Health as/and social capital: A critical history of a concept

Theoretically informed by the regulation school perspective and using a form of discourse analysis framed as an ideological critique, this thesis makes two general arguments. The first and most general is that the popularization of social capital theory is integral to the formulation of an emergently hegemonic discourse of communitarian liberalism that, I argue, is characteristic of a new mode of regulation. The second, and somewhat more specific, argument is that the adoption of social capital into the discourse of population health produces models of health disparities that run with the grain of communitarian liberalism. I argue that the political discourse of communitarian liberalism displaces a critical 'vertical' analysis of inequality as the outcome of dynamic relations of power and structurally determined differential access to resources. It offers instead, I suggest, a 'horizontal' analysis that posits inequality as static hierarchy and that focuses on behavioural aspects of 'exclusion': 'welfare dependency', the putative erosion of civic spirit, political disengagement, epidemic cynicism, and declining levels of trust and reciprocity, at the level of the individual. Social capital provides a timely idiom through which to articulate this horizontal problematic as a new politics of 'common-sense'. I argue that social capital theory in population health gestures toward a stance that invokes the category of the social as a means of enabling more sophisticated and putatively sociological forms of analysis and explanatory models (I call this the 'left wing effect'). The endeavour is ultimately characterized, I argue, by a failure to engage with the complex interrelated contingencies of social settings---a failure rooted in the reductive epistemological orientation (the 'abstract empiricism') of epidemiology and quantitative sociology---offering instead a handful of ahistorical and ostensibly universal proxies. Ultimately, I conclude, population health models deploying the concept of social capital tend to develop explanatory narratives that are congruent with communitarian liberal discourse and which foreground characterizations of the social determinants of health in terms of an individualized (psychosocial) problematic of exclusion (for which the antidote is a sort of moral reengagement in and through virtuous civil communities) rather than critical structural or systemic characterizations.