimension to traditional structural explanations of disease by viewing
communities not just as contextual environments, but also as connected groups of
individuals.ii
The theory of social capital emphasizes multiple dimensions inside the concept. For example,
social capital can be divided into a behavioral/activity component (for example, participation)
and a cognitive/perceptual component (for example, trust). These are respectively being referred
to as structural and cognitive social capital.iii
. Structural and cognitive social capital can therefore
refer to linkages and perceptions in relation to people who are akin to each other; such as people
in one’s own community or people of alike socioeconomic status (referred to as bonding social
capital), or to people who are poles apart; such as people outside one’s community or with a
different social identity (known as bridging social capital). Social capital relations can also occur
in ceremonial institutions such as between community and local government structures (termed
linking social capital)iv
.
Social capital is not a magic pill for improving society’s oral health but, it is a useful concept
which focuses our attention on an important set of resources, inhering in relationships, networks
and associations, which have previously been given insufficient attention in the social sciences
and Dental literature. This is probably partly because they are not easy to categories, study and

2. measure their effects quickly. The social capital perspective therefore broadcast us that if we
normatively approve of the goal of enhancing population oral health, we cannot achieve this
through material inputs alone, or simply through “technological fixes”, whether “forced” or
magnanimously “approved” by those with superior resources. Social capital can contribute
towards health promotion, in the extent to which it can be used for its strategic value; the concept
can be carefully employed within wider health promotion practices which explicitly draw upon
social justice, equity and empowerment principlesv
. Social capital draws on solidarity within
groups, communities, societies as well.
Building or sustaining healthy communities is an important weapon to prevent Dental Problems.
There is emerging evidences that the environment, place where people live is an important factor
in determining and sustaining inequalities in health outcome between individuals. Although there
is substantial geographical variation and inequality in Oral health status, understanding the role of
the social environment in the etiology of poor Oral health status is important for prevention of
Oral Health ailment in the community. There is good evidence in the Medical literature, that
health behavior and health care delivery are influenced by a broad range of systemic and social
factors, like social capital, and not only biomedical factors. Hence there is need to understand
how social capital may translate into better Oral health outcomes and health equity in Indian
Populations. In the Opinion of social scientists, policy makers, and international institutions like
World Health Organization and the World Bank, social capital contributes to health inequalities
within and between populations.
Oral Health-related Behaviors and Social Capital -
Social capital may influence community members’ oral health related behavior by promoting a
more rapid diffusion of health information, activity, and healthy behavior norms, health seeking
behavior (like brushing our teeths twice a day) and by exerting social control over deviant health-
related behavior, such as tobacco chewing. Another pathway is that privileged levels of
community cohesion result in higher degrees of social organization that enhances access to oral
health services that influence people oral health. Individual functioning and well-being is affected
by diverse social experience and conditions, which includes an individual’s social capital
environment. The theory of the diffusion of innovations suggests that the innovative behaviors

3. (e.g. use of preventive services) diffuse much more rapidly in communities that are cohesive and
that have higher levels of trustvi
.
Research in the 1970s on social support suggested a health-enhancing role for social relationships
in buffering the ill effects of stressvii
. People in societies with higher levels of social capital live
longer, have lower premature mortality rates, are less violent, and have lower levels of self-
perception of poor healthviii
. Social capital and social networks could improve community health
by alleviating stress levels caused by emotional and behavior problemsix
. Kawachi et al. 2004
note that ‘the growing gaps between the rich and the poor affect the social organization of
communities and that the resulting damage to the social fabric may have profound implications
for the public’s health.’
A recent ecological study in Brazil has assessed the relationship between income inequality,
social cohesion and dental caries levels in 12-year-old schoolchildren, findings show that income
inequality expressed by the GINI coefficient was significantly associated with percentage of
children free of caries and mean DMFx
. Social cohesion was significantly inversely associated
with percentage of caries free childrenxi
. At a local level oral health input into initiatives such as
the Health Promoting School network can produce sustainable improvements in oral health
outcomesxii
.
Oral health professionals working in isolation are unlikely to achieve sustained long-term
improvements in oral health,xiii
Hence Dentist working in collaborative partnerships with other
relevant professionals and agencies are more likely to produce desired results. Successful
collaborative working requires a shared agenda for action in which common risks/ health factors
are identified.xiv
Conclusion
Common Dental disorders like dental caries and Periodontitis can lead to substantial disabilities;
there is possibility that neighborhoods, residents’, characteristics can affect oral health of people
(which is of increasing interest to social researchers and epidemiologist). Income deprivation
and social capital measured at community level are potentially important joint determinants
of oral health. Poor oral health can be significantly associated with area-level income
deprivation, low social capital and state-society relations in which they are inherently embedded

