Civic engagement, gender and self-rated health in poor communities: evidence from Jordan's refugee camps.(Case study)

ABSTRACT

This paper examines the association between civic engagement and self-rated health among a sample of adults living in refugee camps in Jordan. The analysis is based on a cross-sectional sample survey of all households residing in Palestinian refugee camps in Jordan, and interviewed in the spring and summer of 1999. The outcome variable is self-rated health. Associations between civic engagement and self-rated health are assessed using ?2 tests and logistic regression models. Findings from a logistic regression model show that civic engagement, as measured primarily by membership in clubs and other civic groups, has a significant association with self-rated health net of the effects of demographic, human capital and health risk factors. The final model shows that the effects of control variables are in the anticipated direction, with age, marital status, health risk, education and poverty statistically significant. However, the findings pertaining to civic engagement hold for men but not women. We conclude that civic engagement is a powerful and significant predictor of self-rated health status among refugee men living in poor communities, but not for women. Low literacy and persisting patriarchy may account for the non-significant association between civic engagement and health status among women in this context.

KEY WORDS

civic engagement; gender; self-rated health; refugees; Jordan; sociology

Introduction

Over the past decade, social capital has appeared on the public health agenda worldwide. A main reason for its appeal from a public health perspective, is increasing evidence of its pivotal role in the health and well-being of individuals and communities. Various investigations demonstrate a link between social capital and health-related outcomes, including overall and cause-specific mortality (Kawachi et al 1997; Lochner et al 2003; Skrabski et al 2003), morbidity or self-rated general health (Ellaway and Macintyre 2000; Kawachi et al 1999; Grundy and Slogget 2003), violent and juvenile crime (Sampson 1997; Galea et al 2002; Kennedy et al 1998), drug abuse (Lovell 2002), insecurity (Lindstrom 2003), smoking (Lindstrom 2003), physical activity (Ashton and Alvarez-Dardet 2003; Lindstrom et al 2003), sexual health (Holtgrave and Crosby 2003), mental health (McKenzie et al 2002), teen birth (Gold et al 2002), and access to health services (Aye et al 2002; Hendryx et al 2002). However, available studies have been largely based on secondary, aggregate data from Western societies particularly the US and UK. Despite growing research in this area, no study has examined the association between social capital on the health status of men and women separately in the Middle Eastern context.

This study examines the association between an important 'ingredient' of social capital, civic engagement, and self-rated health among the Palestinian refugee population in Jordan, using unique household survey micro data. The data set is unique in that it includes a wide range of demographic, health and socio-economic items on a population-based, representative sample of Palestinian camp-refugees in Jordan. The focus of the analysis is on the general health status of randomly selected adults aged 15 years and over, living in impoverished refugee camps. Two main questions are addressed: (1) what is the association between civic engagement (measured by group membership and an interest in current events through watching the television news and reading newspapers) with overall morbidity, net of other common risk factors?; and (2) does the association between civic engagement and morbidity differ by gender? Given the context of this study, we expect self-rated health to be associated with measures of civic engagement after controlling for other variables, but only among men.