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Perspectives on social exclusion and inclusion across income groups
Miriam Stewart
Faculty of Nursing and School of Public Health, University of Alberta, Canada
Linda Reutter
Faculty of Nursing, University of Alberta, Canada
Edward Makwarimba
Social Support Research Program, University of Alberta, Canada
Gerry Veenstra
Department of Sociology, University of British Columbia, Vancouver, Canada
Rhonda Love
Department of Public Health Sciences, University of Toronto, Canada
Dennis Raphael
School of Health Policy Management, York University, Canada
Abstract
The goal of this paper is to explore the experiences of exclusion and inclusion of both low and higher-income people within a ‘social determinants of health framework’. In the first phase of this research, individual interviews with 60 high-income and 59 low-income participants, and group interviews with 34 low-income participants were conducted. During the second phase, 1671 higher and low-income participants were surveyed by telephone.
The findings revealed that inadequate financial resources, ill-health, and unwelcoming behaviours inhibited participation in community activities among low-income respondents. Higher-income earners were more likely to engage in social and group civic activities. Participants in the low-income category were less able to participate in desired activities due to user fees and poor health.
Data revealed significant relationships between self-rated health and measures of exclusion and inclusion. Based on the responses of participants, the paper concludes that structural rather than interpersonal change contributes significantly to increased levels of social inclusion, and ultimately, improvements in health outcomes.
Keywords
social exclusion, social inclusion, poverty, low-income, participation, sociology
References
Abbott P and Sapford R (2005) Living on the margins: Older people, place and social exclusion. Policy Studies 26: 29–46.
Baum FE, Bush RA, Modra CC, Murray CJ, Cox EM, Alexander KM and Potter RC (1999) Epidemiology of participation: An Australian community study. Journal of Epidemiological Community Health 54: 414–423.
Baum F and Harris L (2006) Equity and the social determinants of health. Health Promotion Journal of Australia 17: 163–165.
Bittman M (2002) Social participation and family welfare: The money and time costs of leisure in Australia. Social Policy and Administration 36: 408–425.
Campbell K and McLean C (2002) Ethnic identities, social capital and health inequalities: Factors shaping African-Caribbean participation in local community networks in the UK. Social Science and Medicine 55: 643–657.
Cattell V (2001) Poor people, poor places, and poor health: The mediating role of social networks and social capital. Social Science and Medicine 52: 1501–1516.
Crombie IK, Irvine L, Elliott L and Wallace H (2005) Closing the Health Inequalities Gap: An International Perspective. WHO Regional Office for Europe: Copenhagen.
Davies JS (2005) The social exclusion debate: Strategies, controversies and dilemmas. Policy Studies 26: 3–27.
Finch BK and Vega WA (2003) .Acculturation stress, social support, and self-rated health among Latinos in California. Journal of Immigrant Health 5: 109–117.
Galabuzi GE (2004) Social exclusion, in Raphael D (ed) Social Determinants of Health: Canadian Perspectives. Canadian Scholars Press: Toronto, pp.235–251.
Galabuzi GE (2005) Canada’s Economic Apartheid: The Social Exclusion of Racialized Groups in the New Century. Canadian Scholars Press: Toronto.
Gottlieb HB (2000) Selecting and planning support interventions, in Cohen S, Underwood L and Gottlieb H (eds) Social Support Measurement and Intervention: A Guide For Health and Social Scientists. Oxford University Press: Oxford, pp.195–220.
Guildford J (2000) Making the Case for Social and Economic Inclusion. Population and Public Health Branch, Health Canada: Atlantic Region. Accessed August 12 2002 at: http://www.phac-spc.gc.ca/canada/regions/atlantic/pdf/social.pdf
Hatfield M (2004) Vulnerability to persistent low-income. Horizons 7: 19–26.
Heenan D (2004) A partnership approach to health promotion: A case study from Ireland. Health Promotion International 19: 105–113.
Hyman I (2001) Immigration and Health. Health Canada: Ottawa. Accessed 12 August 2002 at: http://dsp-psdcommunication.gc.ca/Collection/H13-5-01-5E.pdf
Joseph Rowntree Foundation (2005) Policies Towards Poverty, Inequality And Exclusion Since 1997. Joseph Rowntree Foundation: York, UK.
Kunz JL and Frank J (2004) Poverty, thy name is hydra. Horizons 6: 4–8.
Kawachi I and Kennedy BP (1997) Health and social cohesion: Why care about income inequality? British Medical Journal 314: 1037–1040.
Kawachi DK, Coutts A and Subramanian S (2004) Commentary: Reconciling the three accounts of social capital. International Journal of Epidemiology 33: 682–690.
Labonte R (2004) Social inclusion/exclusion and health: Dancing the dialectic, in Raphael D (ed) Social Determinants of Health: Canadian Perspectives. Canadian Scholars Press: Toronto, pp.253–266.
Lee KK (2000) Urban Poverty In Canada: A Statistical Profile. Canadian Council on Social Development: Ottawa. Accessed 5 November 2000 at: http://www.ccsd.ca/pubs/2000/up/
Marmot M (2007) Achieving health equity: From root causes to fair outcomes, The Lancet 370: 1153–1163.
Martin S (2004) Reconceptualising social exclusion: A critical response to the neoliberal welfare agenda and the underclass thesis. Australian Journal of Social Issues 39: 79–94.
