Country-Level Investment in Cultural Opportunity Structures. A Potential Source of Health Differences Between 21 European Countries

Individual's participation in cultural activities may positively affect health through a pathway mediated by social capital. We examine whether country-level investment in cultural opportunity structures was associated with between-country differences in self-rated health and, if so, whether these associations were mediated by citizens' confidence in societal institutions, i.e., by institutional trust, regarded as a dimension of social capital. For 24,887 respondents in the European Social Survey, 2006, data on self-rated health, institutional trust (individual-level and country-level), and sociodemographic variables were linked with statistics-based country-level data on 10 indicators of cultural opportunity structures and mediator variables (gross domestic product (GDP), Gini index, and welfare state regime). Over and above the sociodemographics, six cultural indicators contributed to between-country health differences in logistic multilevel regression analysis: the percentage of arts students, the RC index, the percentage of writers and creative artists of total employment, exports of cultural goods, imports of cultural goods, and the number of feature films produced per capita. Controlling, furthermore, for trust, and country-level mediators, only imports of cultural goods contributed to between-country differences in health. No associations with other cultural indicators remained after controlling for GDP or welfare state regime. Institutional trust may partially mediate the significance of cultural investments for self-rated health. However, both cultural investment and trust may be concomitants of general prosperity and welfare policies. Future studies should investigate whether the countries' welfare policies influence the transformation of cultural investment into institutional trust and which types of indicators best depict associations between investments and health.