To examine whether the associations were

To examine whether the associations were consistent with a particular causal direction, we next explored associations between health and Cy3.5 hydrazide capacity in the opposite direction (Table 5). Here we found no evidence of an association between health and any community capacity measure aside from problem assessment (linear trend p=0.020) when partially adjusted (including all covariates aside from income). Given that 21 models were examined, this is at the level expected by chance under the global null hypothesis of no associations. In this instance, good health does not appear to be a prerequisite for individuals to rate their community capacity highly.
Discussion We investigated the relationships between individual community capacity, income, and self-rated health undertaking regression modelling of data from residents of four small, high-deprivation communities in the South Island of New Zealand. Previous research has demonstrated differences in community capacity scores that may be attributed to both the unique context of a community and the population\'s characteristics (Jung & Rhee, 2013; Lovell et al., 2015). In the introduction, we conceived of community capacity as produced via the socio-affective relationships people have with place. We anticipated that individual community capacity scores would be associated with self-rated health. However, evidence indicating a relationship between individual community capacity and self-reported health was unconvincing once the effects of income were incorporated. That is, people rating their town\'s community capacity higher did not have better self-rated health. These results contrast with the work of Minsoo, Jung and Viswanath (2013) who found self-rated health was positively associated with community capacity, notably, they controlled for risk factors such as smoking, obesity and exercise. Turning to the socio-demographic characteristics of our communities, we found consistent positive associations between income and self-rated health. Individual income is well established as a determinant of health (Wilkinson & Marmot, 2003), and was statistically significant in both our unadjusted and partially-adjusted models. Interestingly, when we adjusted for individual community capacity, the association between income and self-rated health was slightly attenuated in some cases, with the strongest effect from including the measure of participation in one\'s community. These findings suggest that individuals who rate their community\'s capacity highly may be more resilient to the detrimental health effects of low income but that these effects are likely to be very small. Overall, this data provides no evidence that intervening to build community capacity will be an effective health promotion strategy to improve health outcomes. Rather, our findings provide further evidence of the need to address income as a sustained and inequitable determinant of health. Interrogating the six dimensions of community capacity highlights the underexplored relationship between local political context and self-rated health. Among the subscales (participation, leadership, social cohesion, sense of place, community attitudes, and problem solving), participation offered the most promise for associations with health (being statistically significant in the unadjusted model, p=0.002, and a non-significant tendency with p=0.063 after adjustment for confounders other than income). Community participation has received considerable attention as a proxy for social capital (Greiner, Li, Kawachi, Hunt, & Ahluwalia, 2004; Pollack & von dem Knesebeck, 2004), and demonstrated a dose-response relationship in our study. Previous research (e.g. Cummins, Stafford, Macintyre, Marmot & Ellaway, 2005; Veenstra, 2000) has provided conflicting evidence for another construct, civic participation. Predominantly explored in the form of voting behaviour, civic participation may capture experiences of marginalisation and disenfranchisement leading to poorer health outcomes (Cummins et al., 2005). Yet, local politics remains under-researched as a dimension of community in the health literature. The small town context of our study enabled us to go beyond variables such as voting behaviour to identify perceived efficacy and responsiveness of local leaders. The tendency for positive perceptions of local leadership to predict higher self-rated health highlights the need for further research to untangle whether such perceptions are consistent with effective governance. Alternatively, positive perceptions of leadership may be associated with psycho-social dimensions such as belonging. These results provide motivation for collecting data on as full a set of potential confounders as possible when examining the complex interplay between any of income, health, and individual community capacity.