RELATION OF SOCIAL CAPITAL TO HEALTH AND WELL-BEING IN THE ASIA PACIFIC VALUES SURVEY: A POPULATION-BASED STUDY

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1 Behaviormetrika Vol.42, No.2, 2015, RELATION OF SOCIAL CAPITAL TO HEALTH AND WELL-BEING IN THE ASIA PACIFIC VALUES SURVEY: A POPULATION-BASED STUDY Kazue Yamaoka and Ryozo Yoshino The relation of social capital to adult health and well-being was examined using data from Asia Pacific Values Survey ( ). The relationships between health and well-being factors (self-reported somatic symptoms [SRSS], subjective health satisfaction [HS], lifesatisfaction [LS], and family life satisfaction [FS]) and social factors (socioeconomic status [SES]) were analyzed by a logistic regression model. Adjusting for SES, the lack of trust measured by three social capital items was related to poor SRSS, HS, LS, and FS, but some relationships were not significant. Among the Asia Pacific countries, Singapore showed good health and well-being compared with Japan. This study provides evidence that social capital dimensions are positively associated with SRSS and overall well-being in Asia Pacific countries. 1. Introduction During recent decades, the effects of social capital on adult health and well-being have attracted attention in the field of public health. Following the influential work of Putnam (1993), social capital is defined in terms of trust, norms of reciprocity, and social networks. While there have been important conceptual revisions of social capital theories, there is still no single unified or generally accepted theory. However, most conceptualizations of social capital include both structural and cognitive aspects. Furthermore, it has been increasingly acknowledged that social capital is an important determinant of health and overall well-being, and a variety of health outcomes and measures of well-being have been linked to the structural and cognitive dimensions of social capital. The structural dimension of social capital as indicated by organizational memberships (the number of organizations to which people belong) and the cognitive dimension of social capital, which is indicated by general trust in people (interpersonal trust) and norms of reciprocity, have been associated with mortality, life expectancy, and self-reported health status and well-being (Kawachi et al., 2004, Mitchell & Bossert, 2006). For a better understanding of the theoretical concept of social capital, it is necessary to break down the concept of social capital into two levels, i.e., at the micro level (of the individual) and at the aggregated level (of the area or nation-state). At the individual level, social capital refers to the network to which an individual belongs. Key Words and Phrases: self-reported somatic symptoms, health satisfaction, well-being, social capital, East Asia, population-based survey Teikyo University Graduate School of Public Health, Kaga, Itabashi-ku, Tokyo , Japan. kazue@med.teikyo-u.ac.jp Survey Science Center, The Institute of Statistical Mathematics, 10 3 Midori-cho, Tachikawa, Tokyo , Japan

2 210 K. Yamaoka and R. Yoshino Individuals derive benefits from knowing others with whom they form networks of interconnected agents. An ecological societal construct rather than a characteristic of individuals is considered at the aggregated (group) level. Social capital in this sense is a resource of a group of people. Some reports have been based on analysis at the individual level (Poortinga, 2006) and others at the aggregated level (Muntaner & Lynch, 2002; Kawachiet al., 2004). For instance, the measures of social capital and individual indicators such as interpersonal trust, norms of reciprocity, and organizational membership used in the General Social Survey have been studied in relation to health (e.g., Kawachi & Kennedy, 1997; Kawachi et al., 1997). Veenstra (2005) examined the relationship between self-reported health and social capital indicators determined from individual responses to items addressing civic participation, trust in government, trust in neighbors, trust in people from the community, and trust in people in general. Associational involvement and/or interpersonal trust were reported to be related to health in studies from Australia (Baum & Ziersch, 2003) and Russia (Rojas & Carlson, 2006) as well as the USA (Kawachi, 1999). Yip et al. (2007) empirically examined relationships between social capital and health and well-being in rural China and found that cognitive social capital (i.e., trust) is positively associated with three outcome measures at the individual level and also with psychological health and well-being at the village level. A national-level study including countries from Europe, North America, and Asia found an index of social capital to be positively associated with satisfaction with life (Bjornskov, 2003). For instance, using crossnational data from the World Values Surveys from the United States and Canada, Helliwell and Putnam (2004) found that civic engagement, trust, and social ties were all independently associated with health and act through health on well-being. Few studies (Yamaoka,2005, 2008; Tsunoda et al., 2008; Sakurai et al., 2010) have been performed in Asian countries compared with Europe and America. Therefore, we have conducted a cross-national interview survey, the Asia Pacific Values Survey: Cultural Manifold (Japan, South Korea, India, Vietnam, Singapore, Beijing, Shanghai, Hong Kong, Taiwan, Australia, and USA) in (Yoshino, 2014a, 2015). We have repeatedly reported regional variations in general response tendencies in our longitudinal and cross-national questionnaire surveys using cultural linkage analysis (Yoshino & Hayashi, 2002) and cultural manifold analysis (Yoshino et al., 2009; Yoshino, 2013, 2014a, 2015) over half a century by the Institute of Statistical Mathematics. For example, Japanese tend to avoid polar answers and prefer neutralcategories, the French tend to choose negative categories, and Indians tend to choose positive categories (Yoshino, Nikaido, Fujita, 2009). To investigate the relations of social and cultural factors to health, we analyzed the nationwide representative data from the East Asia Value Survey performed by Yoshino and his colleagues during The present study aimed to investigate the effects of social capital on individual health in Asia Pacific countries based on the results of a population-based survey. The study question was, Is social capital associated with health and well-being in Asia Pacific countries? Based on our findings, information about the extent to which the

