Local opportunity structures, social capital and social inequalities in health: what can central and local governments do?

Issues addressed: Health promotion policy, and strategies to improve social capital and reduce inequalities in health, should take into account both places and people. Methods: A study of physical features, availability of healthy environments, support services, sociocultural features, area reputation and social capital in two socially contrasting localities in Glasgow. Results: Local opportunity structures that might promote good health, and beneficial social capital, are less likely to be present in poorer areas, and levels of positive assessments of the neighbourhood, civic engagement, social trust and social cohesion are also lower in these areas. Conclusions: Policies should not focus exclusively on either places or people, but should be directed towards both; policies should be directed towards both the physical and social environment; and central and local governments should be encouraged to undertake health impact assessments and health inequalities impact assessments, on policies with an impact on the health of the local population. So what? The data suggest that the role of central and local government should be to strengthen infrastructural resources that promote health and social capital in more disadvantaged communities, to assess the possible consequences on population health and inequalities in health of a range of policies and programs and to use their planning powers to improve physical and social opportunity structures. (author abstract)