Introduction

The health status and life opportunities of those in poorer communities are less than those elsewhere (Australian Institute of Health and Welfare 1998). Responding to this situation is internationally recognised as requiring a multifaceted national as well as community approach that includes both social and economic initiatives (World Health Organization 1986a). This chapter explores the potential for social capital to provide a framework for developing communities in such a way that the health and life opportunities of poorer communities are improved.

We address the relationship between social capital and the health and life opportunities of people in communities. This includes not only the individual health of those in communities, as often measured by mortality, morbidity, and quality of life instruments, but also the idea that there are ‘healthy communities’ in and of themselves - communities in which there is a good stock of social capital and other forms of resource. ‘Life opportunities’ refers to the equality of opportunity that comes about through the local availability of many types of resources - for example, access to local childcare to encourage early child development that is so important to later achievements at school and beyond. Indeed, where access to and availability of social, economic and cultural resources are limited, so the life opportunities are also limited and this eventually becomes reflected in health statistics.

The breadth of views about social capital necessitates a brief investigation of its historical origins and the way different disciplines have conceptualised the links to health and life opportunities. We begin with the theoretical underpinnings, address some of the key empirical findings and them describe the Adelaide study of health development and social capital. This is a study that pays attention to levels and types of local participation in community life, the role of organisations and groups in the generation of social capital in communities, and the predictive value of social capital on health status.

Historical and theoretical underpinnings

The 1960s saw the adoption of ideas about social capital as the source for social action in a range of community studies.

Why publish yet another book about the social determinants of health? This was the initial reaction of a reader to whom Cambridge University Press sent our book proposal. The response is unsurprising. The past decade has seen the publication of some 15 books, major reports or special journal issues dealing with the social determinants of health. The number of individual journal articles has soared.

Can there really be a need for another overview of the subject? Cambridge's reader went on to say the initial scepticism was immediately dispelled by the originality of the material and the arguments put forward by the individual contributors: ‘I am persuaded that this book will make a substantial, and novel, contribution to the literature, both in Australasia as well as internationally.'

We are also confident of the value of this book—for two main reasons. First, the existing literature has focused on the North American and European situations; we want to put the Antipodes on the social epidemiological map. Secondly, the recent literature has concentrated on socio-economic inequality as a prime determinant of health; we believe this book adds important historical, global and cultural dimensions to the social sources of health and well-being.

The book has its origins in the establishment of the Health Inequalities Research Collaboration by the Australian Commonwealth Department of Health and Aged Care to promote a better understanding of why some groups in the community are healthier than others. One of the early tasks of the Collaboration was to organise a major conference, held in Canberra in July 2000. Its aim was to build scientific, public and policy recognition of the importance of the social determinants of health. New Zealand participants and perspectives were included because research and policy development in this area are more advanced there than in Australia.

From the conference came the book. It brings together leading scholars from both countries to establish a baseline of what we know and what we need to do. There are, inevitably, omissions. Between conference and book, a few contributions fell by the wayside. But other perspectives were added, particularly on the implications for policy, intervention and research.

Our virtues? – We probably still have our virtues too, although of course they will not be those trusting and muscular virtues for which we hold our grandfathers in honor – but also slightly at arm's length. We Europeans from the day after tomorrow, we firstborn of the twentieth century, – with all of our dangerous curiosity, our diversity and art of disguises, our worn-out and, as it were, saccharine cruelty in sense and in spirit, – if we happen to have virtues, they will presumably only be the ones that have learned best how to get along with our most secret and heartfelt propensities, with our most fervent desires. So let us look for them in our labyrinths! where, as we know, so many things lose their way, so many things get entirely lost. And is there anything more beautiful than looking for your own virtues? Doesn't this almost mean: believing in your own virtue? But this “believing in your own virtue” – isn't this basically what people used to call their “good conscience,” that venerable, long-haired pigtail of a concept that hung on the back of our grandfathers' heads, and often enough behind their intellects too? And so it seems that however up-to-date and unworthy of grandfatherly honor we might otherwise appear, there is nevertheless one respect in which we are the worthy grandchildren of these grandfathers, we last Europeans with a good conscience: we still wear their pigtail.

Suppose that truth is a woman – and why not? Aren't there reasons for suspecting that all philosophers, to the extent that they have been dogmatists, have not really understood women? That the grotesque seriousness of their approach towards the truth and the clumsy advances they have made so far are unsuitable ways of pressing their suit with a woman? What is certain is that she has spurned them – leaving dogmatism of all types standing sad and discouraged. If it is even left standing! Because there are those who make fun of dogmatism, claiming that it has fallen over, that it is lying flat on its face, or more, that dogmatism is in its last gasps. But seriously, there are good reasons for hoping that all dogmatizing in philosophy was just noble (though childish) ambling and preambling, however solemn, settled and decisive it might have seemed. And perhaps the time is very near when we will realize again and again just what actually served as the cornerstone of those sublime and unconditional philosophical edifices that the dogmatists used to build – some piece of folk superstition from time immemorial (like the soul-superstition that still causes trouble as the superstition of the subject or I), some word-play perhaps, a seduction of grammar or an over-eager generalization from facts that are really very local, very personal, very human-all-too-human.