3 RELATION OF SOCIAL CAPITAL TO HEALTH AND WELL-BEING IN THE ASIA PACIFIC VALUES SURVEY: A POPULATION-BASED STUDY 211 concept of social capital can be transferred to Asian Pacific countries can be used to suggest policy recommendations. 2. Method 2.1 Study population and sample surveys Data were collected from cross-national surveys conducted in the Asia Pacific Values Survey countries (Japan, South Korea, India, Vietnam, Singapore, Beijing, Shanghai, Hong Kong, Taiwan, Australia, and USA) in The target population included adults (mainland China and Hong Kong: aged 18 years and older; other countries: aged 20 years and older) residing in each country. Each survey involved a face-to-face interview conducted by interviewers who had extensive experience conducting interviews and who were specifically trained to conduct this particular interview. The questionnaire was a structured questionnaire specifically developed for the study and was accompanied by a standardized answer sheet to record the responses. Because one of the most important objectives of our survey was to investigate the applicability of statistically rigorous methods of random sampling, we made every effort to use probabilistic random sampling whenever possible. Specifically, we could not use resident or voting registration lists except in Japan, where the respondent was selected directly with a stratified two-stage sampling method using resident and voter registration lists. The sample selection process differed between countries corresponding to their local circumstances. The details of the survey methods and survey results are shown by Yoshino (Yoshino, 2014a, 2015). 2.2 Measures The original structured questionnaire consisted of 60 items related to social and cultural attitudes and values, such as cultural identity, socioeconomic status (SES), interpersonal relationships, leadership, religious attitudes, and social values regarding science and technology, politics, social security, freedom of speech, quality of life, and health, and five SES items. In all questionnaires, linguistic cross-cultural comparability was investigated using a translation and back-translation method between Japanese and each country s language. In this study, we focused on the items related to social capital and SES as explanatory variables and health and well-being as outcome measures. The questions used were shown in Appendix and summary tables are available in Yoshino (2014a, 2015). To measure individual-level factors related to social capital, the number of organizational memberships (structural social capital) and sense of trust (cognitive social capital) were used. Items related to socioeconomic and sociodemographic variables (SES) were also used as explanatory variables Social capital and social support Organizational membership (or civic associations), a dimension of structural social

