EXTRACCIÓN DE LA ESCUELA

Th e fi rst group of publications (discussed here) demonstrates a relation- ship between social cohesion in terms of civic participation (electoral behavior, membership in political or nonpolitical associations), trust in governments and health. According to some authors, low participation together with worsening material factors aff ects health negatively (Marmot and Bobak 2000). Other authors examine civic participation without investigating the eff ects of other material factors. For example, Kennedy et al. (1998), Reitan (2003) and Carlson (1998) study participation rates exclusively and reach the general conclusion that countries with higher rates of civic participation (expressed in voting or in membership in nonpolitical organizations) have better health.

Kennedy et al. (1998) attempt to establish particular ways in which individual health is related to social context. Th ey argue that if people do not vote and do not show interest in politics (which prevents good governance), their quality of life and health will worsen. Th e authors rely on secondary data (that is not on their data but on social capital in the sociological literature) to support their argument about the salience of “social capital” and the assumed “lack of civil society” in Russia. Some of their fi ndings suggest that the mortality rates of isolated people is twice or three times that of more well-connected people.

Countries with higher rates of civic participation have better health.

Bypassing the large fi eld of criticism of the social support theory (see further below) the authors argue that it is a well-established fact that social cohesion enhances well-being.

In a more critical manner, Reitan (2003) examines the relationship between life expectancy and electoral turnout. He concludes that his research has not found a clear causal link between the two despite some existing correlations. Moreover, the author suggest that there will be other factors at play even when regions with relatively higher life expectancy are more likely to produce higher turnout at elections. He names higher income and regional prosperity, both of which are context related factors. Th e author suggests that there may be an independent path of public health (that is that public health may be infl uenced by other factors) whose path trajectory (that is the way health improves or deteriorates) just happens to coincide with the electoral turnout’s one.

Despite certain self-admitted limitations Carlson (1998) presents more nuanced data than the previously mentioned research. His results show that countries with a higher degree of membership in organizations have better self-perceived health. However, for people in Eastern Europe it was found that life-control matters more than membership in organizations in assessing self-perceived health. Th e most powerful predictor of self-perceived health in both Western and Eastern Europe remained economic satisfaction. In this way, the author concludes that household economies must be improved fi rst despite the importance of control in everyday life and the need for a stronger civil society. Th e author argues that processes at both micro (at individual and household level) and macro (for example macroeconomic or political) levels should both be considered in relation to health

Unfortunately, all three publications are concerned with very large areas (Europe as a continent, whole countries, or regions) and their fi ndings tell little about the day-to-day realities and the actual mechanisms through which their fi ndings work. All of them present diff erent evidence about the causal (or other) links between social cohesion (in terms of civic participation) and health. Two of the

Political disengagement can be protective and lead to a better psychological health and, thus, a better ability to cope with post-confl ict situations.

authors show that there may be no link at all and that there may be other signifi cant factors aff ecting health. Rose (2001) demonstrates that most of his indicators of social integration (for example membership in organizations) consistently fail to appear to have a signifi cant infl uence on health. Th e work by Jones (2002) even suggests that, in particular situations, such as the postwar one, lack of participation may be more constructive in some respects.

Jones (2002) provides data from an extensive qualitative research on youth and political engagement in Bosnia and Herzegovina. She argues that while political engagement may be useful for health in low- level confl icts (where there is a scope for action), in other cases political disengagement may be protective and may lead to a better psychological health and, thus, to a better ability to cope with the postconfl ict situation. She points however to one drawback in disengagement in this situation: the risk of ethnic separatism remaining unquestioned.

Th is study highlights the great importance of context in considering civic engagement and health and the need to address the entire complexity of the society. Th e author also shows that focusing on individual psychological recovery is important but structural changes (reenergizing the economy, integration and modernization of the education system, political initiatives, etc) have equally important and sustainable results on psychological well-being.

Th e research on these themes suggests that there might be very limited conclusive evidence about health and civic participation and the only certainty is that there is no clear or solid causal link between the two.