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Over the past 25 years, research has established a causal association between social relationships and health.1,2 People who are socially isolated and have few ties to other individuals are more likely to suffer from poor physical and mental health and to die prematurely.
The notion of "social capital" has received increasing attention in health research. Social capital is generally defined as aspects of social organization, such as civic participation and trust in others, that facilitate cooperation among community members.3 High levels of social capital have been linked to lower mortality rates, lower rates of crime, and positive perceptions of health.3-7
There is, however, some debate about whether social capital benefits the community at large or individual residents, who profit directly from feelings of connectedness to the community. A recent study suggests that the association between social capital and positive perceptions of health is important at the individual level.7 It is hypothesized that feeling "connected" to one's community promotes health because such ties promote mutual respect, and thereby increase self-esteem. Another possibility is that interaction among community members results in the transmission of social norms related to health-promoting behaviours such as physical activity and refraining from smoking.1,2
Since its inception in 2000/2001, the Canadian Community Health Survey (CCHS) has included a question on community belonging. An earlier paper, based on data from the 2000/2001 CCHS, revealed an association between individuals' sense of belonging and their general self-perceived health.8 With data from the 2005 CCHS, this article updates that earlier work.
Comparisons are made between rates of community belonging at the provincial or territorial and health region levels. Because the 2005 CCHS contains questions about self-perceived mental health, the previous analysis can be extended by measuring associations between community belonging and mental as well as general health.
Majority feel connected
In 2005, close to two-thirds of Canadians (64%) reported a strong sense of community belonging; this included 17% who described their sense of belonging as very strong, and 47% who reported it as "somewhat strong." Just over a quarter (26%) reported a "somewhat weak" sense of community belonging; and 10%, "very weak."
Higher in Atlantic provinces and the territories
The likelihood of reporting a strong sense of community belonging varied across the country (Figure 1, Appendix Table A). Approximately three-quarters of the residents of the Atlantic provinces reported a strong sense of belonging, with Newfoundlanders having the highest rate among the ten provinces at 79%. Rates were also high for residents of the territories: 71% for Yukon Territory, 74% for the Northwest Territories, and 83% for Nunavut. Residents of Quebec were the least likely to feel connected, with only 55% reporting a strong sense of belonging. A previous study found that Quebecers were less likely to report a strong sense of belonging to Canada, but their sense of belonging to their province was similar to that of other Canadians.9
The degree to which the residents of health regions within each province felt connected to their respective communities also differed widely. Health regions made up of major urban centres tended to have the lowest rates of community belonging. For people living in predominately urban health regions (80% to 100% urban), the overall community belonging rate was 62%. In Ontario, the lowest rates were for the health regions of the City of Toronto, York, and the City of Ottawa; in Manitoba, the lowest rate was for Winnipeg; in Saskatchewan, Saskatoon; in Alberta, Calgary and the Capital health region (Edmonton); and in British Columbia, Vancouver. Conversely, rural health regions had higher rates of belonging. The figure for residents of health regions that were predominantly rural (10% or less urban) was 88% (Figure 2). The highest rate in the country was 90% in the Labrador-Grenfell health region in Newfoundland and Labrador.
The question on community belonging has been included in every CCHS cycle since 2000/2001. Because some cycles included only the population aged 15 or older and some excluded the territories, trends in rates were compared for the population aged 15 or older living in the ten provinces (Figure 3). From 2000/2001 to 2002, the proportion of the population reporting a strong sense of community belonging rose slightly from 57% to 58%. By 2003, the rate had risen 5 percentage points to 63% and has remained stable since then.
Between 2000/2001 and 2005, significant increases in community belonging occurred in all provinces except Newfoundland and Labrador (Figure 1) The sharpest upturn was in New Brunswick, where the rate rose from 62% to 73%. Conversely, in the territories, rates decreased in Nunavut and Yukon Territory, and no significant change was observed for the Northwest Territories.