4 212 K. Yamaoka and R. Yoshino capital, has been cited as a factor that influences health (Kawachi & Kennedy, 1997). It was measured as being involved in one or more voluntary organizations, which included sports, hobby, or literature groups, alumni associations, church groups, or political organizations. This item was used as a dichotomous variable (belonging to any: 1; none: 0). Subgroup analysis was performed to clarify the difference between voluntary and benefit-oriented associations. The results were almost concordant; therefore, the combined measurement was used in the present study. Sense of trust, a dimension of cognitive social capital, is measured by three items related to trust. These questions were from the General Social Survey conducted by the National Opinions Research Center (Chicago, IL, USA), namely interpersonal trust (assessed by the question: Generally speaking, would you say that most people can be trusted or that you can t be too careful in dealing with people? with two possible answers: can be trusted or can t be too careful ); norms of reciprocity (assessed by the question: Would you say that most of the time, people try to be helpful, or that they are mostly just looking out for themselves? with two possible answers: try to be helpful or look out for themselves ); and fairness (assessed by the question: Do you think that most people would try to take advantage of you if they got the chance, or would they try to be fair? with two possible answers: take advantage or try to be fair ). Trust in organizations, a dimension of cognitive social capital, was also measured. Ten items related to trust in social organizations and science and technology (religion, the law and legal system, press and television, police, national government bureaucracy, national assembly, nonprofit and nongovernmental organizations, social welfare facilities, United Nations, or science and technology) were used. The number of positive responses of very confident and somewhat confident was recorded and used as an item of trust in organizations. A higher score denoted greater trust (maximum: 10; minimum:0). Social support is measured by the items related to person to consult and human support as follows. The question of person to consult is With whom of the following people would you consult first for your personal problems and important matters? Problems meant troublesome or worrisome issues, such as health, money, or interpersonal relations. Response categories are father, mother, brother and sister, other family member or relative, school teacher, friend, other, I don t have anyone with whom I can confide, and I don t have any problems. The response I don t have anyone with whom I can confide was considered to express poor social support (human support). Items related to human support for material, spiritual, consulting, and esteeming were used as other social support items. These were assessed by the question: How many friends or family members can you count on for each of the following? A (material): Lend you money, a helping hand, or anything you might need to borrow, B (spiritual): Understand your feelings and situation, C (consulting): Let you call them anytime to speak freely or seek advice, D (esteeming): Highly appreciate and respect you ; with four possible answers: a lot, some, one, and nobody for each. For these, we treated the former three categories as having as opposed to nobody.

5 RELATION OF SOCIAL CAPITAL TO HEALTH AND WELL-BEING IN THE ASIA PACIFIC VALUES SURVEY: A POPULATION-BASED STUDY SES Variables analyzed included self-reported social class as well as sociodemographic factors, which were sex, age, and education. There were five answers to self-reported social class : high, fairly high, middle, fairly low, and low. The variable of age was divided into three categories (<34, 35 49, or 50+ years). Education was classified into three categories (low, middle, or high) by each country. In the logistic regression model, education was used as a continuous variable because a linear association was confirmed Outcome measures It is widely reported that self-reported health in women is slightly poorer than in men and that self-reported health is a powerful predictor of clinical outcome, mortality, and morbidity (Fayers & Sprangers, 2002), even though the mortality rate in women is lower than that in men. In the present study, we used four measures of health and well-being: number of self-reported somatic symptoms (SRSS), degree of subjective health satisfaction (HS), life satisfaction (LS), and family life satisfaction (FS). Items included somatic symptoms such as headache, backache, nervousness, depression, and insomnia. The number of SRSS was calculated as the sum of reports of the five symptoms and a dichotomous variable (having any symptoms: 1; none: 0) was used for SRSS. HS, LS, and FS were assessed by the questions: In relation to others of your age, how satisfied are you with your health? and How satisfied are you with your life as a whole these days? Respondents chose from four possible answers: very satisfied, satisfied, not very satisfied, and not satisfied for HS, and five possible answers: very satisfied, satisfied, neutral, not very satisfied, and not satisfied for LS and FS. For the purpose of analysis, responses of not very satisfied or not satisfied were classified as dissatisfied, while the remaining categories were classified as satisfied for each (i.e., dissatisfied was given a score of 1 and satisfied 0 ). 2.3 Statistical analysis Responses to the individual questions, proportions (%) of those with poor SRSS, HS, LS, and FS were summarized by country and sex. The structure of the items was analyzed by the Hayashi s quantification method 3 (Hayashi, 1953), which is mathematically equal to correspondence analysis and analyzed using the SAS CORRESP procedure (SAS, Inc., Cary, NC). To examine the similarity and dissimilarity of the exploratory variables between countries, we performed the following analyses. First, the relationship between health and well-being and all exploratory variables, such as country, social capital, sex, age, and other social conditions, were analyzed using a logistic model and crude and adjusted odds ratios (OR) with their 95% confidence intervals (95% CI) were calculated. The OR reflected an increase in the odds of poor SRSS, HS, LS, and FS. Second, the