4. and it also relies on the distinction between bonding, bridging and linking forms of social capital.
A “healthy society”, capable of consistently promoting the health of its citizens health, will be
characterized by a balanced distribution of a relatively rich endowment of all three of these forms
of social capital. Whether or not the resources of social capital which exist in any society will
take on health-promoting or health-degrading net effects is still not clear with diversified view of
pioneers in social capital.
References-
i
Putnam, Robert 1995. “Bowling Alone: America’s Declining Social Capital.” Journal of
Democracy, 6 (1): 65-78.
ii
Cullen, M and Whiteford, H (2001). The Interrelations of Social Capital with Health and Mental
Health. Canberra, National Mental Health Strategy, Canberra, Australia: Commonwealth
Department of Health and Aged Care.
iii
Bain, K and Hicks, N. Building social capital and reaching out to excluded groups: the
Challenge of partnerships. Paper presented at CELAM meeting on The Struggle against Poverty
towards the turn of the Millennium, Washington D.C., 1998.
iv
Szreter S, Woolcock M. Health by association? Social capital, social theory, and the political
economy of public health. Int J Epidemiol. 2004;33:650–667
v
Wakefield, S. E. L., & Poland, B. (2005). Family, friend or foe? Critical reflections on the
relevance and role of social capital in health promotion and community development. Social
Science & Medicine, 60(12), 2819-2832.
vi
Rogers, E. 1983. Diffusion of innovations. New York: Free Press
vii
Cassel, J. 1976. ‘‘The Contribution of the Social Environment to Host Resistance.’’ American
Journal of Epidemiology 104 (2): 107–23.
viii
Kawachi I, Kennedy B, Lochner K, Prothrow-Stith D. Social capital, income inequality and
mortality. Am J Public Health 1997; 87:1491–8?

5. ix
Berkman LF, Glass TA, Brissette I, Seeman TE From social integration to health: Durkheim in
the new millennium. Soc Sci Med. 2000;51:843–857
x
Marcos Pascoal Pattussi, Rebecca Hardy, and Aubrey Sheiham, “Neighborhood Social Capital
and Dental Injuries in Brazilian Adolescents” Am J Public Health.96:1462–1468; 2006
xi
Pattussi M, Marcenes W, Croucher R, Sheiham A in press The relationship between dental
caries in 6–12 year-old Brazilian school children and social deprivation, income inequality and
social cohesion. Soc Sci Med;in press
xii
Moyses S. The impact of health promotion policies in schools on oral health in Curitiba, Brasil.
PhD Thesis. University College London;2000.
xiii
Sprod A, Anderson R, Treasure E. Effective oral health promotion. Literature Review. Cardiff:
Health Promotion Wales;1996
xiv
Sheiham A, Watt R. The common risk factor approach – a rational basis for promoting oral
health. Community Dent Oral Epidemiol 2000; 28:399–406.
1) Author-
Dr.Shoeb Ahmed
B.Sc.,BDS, M.Sc.(Biotech),M.Sc.(Psy), MHRM,
M.PHIL (HHSM), EMSRHS, PGDMLE, PGDHM, PGDHA,
DEM & ISO14000/14001.
E-Mail- drshoeb_2k@yahoo.com
2) CO-Author
Dr.Irfana Sultana
BDS.
e-mail- irfana.anwar@gmail.com