Home language and cultural group
Community belonging was related to home language (Table 1). Among people who spoke mostly English at home, 68% reported a strong sense of community belonging. The figure was considerably lower (55%) among those whose home language was French. For those who spoke some other language at home, 60% reported a strong sense of belonging.
This low rate of community belonging at the national level for people whose home language was French reflects the situation in Quebec. In Quebec, a strong sense of belonging was reported by 61% of those whose home language was English, compared with 54% of those whose home language was French (data not shown). By contrast, in the other provinces and territories, the likelihood of reporting a strong sense of belonging was similar regardless of whether the home language was English or French (68% and 67%, respectively).
Associations between community connectedness and cultural or racial group were also observed. Among Whites, 65% reported a strong sense of community belonging. The figure was higher for South Asians (74%), and lower for Koreans (50%), Chinese (52%), Southeast Asians (52%) and Latin Americans (54%).
Age, marital status, socio-economic characteristics
While the proportions of men and women who reported a strong sense of community belonging did not differ, rates did vary by age group. More than three-quarters (77%) of youth aged 12 to 17 reported a strong sense of belonging, but among young adults aged 18 to 29, the figure was much lower at 55%. At older ages, the rate increased steadily from 62% among those aged 30 to 44 to 72% among seniors (65 or older).
Feeling connected to the community was less common among people who were divorced or separated (57%) or never married (54%) than among those who were married or living common-law (65%). People living with young children were slightly more likely than those who did not have young children in their household to have a strong sense of belonging.
Modest associations were observed between community belonging and socio-economic status. People in the lowest household group were less likely to report a strong sense of community belonging, compared with those in the middle-income group, but there were no differences for the remaining income groups. The only association with education was that postsecondary graduates were slightly less likely to feel connected than were people who had completed only high school.
Home ownership, however, did make a difference, with 67% of owners reporting a strong sense of community belonging, compared with 55% of those who were not owners.
When examined in a multivariate model, these associations between community belonging and cultural and socio-demographic characteristics generally persisted (Appendix Table B). Because rates of community belonging differed by age group and the age structure of the population has shifted slightly since 2000, rates over time were recalculated to standardize to the 2005 population. The crude and age-standardized rates were virtually identical (data not shown), indicating that the increases over time were not due to changes in the age distribution of the population. As well, to ensure that geographical differences were not the result of differing age distributions, provincial and health region rates were age-standardized to the overall 2005 Canadian population. Again, the crude and adjusted rates were similar; the results of significance testing between provincial and health region rates versus the overall Canadian rate (Appendix Table B) remained virtually unchanged when based on adjusted rates.
Community belonging and health
Close to two-thirds of those who felt a very strong or somewhat strong sense of community belonging reported excellent or very good general health (Figure 4). By contrast, about half (51%) of those with a very weak sense of belonging viewed their general health favourably. These findings are particularly relevant in view of evidence that self-perceived general health is predictive of chronic disease incidence, use of medical services, recovery from illness, functional decline, and mortality.10-15
The likelihood of reporting excellent or very good mental health also paralleled decreases in connectedness—from 81% among those with a very strong sense of community belonging down to 64% among those whose sense of community belonging was very weak (Figure 4).
Even when other potentially confounding factors were taken into account, community belonging was strongly related to self-perceived general and mental health (Table 2). Compared with people whose sense of community belonging was weak, those with a very strong sense had close to twice the odds of reporting excellent or very good general health (Model 1), and over twice the odds of reporting excellent or very good mental health (Model 3).
When people rate their general health, psychological factors play a role in perceptions.19 Therefore, the degree to which physical and mental factors contribute to associations between community belonging and perceptions of general health is unknown. When the relationship between community belonging and self-perceived general health was examined in a model controlling for self-perceived mental health in addition to other possible confounders, the odds ratios for community belonging diminished but were still significant (Model 2). This suggests that a sense of community belonging is associated with both physical and mental health. However, because of the cross-sectional nature of this analysis, it is not possible to determine if health exerts an influence on sense of community belonging or the other way around.
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