McClure P (2000) Participation Support For A More Equitable Society: Final Report Of The Reference Group On Welfare Reform. Department of Family and Community Services: Canberra.
Mendes P (2002) Excluding undesirables from the local community. Social Alternatives 21: 48–54.
Ministry of Health and Social Affairs (2005) Sweden’s Report On Measures To Prevent Poverty And Social Exclusion. Government Offices of Sweden: Stockholm.
Mohan G and Mohan J (2002) Placing social capital. Progress in Human Geography 26: 191– 210.
Myles J (2005) Postponed Adulthood: Dealing with the New Economic Inequality, New Social Architecture Series, Canadian Council on Social Development. Accessed 4 April 2006 at: http://www.ccsd.ca
National Council of Welfare (2004) Poverty Profile 2001. Minister of Public Works and Government Services: Ottawa, Canada.
National Council of Welfare (2005) Welfare Incomes 2004. Minister of Public Works and Government Services: Ottawa, Canada.
Pantazis C, Gordon D and Levitas R (eds) (2006) Poverty and Social Exclusion in Britain. The Policy Place: Bristol.
Papillon M (2002) Immigration, Diversity and Social Inclusion in Canada’s Cities. Discussion Paper F/27, Family Network, Canadian Policy Research Networks: Canada.
Peterson NA and Hughey J (2004) Social cohesion and interpersonal empowerment: Gender as moderator. Health Education Research: Theory and Practice 19: 533–542.
Raphael D (2004) Introduction to the social determinants of health, in Raphael D (ed) Social Determinants of Health: Canadian Perspectives. Canadian Scholars Press: Toronto, pp.1–18.
Raphael D (2007) Poverty and Policy in Canada: Implications for Health and Quality of Life. Canadian Scholars' Press: Toronto.
Repper J (2000) Adjusting the focus of mental health nursing: Incorporating service users. experience of recovery’ Journal of Mental Health 9: 575–587.
Richardson L and Le Grand J (2002) Outsider and insider expertise: The response of resident of deprived neighbourhoods to an academic definition of social exclusion. Social Policy and Administration 36: 496–515.
Richmond T and Saloojee A (eds) (2005) Social Inclusion: Canadian Perspectives. Fernwood Publishing: Halifax.
Room GJ (1999) Social exclusion, solidarity and the challenge of globalisation. International Journal of Social Welfare 8: 166–174.
Ross NA, Wolfson MC, Dunn JR, Berthelot J-M, Kaplan GA and Lynch JW (2000) Relationship between income inequality and mortality in Canada and in the United States: Cross sectional assessment using census data and vital statistics. British Medical Journal 320: 898–902.
Santana P (2000) ‘Ageing in Portugal: Regional inequalities in health and health care. Social Science and Medicine 50: 1025–1036.
Santana P (2002) Poverty, social exclusion and health in Portugal. Social Science and Medicine 55: 33–45.
Scharf T, Phillipson C and Smith AE (2005) Social exclusion of older people in deprived urban communities of England European Journal of Ageing 2: 76–87.
Schofield T (2007) Health inequity and its social determinants: A sociological commentary. Health Sociology Review 16: 105–114.
Seguin AM and Divay G (2002) Urban Poverty: Fostering Sustainable And Supportive Communities. Canadian Policy Research Networks: Ottawa.
Statistics Canada (2001) Incidence of Low Income among the Population Living in Private Households, Census Metropolitan Areas. Accessed 4 January 2002 at: http://statcan.ca/English/Pgdb/famil60i.htm
Stevens A, Bur A-M and Young L (2003) People, jobs, rights and power: The roles of participation in combating social exclusion in Europe. Community Development Journal 38: 84–95.
Stickley T (2005) Developing a social inclusion strategy for people with ongoing mental health problems. Mental Health Practice 8: 12–15.
UNICEF (2006) The State Of The World’s Children 2006 UNICEF: Geneva. Accessed 22 October 2006 at: http://www.unicef.org/sowc06/fullreport
Veenstra G (2006) Social capital and health in Canada: (Compositional) effects of trust, participation in networks and civic activity on self-rated health, in Johnston R and Kay F (eds) Social Capital, Diversity, and the Welfare State. UBC Press: Vancouver, pp.249–275.
Voyer J-P. (2004) Poverty and exclusion: New perspectives, new approaches. Horizons 6: 1–2.
Wagstaff A (2002) Poverty and health sector inequalities. Bulletin of the World Health Organisation 80: 97–105.
Wat, G (2001) Policies to tackle social exclusion: Must deal with the iceberg and not just its tip; this is an issue for all society. British Medical Journal 323: 175–176.
Wilkinson RG (1996) Unhealthy Societies. Routledge: London.
Wilkinson R and Marmot M (eds) (1998) Social Determinants Of Health: The Solid Facts. World Health Organization Regional Office for Europe: Copenhagen. Accessed 28 September 2000 at: http://www.euro.who.int/document/e81384.pdf
WHO (2005) Priorities for research to take forward the health equity policy agenda. Bulletin of the World Health Organisation 83: 948–953.
Williams C. (2004) Access to justice and social inclusion: The policy challenges in Wales. Journal of Social Welfare and Family Law 26: 53–68.
Yngwe MA, Fritzell J, Burstrom B and Lundberg, O. (2005) Comparison or consumption? Distinguishing between different effects of income on health in Nordic welfare states. Social Science and Medicine 61: 627–635.
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