Despite the vast sums of money the United States invests in health care annually, the nation’s health outcomes have been steadily deteriorating. While public health scholars have long recognised that social determinants—such as where one lives, works, and goes to school—play a crucial role in shaping individual and community health, new research from the University of Kansas adds a compelling dimension to this understanding. The study finds that robust social infrastructure is closely linked to healthier populations, suggesting that how communities are socially organised may be just as critical to public well-being as clinical care.
The research draws upon a social determinants of health framework and introduces a multidimensional measure of social infrastructure, encompassing social, human, and cultural capital. Researchers found a consistent pattern: counties with stronger levels of these forms of capital also had markedly better health outcomes. Social capital was defined through indicators such as civic organisation density, human capital through education levels, and cultural capital through the presence and concentration of arts institutions. These elements, taken together, constitute what the authors term “social infrastructure”—the collective social resources that underpin community resilience and vitality.
Professor Dorothy Daley of the School of Public Affairs & Administration and the Environmental Studies Program at the University of Kansas, one of the co-authors of the study, explained that people often mistakenly equate health with access to health care alone. “That is actually just one small part of how healthy a person is,” Daley noted. “Where you live, where you work, where you go to school all shape your health, and we’re finding cultural capital can as well.” In this context, cultural capital refers to the presence of institutions and opportunities that promote artistic and creative engagement, which in turn facilitate social cohesion and individual well-being.
The study’s methodology involved compiling and analysing data from various public datasets. Health outcome metrics were sourced from the County Health Rankings and Roadmap project. At the same time, indicators of social, human, and cultural capital were aggregated to construct a composite index of social infrastructure. Lead author Alisa Moldavanova, now an associate professor at the University of Delaware, explained that although previous studies have linked arts participation with individual health benefits, this research expands the scope by investigating how community-level investments in social infrastructure affect population health more broadly. The study thus offers empirical evidence to support the notion that health policy should move beyond hospitals and clinics to encompass cultural and social assets.
Perhaps most strikingly, the research found that as levels of social, human, and cultural capital increased, the percentage of people reporting fair or poor health declined significantly. These types of capital are the product of sustained public and private investment over generations. As such, the authors argue that improving health outcomes requires a long-term commitment to nurturing these elements within communities. Public health, they contend, cannot be disentangled from the social and cultural fabric of daily life. This insight calls for a more integrated policy approach that includes the support of arts, education, and civic life as part of a broader strategy for health promotion.
In their article, published in The American Review of Public Administration, Moldavanova, Daley, and co-author John Pierce emphasise the policy implications of their findings. They argue that while physical infrastructure—such as roads, utilities, and health care facilities—remains essential, social infrastructure must be given equal priority. Especially in an era of constrained public budgets, policymakers should be cautious not to overlook the long-term benefits of investing in social and cultural institutions. “We should be mindful as policymakers of supporting cultural infrastructure,” said Moldavanova. “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.” The study thus offers a timely reminder that building healthier communities requires not only medical resources but also the cultivation of environments where social and cultural life can flourish.
More information: Alisa Moldavanova et al, What Does it Take to Have a Healthy Community? Exploring the Role of Social Infrastructure in Shaping Public Health, The American Review of Public Administration. DOI: 10.1177/02750740251346805
Journal information: The American Review of Public Administration Provided by University of Kansas
