The Healthy People 2020 Social Determinants of Health topic area is organized into 5 place-based domains:
- Economic Stability
- Health and Health Care
- Neighborhood and Built Environment
- Social and Community Context
Civic Participation is a key issue in the Social and Community Context domain.
Civic participation encompasses a wide range of formal and informal activities.1 Examples include voting, volunteering, participating in group activities, and community gardening. Some are individual activities that benefit society (e.g., voting) or group activities that benefit either the group members (e.g., recreational soccer teams) or society (e.g., volunteer organizations).1 In addition to the direct benefit that civic participation provides to the community, it also produces secondary health benefits for participants.2, 3 This summary focuses on the relationship between civic participation, health, and well-being.
One way civic participation improves health is by building social capital, which is defined as “features of social organization such as networks, norms, and social trust that facilitate coordination and cooperation for mutual benefit.”4 For example, a study found that members of civic groups were more likely to be physically active. Belonging to civic groups expanded participants’ social networks, which made them more aware of opportunities to be physically active in their community.2 Engaging in meaningful civic activities can also help individuals develop a sense of purpose, which may promote continued civic participation.5 Social capital is discussed in more detail in the Social Cohesion summary.
Participating in the electoral process by voting or registering others to vote is an example of civic participation that impacts health.3 A study of 44 countries (including the United States) found that voter participation was associated with better self-reported health, even after controlling for individual and country characteristics.3 In another study, individuals who did not vote reported poorer health in subsequent years.6
Volunteering is a common form of civic participation that can yield health benefits.7, 8 Studies show that volunteers enjoy better psychological well-being and more positive emotional health.7, 9 Volunteering can increase social resources like having friends to call,9 which may help explain the association between volunteering and reduced levels of anxiety and depressive symptoms.9, 10 Additionally, 1 study found that volunteers have fewer risk factors for cardiovascular disease.8 Volunteering might be especially beneficial for older adults; a study of adults age 60 and older found that volunteers had a lower risk of cognitive impairment.11
Simply belonging to groups can improve health as well. Membership in formal groups (e.g., Girl Scouts, Kiwanis, Rotary, PTA) or informal groups (e.g., book clubs, bird watching clubs) has been shown to increase social capital and decrease social isolation among members.12, 13 As a result, these groups may indirectly improve the physical and mental health of their members.12 For example, a women’s group, the Red Hat Society, has been shown to provide emotional support and a sense of community to its members.13 Many formal and informal groups also engage in charitable activities that directly benefit health research (e.g., the Ice Bucket Challenge, Susan G. Komen Race for the Cure).
Individuals who are involved in community gardening may form a sense of neighborhood pride,14 experience an increased appreciation for their neighborhood and be more motivated to get involved in community life.15, 16 Community gardens also increase access to healthy foods. The California Healthy Cities and Communities project found that West Hollywood students with school community gardens increased their fruit and vegetable consumption by 10%.17
Civic participation varies by generation18 and education.5 Today’s young adults may be less likely to participate in civic activities18, 19 because they may not have access to information on how to get involved or they may not know how they can make a difference.19 Individuals with higher education levels may have more opportunities for civic engagement, as college students have opportunities to get involved in community affairs through fraternities, sororities, or other student organizations—but male college students are less likely to engage in civic activities than female students.20, 21 Other studies have found that African American, Latino, and Asian American college students are more likely to intend to volunteer than their white peers.20
Many different strategies can promote civic participation. Encouraging young people to be active in their community is important for promoting life-long civic participation. One study found that high school students involved in community service are more likely to vote and volunteer in adulthood.22 Initiatives like AmeriCorps, which are designed to help young adults serve their communities, have been shown to increase civic participation later in life as well.23, 24 Public health media advocacy campaigns are another strategy;—they promote policy change through media engagement and community action.25 Social media platforms like Facebook, Twitter, and YouTube offer a new frontier for civic participation (e.g., It Gets Better Project) and are associated with increased political participation offline as well.26
Additional research is needed to increase the evidence base for what can successfully impact the effects of civic participation on health outcomes and disparities. This additional evidence will facilitate public health efforts to address civic participation as a social determinant of health.
Disclaimer: This summary of the literature on access to primary care as a social determinant of health is a narrowly defined review that may not address all dimensions of the issue.i, ii Please keep in mind that the summary is likely to evolve as new evidence emerges or as additional research is conducted.
i Terminology used in the summary is consistent with the respective references. As a result, there may be variability in the use of terms, for example, black versus African American.
ii The term minority, when used in a summary, refers to racial/ethnic minority, unless otherwise specified.
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