Community belonging and self-perceived health:
Early CCHS findings (January to June 2005)

Majority feel connected to local community
Higher in Atlantic provinces
Rates increasing
Associated with age
Community belonging and health
Data source
The questions
References

Over the past 25 years, research has clearly established a causal association between social relationships and health^{1, 4}. People who are socially isolated and have few ties to other individuals are more likely to suffer from poor physical and mental health and are more likely to die prematurely.

More recently, the notion of “social capital” has received increasing attention in health research. Social capital is generally defined as aspects of social organization, such as civic participation and trust in others, that facilitate cooperation among community members⁹. High levels of social capital have been linked to lower mortality rates, lower rates of crime and increased perceptions of positive health^{8, 9, 10, 11, 12}.

There is, however, some debate about whether social capital benefits the community at large or individual residents--who profit directly from feelings of connectedness to the community. A recent study suggests that the association between social capital and positive perceptions of health is more important at the individual level¹². It is hypothesized that feeling “connected” to one’s community promotes health because such ties promote mutual respect, and thereby increase self-esteem. Another possibility is that interaction among community members results in the transmission of social norms related to health-promoting behaviours such as physical activity and refraining from smoking^{1, 4}.

Since its inception in 2000/01, the Canadian Community Health Survey (CCHS) has included a question on community belonging. Therefore, it is possible to track the degree to which Canadians feel connected to their local communities. An earlier paper, based on data from the 2000/01 CCHS, revealed an association between individuals’ sense of belonging and their general self-perceived health¹⁴. Based on the first 6 months (January to June) from the 2005 CCHS, this article updates the earlier article.

Comparisons are made between community belonging rates at provincial and health region levels. Because the 2005 CCHS includes questions about self-perceived mental health as well as general health, the previous analysis can be extended by measuring associations between community belonging and mental as well as physical health.


Majority feel connected to local community

In 2005, close to two-thirds of Canadians (64%) reported a strong sense of community belonging; this included 17% who described their sense of belonging as very strong and 47% who reported it as somewhat strong. Just over a quarter (26%) reported a somewhat weak sense of community belonging; 9%, very weak.

Higher in Atlantic provinces

The likelihood of reporting a strong sense of community belonging varied considerably across provinces (Chart 1, Table 1). Approximately three-quarters of the residents of the Atlantic provinces reported a strong sense of belonging, with Newfoundlanders having the highest rate in the country at 79%. Relatively high rates were also reported in Saskatchewan (73%) and British Columbia (69%). Residents of the province of Quebec were the least likely to feel connected, with only 54% reporting a strong sense of belonging. A previous study found that Quebecers were also less likely to report a strong sense of belonging to Canada, but their sense of belonging to their province was similar to that of other Canadians¹⁶.

The degree to which the residents of health regions within each province felt connected to their respective communities also differed widely. Health regions comprised of major urban centres tended to have the lowest rates of community belonging. For example, in Ontario, the lowest rates were among residents of the health regions of York and the City of Toronto; in Manitoba the lowest rate was for Winnipeg; for Saskatchewan, Saskatoon; for Alberta, Calgary and the Capital health region (Edmonton); and for British Columbia, Vancouver. Conversely, predominantly rural health regions had higher rates of belonging. For people living in predominately urban health regions, the average community belonging rate was 63%. By contrast, the average for those living in health regions that were pronominally rural was 77% (Chart 2). The highest belonging rate in the country was 89% in the Labrador-Grenfell health region in Newfoundland and Labrador and the lowest was in the Laval health region in Quebec (44%).

Rates increasing

Between 2000/01 and 2005, the proportion of Canadians reporting a strong sense of belonging to their local community rose from 58% to 64%. Significant increases occurred in all provinces except Newfoundland and Labrador (Chart 3). Community belonging increased the most in New Brunswick, where the rate rose from 62% to 73%.

Associated with age

The proportions of men and women who reported a strong sense of community belonging did not differ (Table 2). However, rates did vary by age group. A high proportion (77%) of youth aged 12 to 17 reported a strong sense of belonging, but among young adults aged 18 to 29, the figure was much lower at 55%. At older ages, the rate increased steadily from 61% among those aged 30 to 44 to 72% among seniors (65 or older).