6 214 K. Yamaoka and R. Yoshino differences between countries were examined according to the significance of an interaction term of country and each exploratory variable (included one by one) in the logistic regression model. Furthermore, an analysis using the logistic model by country was also conducted. These steps confirmed the effects of the variables. In addition, to examine the effects of the missing data, a sensitivity analysis using a multiple imputation method (SAS MI procedure) (Rubin, 2004) was conducted for the multivariate model under the assumption of missing at random. Analyses were conducted using SAS software (Version 9.13 for Windows; SAS, Inc.). All tests were two-sided, with a significance level of 5%. 3. Results 3.1 Demographic characteristics Table 1 shows the distribution of exploratory variables by country and sex. The proportions were calculated without missing data. Respondents were older in Japan compared with other countries. Except in Beijing, there were more women than men. In Vietnam, there were fewer respondents with a high level of education compared with other countries. Compared with Asian countries, a high proportion of Australian and American participants lived alone. In China, Vietnam, Singapore, India, and Australia, participants had a lower proportion of poor trust and human support. There was a large amount of missing data in the trust in organization variable. 3.2 Health and well-being The proportion of those with poor SRSS (having any symptoms) (Table 2) was highest in Hong Kong (men: 62.2%; women: 79.2%) and lowest in Singapore (men: 36.1%; women: 51.3%). In all countries, women showed poor symptoms compared with men. Low self-reported social class showed poor symptoms in most countries. Low trust showed poor symptoms in the related items, though the proportions were somewhat varied and relations were not concordant between countries. The proportion of those with poor HS (Table 3) was the highest in Japan (men: 26.9%; women: 18.1%) and South Korea (men: 22.1%; women: 27.5%) and the lowest in Singapore (men: 6.6%; women: 4.8%) and India (men: 6.8%; women: 4.7%). In many of the countries, women denoted poor HS compared with men except for Japan, Beijing, Shanghai, Singapore, and India. Low self-reported social class denoted poor symptoms in most of the countries. A similar tendency was observed for trust items and human support items. The proportion of those with poor LS (Table 4) was the highest in South Korea (men: 13.7%; women: 10.7%) and in Japan (men: 13.4%; women: 14.1%) and lowest in India (men: 1.5%; women: 1.1%). Low self-reported social class related to poor HS. Low trust related to poor LS in most countries. Not having any material, spiritual, consulting, and esteeming human support denoted poor LS in many countries.

7 RELATION OF SOCIAL CAPITAL TO HEALTH AND WELL-BEING IN THE ASIA PACIFIC VALUES SURVEY: A POPULATION-BASED STUDY 215 Table 1: Proportion of responses (%) by country and sex SRSS HS LS FS Age group Education Live alone Self-reported social class Organizational membership Interpersonal trust Norms of reciprocity Fairness Trust in organization Person to consult Material Spiritual Consulting Esteeming Country Japan Beijing Shanghai Hong Kong Taiwan Vietnam Singapore South Korea India Australia USA Sex Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women N Poor (Missing) # (0) (0) (0) (0) (1) (0) (0) (0) (0) (0) (0) (0) (0) (3) (0) (0) (4) (9) (0) (0) (0) (0) Poor (Missing) (1) (0) (0) (2) (3) (5) (3) (7) (1) (3) (0) (0) (0) (0) (0) (1) (0) (0) (0) (0) (2) (1) Poor (Missing) (0) (0) (0) (0) (3) (0) (0) (1) (0) (1) (0) (0) (0) (0) (1) (1) (1) (1) (0) (1) (0) (0) Poor (Missing) (1) (3) (0) (0) (1) (3) (2) (0) (1) (0) (0) (0) (1) (0) (0) (2) (2) (0) (1) (0) (3) (5) < (Missing) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (1) (2) (0) (0) Low Middle High (Missing) (2) (4) (2) (1) (13) (6) (4) (4) (1) (0) (0) (0) (1) (1) (0) (0) (0) (0) (6) (10) (11) (7) Alone (Missing) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) ) (0) 1 (High) (Low) (Missing) (3) (4) (4) (1) (7) (11) (5) (9) (7) (11) (0) (0) (1) (0) (2) (1) (1) (0) (5) (0) (5) (2) (Missing) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) Trust (Missing) (26) (43) (7) (6) (21) (24) (27) (26) (16) (10) (1) (3) (14) (20) (9) (11) (8) (12) (15) (8) (21) (16) Trust (Missing) (27) (49) (10) (10) (24) (28) (55) (75) (15) (15) (0) (2) (12) (16) (13) (12) (2) (5) (12) (10) (25) (25) Trust (Missing) (25) (35) (54) (57) (76) (97) (57) (88) (37) (46) (3) (2) (14) (20) (22) (26) (3) (10) (15) (9) (25) (25) (Missing) (29) (94) (72) (75) (134) (166) (41) (88) (34) (62) (30) (33) (16) (29) (41) (50) (99) (125) (16) (16) (48) (83) None (Missing) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) None (Missing) (11) (22) (6) (3) (25) (28) (14) (13) (9) (6) (3) (2) (12) (9) (24) (31) (2) (5) (1) (0) (8) (6) None (Missing) (4) (7) (9) (2) (17) (28) (15) (14) (6) (5) (3) (3) (1) (4) (14) (9) (7) (6) (1) (0) (5) (3) None (Missing) (2) (2) (4) (1) (18) (22) (9) (6) (2) (3) (2) (2) (2) (3) (11) (10) (5) (6) (3) (0) (5) (5) None (Missing) (22) (49) (18) (19) (68) (62) (38) (42) (28) (36) (5) (6) (5) (4) (57) (56) (9) (5) (8) (1) (12) (9) Note: Percentages did not include missing data. # in parentheses denotes number of missing (= other + DK).

