Study finds high levels of social infrastructure lead to healthier communities

LAWRENCE — The United States spends significant amounts of money on health care every year, yet health outcomes have been declining. Scholars have long known that where a person lives, what they do for a living and other factors influence health, but new research from the University of Kansas has found that high levels of social infrastructure are associated with healthier communities.

Despite declining health outcomes across the country, some counties are consistently healthier than others. Using a social determinants of health theoretical framework, the researchers developed a multidimensional measure of social infrastructure and examined its relationship to public health outcomes. They found that communities with higher levels of social infrastructure — measured as social, human and cultural capital — also had better health outcomes.

Poor health outcomes in the United States are often described as a “wicked problem” in public affairs scholarship.

“This is something the U.S. has been going in the wrong direction on for quite a while. When people think about health, they often think of health care,” said Dorothy Daley, professor in the School of Public Affairs & Administration and the Environmental Studies Program at KU, one of the study’s authors. “That is actually just one small part of how healthy a person is. Where you live, where you work, where you go to school all shape your health, and we’re finding cultural capital can as well.”

For the study, researchers assembled and analyzed data from a variety of existing sources. Local health data was drawn from the County Health Ranking and Roadmap project. Social infrastructure measures were constructed using data measuring a range of civic organizations (social capital), educational attainment (human capital) and density of local arts organizations (cultural capital).

“Social infrastructure matters when it comes to public health outcomes, just like other factors we might think of more often like air quality,” said lead author Alisa Moldavanova, an associate professor at the University of Delaware who earned her doctorate from KU. “There was literature showing that people who engage in the arts form connections and have good health outcomes, but there were not studies on community-level outcomes and social infrastructure or its influence on a macro scale.”

The findings indicated that communities with more cultural capital are also more likely to have a higher percentage of residents in good health. The study’s authors say it both helps develop the concept of social infrastructure and its role in public health as well as testing the relationship among public health and social, human and cultural capital pillars of the concept.

The study, written by Moldavanova, Daley and John Pierce, affiliate professor of public affairs & administration at KU, was published in the journal The American Review of Public Administration.

A new dimension to public health policy

Overall, the results show that the percentage of people reporting fair or poor health declines as the density of social, human and creative cultural capital increases. Social, human and cultural capital are results of multigenerational public and private investment, and their association with better health outcomes suggest policy should support all three to help achieve better public health, the authors wrote. 

Often, especially in times of limited budgets, localities tend to focus on infrastructure like transit, bridges and utilities. And in terms of health care, policy often focuses on numbers of hospitals, beds available and numbers of health care professionals. While all of those are important, the findings show long-term community investment in social infrastructure, including arts and cultural capital, can have long-term, wide-ranging benefits, including improved public health. 

“We should be mindful as policymakers of supporting cultural infrastructure,” Moldavanova said. “It provides a sense of well-being at the community level. Even in communities without top-notch hospitals, the connection has positive effects. We shouldn’t be only looking at hospitals and physicians when thinking about health outcomes.”