Feeling connected to the community was less common among people who were divorced or separated (57%) or never married (54%), compared with those who were married or living common-law (65%). People living with young children were slightly more likely than those who did not have young children in their household to have a strong sense of belonging.

Modest associations were observed between community belonging and socio-economic status. People with a low household income were less likely to report a strong sense of community belonging, but there were no differences between those with lower-middle, middle, upper-middle or high household incomes. The only association with education was that postsecondary graduates were slightly less likely to feel connected, than were people who had completed only high school.

Community belonging and health

A relatively high proportion of people who felt connected to their local community perceived their health positively. Close to two-thirds of those who felt a very strong or somewhat strong sense of community belonging reported excellent or very good general health (Chart 4). In contrast, only half of those with a very weak sense of belonging viewed their general health so favourably.

At the provincial level, significant associations between community belonging and self-perceived general health emerged in all provinces except Prince Edward Island and Quebec (Chart 5). Associations were particularly strong in British Columbia and Ontario. In British Columbia, 64% of residents with a strong sense of belonging reported excellent or very good general health compared with 51% among those with a weak sense, and in Ontario 64% versus 55%. These findings are particularly relevant in view of evidence that self-perceived general health is predictive of chronic disease incidence, use of medical services, recovery from illness, functional decline, and mortality^{2, 3, 5, 6, 7, 18}.

The likelihood of reporting excellent or very good mental health also declined in parallel with decreases in degree of connectedness—from 81% for those with a very strong sense down to 63% for those with a very weak sense of community belonging (Chart 6). At the provincial level, a strong sense of community belonging was associated with an increased probability of reporting excellent or very good mental health in all provinces except Prince Edward Island (Chart 7).

Even after other potentially confounding factors were taken into account, sense of community belonging was strongly related to both self-perceived general and mental health (Table 3). Compared with those with a weak sense of community belonging, people with a very strong sense had close to twice the odds of reporting excellent or very good general health (Model 1). Similarly, those with a very strong sense of belonging had over two times the odds of excellent or very good mental health (Model 3). When people are asked to rate their general health, psychological factors play a role in perceptions¹⁷. Therefore, the degree to which physical and mental health factors contribute to associations between community connectedness and perceptions of general health is unknown. However, when the relationship between community belonging and self-perceived general health was examined in a model controlling for self-perceived mental health in addition to other possible confounders, the odds ratios for belonging diminished but were still significant (Model 2). This suggests that sense of community belonging is associated with both the physical and mental health of individuals. Although due to the cross-sectional nature of this analysis, it is not possible to determine whether it is health that influences sense of community belonging or the other way around.

Data source

Estimates are based on data from the first 6 months of the 2005 (Cycle 3.1) Canadian Community Health Survey (CCHS), collected between January and June of that year. The CCHS covers the population aged 12 or older living in private households. It does not include residents of Indian reserves, Canadian Forces bases, or some remote areas. Although residents of the three territories are part of the CCHS sample, they are not included in this early release. The overall response rate for this first release of the 2005 CCHS was 76%; the total sample size was 67,741. Approximately 3% of this sample was excluded from this analysis because of non-response to the question on community belonging. All estimates were weighted to be representative of the household population aged 12 or older in 2005. Differences between estimates were tested to ensure statistical significance, which was established at the 0.05 level. To account for survey design effects, standard errors and coefficients of variation were estimated using the bootstrap technique^{13, 15, 19}.

The questions

To measure sense of community belonging, respondents to the Canadian Community Health Survey were asked, “How would you describe your sense of belonging to your local community? Would you say it is: very strong? somewhat strong? somewhat weak? very weak?”.

Self-perceived general health was assessed with the question, “In general, would you say your health is: excellent? very good? good? fair? poor?”

Self-perceived mental health was measured with the question, “In general, would you say your mental health is: excellent? very good? good? fair? poor?”

Household income was based on the number of people in the household and total household income from all sources in the 12 months before the interview.

An urban/rural variable was assigned to each record based on the percent urban composition of the health region where the respondent lived. Urban areas were defined as Census Metropolitan Area (CMA), Census Agglomeration (CA) or communities that fall outside CMAs/CAs that have at least 30% of the employed labour force commuting to CMAs/CAs. The percent urban composition was calculated for each region by dividing the population living in these urban areas by the total population of the health region.