Social Inclusion & Health Equity

What is social exclusion?

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Social exclusion encompasses many dimensions, including income poverty, unemployment, access to education, information, childcare and health facilities, living conditions, as well as social participation. People at risk of social exclusion from society are more likely to die prematurely due to unhealthy lifestyles and poor living and working conditions.  

Health plays an important role in the pathways that lead from poverty to social exclusion and vice versa. There is a very strong association between poverty and health that is evident from the results of a great deal of research conducted over the last years, which reflects a marked correlation between socio-economic status (SES) and health. 

On average, the more advantaged the individuals, the better their health – whether measured in terms of disease and mortality or in terms of self-assessed physical and psycho-social health. The relationship between health and low socio-economic status can be explained in different ways: the health selection theory suggests that a person’s socio-economic status is determined by their health while the health causation theory holds that the conditions of poverty result in poor health and premature death. In other words, those with a higher socio-economic status are more likely to have better health and to move up the occupational ladder, amplifying the health advantages associated with higher socioeconomic status.

Either ways, it is essential to understand the socio-economic determinants that influence health and the ways in which they promote or break down health. A comprehensive analysis of these determinants includes macroeconomic contexts and social factors which can be grouped under three broad headings: material, behavioural and psychosocial determinants.

In its recommendations, the WHO Commission of Social Determinants of Health (CSDH) demonstrates how a policy process aiming for social inclusion should include measures that will benefit health equity:

  • Make full and fair employment and decent work a central goal; 
  • Improve the conditions in which people are born, grow, live and work;
  • Empower all groups in society. 

What are Social Determinants of Health?

Social determinants of health are the conditions in which people are born, grow up, live, work and age. These conditions influence a person’s opportunity to be healthy, his/her risk of illness and life expectancy. Social inequities in health – the unfair and avoidable differences in health status across groups in society – are those that result from the uneven distribution of social determinants. Social determinants of health and health inequities are amenable to change through policy and governance interventions.

content.social.determinants.jpgOver the last century, average health status improved in Europe. However, these gains are not evenly distributed across countries or across social groups within the same country. Health inequities can be observed in higher and lower income countries alike across the WHO European Region.

Poverty is a key factor in explaining poorer levels of health between the most and least well-off countries and population groups within the same country. Yet differences in health also follow a strong social gradient. This reflects an individual or population group’s position in society, which translates in differential access to, and security of, resources, such as education, employment, housing, as well as differential levels of participation in civic society and control over life.

Pathways for progress

Article 2 of the EU Treaty commits the EU to combating social exclusion, and Article 9 contains a “social clause” whereby social issues, promotion of a high level of employment, the guarantee of adequate social protection, the fight against social exclusion, and a high level of education, training and protection of human health, must be taken into account when defining and implementing all policies. This article requires the mainstreaming of social issues throughout the EU's policies, extremely important in the context of tackling the social, economic and environmental determinants that lead to social exclusion. Art. 34(3) of the EU Charter of Fundamental Rights, now incorporated within the Treaty, also recognises the right to social and housing assistance.

The EU Social Protection and Social Inclusion Strategy addresses social inclusion by using the Open Method of Coordination. Although social inclusion policies are the responsibility of national and local governments the EU has played a role in encouraging Member States to set common targets, and to share best practices and plans as to how they will achieve these benchmarks. National Action Plans on social inclusion and social protection are also produced under the Lisbon Strategy – to be replaced in 2010 by Europe 2020:  A European strategy for smart, sustainable and inclusive growth. 

A key priority for this new strategy is to ensure social inclusion alongside economic growth - fostering a high-employment economy delivering both social and territorial cohesion throughout Europe. In order to achieve this, the European Commission has set quantitative targets including reducing the number of Europeans living below the national poverty lines by 25% by 2020.