Access to health care could contribute to community cohesion

Access to health care can contribute to social cohesion in a community, while the lack of it can have the opposite effect, according to research published in the Journal of Health and Social Behavior.

The study, “Beyond health effects? Examining the social consequences of community levels of uninsurance pre-ACA,” is an effort from the University of California, Los Angeles (UCLA) and Vanderbilt University to determine the effects of health insurance access on communities.

“We find that living around a lot of people who have insurance makes you more likely to trust the people you live around, makes you more likely to have common goals and values, and feel like those goals and values are shared,” Tara McKay, PhD, assistant professor of Medicine, Health and Society at Vanderbilt University and coauthor of the study, said in a press release. “Conversely, low levels of insurance in a community strain relationships and trust among people who do live here.” McKay conducted the research with Stefan Timmermans, PhD, professor of sociology at UCLA.

According to the release, the researchers analyzed a series of surveys conducted from 2000 to 2002 and 2006 to 2008 by the Los Angeles Family and Neighborhood Survey (L.A. FANS), as well as information collected from the U.S. Census Bureau. L.A. FANS is a multistage probability sample of adults living in Los Angeles County and is designed to study neighborhood effects on resident health and well-being.

Data were collected to account for factors that could confound results, such as age, race, ethnicity, nativity and income composition. The data were used to examine neighborhood and household effects on health and mortality, as well as health care access and utilization.             

According to the release, researchers based their analysis on 1,195 respondents to a L.A. FANS survey and a series of multilevel regression analyses to demonstrate that before the ACA, individuals who lived in communities with low levels of insurance reported lower levels of social cohesion.

“After adjusting for individual and community characteristics, we find a 34% decrease in social cohesion scores when moving from a neighborhood with the highest levels of insurance to one with the lowest levels of insurance,” McKay said.

In addition, when the researchers estimated the effects of an ACA-type insurance expansion on the same respondents, they found social cohesion increased with time.


McKay T, et al. J Health Soc Behav. 2017;doi:10.1177/0022146516684537.

Disclosure: The researchers report the study was funded by the Robert Wood Johnson Foundation and the California Center for Population Research.

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