O sancta simplicitas! What a strange simplification and falsification people live in! The wonders never cease, for those who devote their eyes to such wondering. How we have made everything around us so bright and easy and free and simple! How we have given our senses a carte blanche for everything superficial, given our thoughts a divine craving for high-spirited leaps and false inferences! – How we have known from the start to hold on to our ignorance in order to enjoy a barely comprehensible freedom, thoughtlessness, recklessness, bravery, and joy in life; to delight in life itself! And, until now, science could arise only on this solidified, granite foundation of ignorance, the will to know rising up on the foundation of a much more powerful will, the will to not know, to uncertainty, to untruth! Not as its opposite, but rather – as its refinement! Even when language, here as elsewhere, cannot get over its crassness and keeps talking about opposites where there are only degrees and multiple, subtle shades of gradation; even when the ingrained tartuffery of morals (which is now part of our “flesh and blood,” and cannot be overcome) twists the words in our mouths (we who should know better); now and then we still realize what is happening, and laugh about how it is precisely the best science that will best know how to keep us in this simplified, utterly artificial, well-invented, well-falsified world, how unwillingly willing science loves error because, being alive, – it loves life!

In Europe these days, moral sentiment is just as refined, late, multiple, sensitive, and subtle as the “science of morals” (which belongs with it) is young, neophyte, clumsy, and crude: – an attractive contrast, and one that occasionally becomes visible, embodied in the person of the moralist himself. Considering what it signifies, the very phrase “science of morals” is much too arrogant and offends good taste, which always tends to prefer more modest terms. We should admit to ourselves with all due severity exactly what will be necessary for a long time to come and what is provisionally correct, namely: collecting material, formulating concepts, and putting into order the tremendous realm of tender value feelings and value distinctions that live, grow, reproduce, and are destroyed, – and, perhaps, attempting to illustrate the recurring and more frequent shapes of this living crystallization, – all of which would be a preparation for a typology of morals. Of course, people have not generally been this modest. Philosophers have all demanded (with ridiculously stubborn seriousness) something much more exalted, ambitious, and solemn as soon as they took up morality as a science: they wanted morality to be grounded, – and every philosopher so far has thought that he has provided a ground for morality. Morality itself, however, was thought to be “given.” What a distance between this sort of crass pride and that supposedly modest little descriptive project, left in rot and ruin, even though the subtlest hands and senses could hardly be subtle enough for it.

The human soul and its limits, the scope of human inner experience to date, the heights, depths, and range of these experiences, the entire history of the soul so far and its still unexhausted possibilities: these are the predestined hunting grounds for a born psychologist and lover of the “great hunt.” But how often does he have to turn to himself in despair and say: “Only one! only a single one! and this huge forest, this primeval forest!” And then he wishes he had a few hundred hunting aides and well-trained bloodhounds he could drive into the history of the human soul to round up his game. To no avail: time and again he gets an ample and bitter reminder of how hard it is to find hounds and helpers for the very things that prick his curiosity. The problem with sending scholars into new and dangerous hunting grounds, where courage, intelligence, and subtlety in every sense are needed, is that they stop being useful the very moment the “great hunt” (but also the great danger) begins: – this is just when they lose their sharp eye and keen nose. For instance, it might take somebody who is himself as deep, as wounded, and as monstrous as Pascal's intellectual conscience to figure out the sort of history that the problem of science and conscience has had in the soul of homines religiosi so far.

Genuine teachers only take things seriously where their students are concerned – even themselves.

“Knowledge for its own sake” – this is the final snare morality has laid; with it, we become completely entangled in morals once again.

Knowledge would have little charm if there were not so much shame to be overcome in order to reach it.

People are at their least honest when it comes to their God: he is not allowed to sin!

The tendency to let oneself be debased, robbed, lied to, and exploited could be the shame of a god among men.

It is barbaric to love one thing alone, since this one love will be pursued at the expense of all others. This includes love of God.

“I did that” says my memory. I couldn't have done that – says my pride, and stands its ground. Finally, memory gives in.

You have been a poor observer of life if you have not also seen the hand that, ever so gently – kills.

If you have character, you also have a typical experience that always comes back.

The sage as astronomer. – If you still experience the stars as something “over you,” you still don't have the eyes of a knower.

It is not the strength but the duration of high feelings that makes for high men.

Precisely by attaining an ideal, we surpass it.

Many peacocks hide their peacock tails – and call that their pride.

The will to truth that still seduces us into taking so many risks, this famous truthfulness that all philosophers so far have talked about with veneration: what questions this will to truth has already laid before us! What strange, terrible, questionable questions! That is already a long story – and yet it seems to have hardly begun? Is it any wonder if we finally become suspicious, lose patience, turn impatiently away? That we ourselves are also learning from this Sphinx to pose questions? Who is it really that questions us here? What in us really wills the truth? In fact, we paused for a long time before the question of the cause of this will – until we finally came to a complete standstill in front of an even more fundamental question. We asked about the value of this will. Granted, we will truth: why not untruth instead? And uncertainty? Even ignorance? The problem of the value of truth came before us, – or was it we who came before the problem? Which of us is Oedipus? Which one is the Sphinx? It seems we have a rendezvous of questions and question-marks. – And, believe it or not, it ultimately looks to us as if the problem has never been raised until now, – as if we were the first to ever see it, fix our gaze on it, risk it. Because this involves risk and perhaps no risk has ever been greater.