8 216 K. Yamaoka and R. Yoshino Table 2: Proportion (%) of having any self-rated somatic symptoms (SRSS) among the 5 items (Question No.21 a e ) by country and sex Item Category Japan Beijing Shanghai Hong Kong Taiwan Vietnam Singapore South Korea India Australia USA Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Total Age group Education Live alone Self-reported social class Organizational membership Interpersonal trust Norms of reciprocity Fairness Trust in organizations Person to consult Material Spiritual Consulting Esteeming < Low Middle High Not alone Alone Low Middle High Low t High Low High Low High (Low) None Yes None None None None

9 RELATION OF SOCIAL CAPITAL TO HEALTH AND WELL-BEING IN THE ASIA PACIFIC VALUES SURVEY: A POPULATION-BASED STUDY 217 Table 3: Proportion (%) of subjective health satisfaction by country and sex (% of unsatisfied) Item Category Japan Beijing Shanghai Hong Kong Taiwan Vietnam Singapore South Korea India Australia USA Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Total Age Education Live alone Self-reported social class Organizational membership Interpersonal trust Norms of reciprocity Fairness Trust in organizations Person to consult Material Spiritual Consulting Esteeming < Low Middle High Not alone Alone Low Middle High Low High Low High Low High (Low) None Yes None None None None

10 218 K. Yamaoka and R. Yoshino Table 4: Proportion (%) of subjective life satisfaction by country and sex (% of unsatisfied) Item Category Japan Beijing Shanghai Hong Kong Taiwan Vietnam Singapore South Korea India Australia USA Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Total Age Education Live alone Self-reported social class Organizational membership Interpersonal trust Norms of reciprocity Fairness Trust in organizations Person to consult Material Spiritual Consulting Esteeming < Low Middle High Not alone Alone Low Middle High Low High Low High Low High (Low) None Yes None None None None

11 RELATION OF SOCIAL CAPITAL TO HEALTH AND WELL-BEING IN THE ASIA PACIFIC VALUES SURVEY: A POPULATION-BASED STUDY 219 Table 5: Proportion (%) of subjective life satisfaction by country and sex (% of unsatisfied) Item Category Japan Beijing Shanghai Hong Kong Taiwan Vietnam Singapore South Korea India Australia USA Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Total Age Education Live alone Self-reported social class Organizational membership Interpersonal trust Norms of reciprocity Fairness Trust in organizations Person to consult Material Spiritual Consulting Esteeming < Low Middle High Not alone Alone Low Middle High Low High Low High Low High (Low) None Yes None None None None

12 220 K. Yamaoka and R. Yoshino The proportion of those with poor FS (Table 5) was relatively small at less than 10% in all countries. Although somewhat similar relations were observed for trust and human support items, we should carefully interpret these results. 3.3 Relation of social capital to health and well-being An analysis using the logistic model was conducted to examine the similarity and dissimilarity of the exploratory variables between countries (Table 6). A multivariate-adjusted OR denoted that poor SRSS was less prevalent in Singapore and more prevalent in most countries except for Beijing and South Korea comparedwithjapan(p<0.001). Older age class (p <0.001), female sex (p <0.001), low education level (p =0.047), and low self-reported social class (p < 0.001) related to poor SRSS. High organization membership (p <0.001), low interpersonal trust (p < 0.001), low norms of reciprocity (p =0.041), and low fairness (p < 0.001) were significantly related to poor SRSS, while no significant relations were obtained for human support items. As for HS, Singapore, India, and USA showed favorable HS compared with Japan (p < 0.001). Older age (p < 0.001), female sex (p = 0.002), and low self-rated social class (p <0.001) denoted similar tendency to SRSS. Low norms of reciprocity (p <0.001), low fairness (p <0.001) and low trust in organizations (p =0.007) were significantly related to poor HS. As for LS, except for Beijing, Shanghai, and Taiwan, other countries showed favorable LS compared with Japan (p <0.001). Middle age and low self-reported social class related to poor LS (p <0.001 for both), but sex was not significant. Poor trust (interpersonal trust: p = 0.036; norms of reciprocity: p < 0.001; trust in organizations: p = 0.005) and human support (person to consult: p =0.002; material: p =0.003; esteeming: p =0.001) were significantly related to poor LS. As for FS, Beijing, Singapore, and India showed better LS compared with Japan (p <0.001). Low self-reported social class was related to poor FS (p <0.001). Live alone, low norms of reciprocity, trust in organizations, having no person to consult, and esteeming human support were relatedtopoorfs(p<0.001 for all). As for the similarity and dissimilarity of the association between countries, it wasmoderately concordant with the configuration of countries in Figure 1. Roughly speaking, Japan, South Korea, Shanghai, Hong Kong, and Taiwan were located in the positive direction of the first latent eigenvalue (horizontal axis) and these countries were not significantly different from Japan in the result of the multivariate-adjusted OR for each health- and well-being-related items shown in Table 6. Furthermore, the associations were almost similar to the results using the sensitivity analysis with a multiple imputation method (results not shown). In addition, the result using the logistic model including interaction term revealed that most of the associations between health and well-being and the exploratory variables showed a similar direction, but the level of the strength of the association was different except for LS and consulting human support. The logistic model by country revealed significant opposite differences: having spiritual human support related to poor LS in Beijing, but an

13 RELATION OF SOCIAL CAPITAL TO HEALTH AND WELL-BEING IN THE ASIA PACIFIC VALUES SURVEY: A POPULATION-BASED STUDY 221 Table 6: Multivariate-adjusted OR and 95% CIs for health- and well-being-related items analyzed using a logistic model Item Category odds ratio SRSS HS LS FS n=7977 n=7973 n=7980 n=7972 (95% CI) p-value odds (95% CI) p-value odds (95% CI) p-value odds (95% CI) p-value lower upper ratio lower upper ratio lower upper ratio lower upper Country Japan 1.00 < < < <0.001 Beijing Shanghai Hong Kong Taiwan Vietnam Singapore South Korea India Australia USA Age group < <0.001 $ 1.00 <0.001 $ < Sex Women/Men <0.001 $ $ Education level High #2 Live alone Alone < <0.001 Self-reported social class Low < < <0.001 $ <0.001 $ Organizational membership High < Interpersonal trust High <0.001 $ < Norms of reciprocity High < <0.001 Fairness High $ < #3 Trust in organizations Having (1 ) Person to consult Yes Material Spiritual # Consulting Esteeming <0.001 $ SRSS: self-reported somatic symptoms; HS: degree of subjective health satisfaction; LS: life satisfaction; FS: family life satisfaction. $: Interaction term with country was significant but the directions of association analyzed by country revealed to be same among countries. #1: Interaction term with country was significant and the direction of association analyzed by country was high in South Korea and low in Beijing. #2: Interaction term with country was significant and the direction of association analyzed by country was low in Vietnam. #3: interaction term with country was significant and the direction of association analyzed by country was low in Shanghai.

14 222 K. Yamaoka and R. Yoshino Figure 1: Pattern analysis of well-being variables for all countries: a corresponding analysis (n=7096). Framed rectangle denotes positive value in the first (horizontal line) and the second (vertical line) axes (maximum eigenvalues). opposite relation was observed in South Korea. Having lower education level related to poor FS in Vietnam and lower fairness related to poor FS in Shanghai. The other interactions were caused by the difference of the level and similarity in direction. 4. Discussion There are many explanations for the relation of social capital to adult health, but many issues remain unresolved. To investigate the influence of individual-level social capital on self-reported health, we analyzed nationwide representative data from our Asia Pacific Values Survey performed from 2010 to The results provide evidence that cognitive dimensions of social capital at the individual level are positively associated with health and overall well-being in Asia Pacific countries. Differences in adult health between the sexes have been observed for SRSS and HS, but not for LS and FS in Asia Pacific countries. Recently, Marmot (2005) examined the social determinants of health inequalities between and within countries. Marmot noted that an important social justice issue