Academic journal article Journal of Health Population and Nutrition

Relationships of Exclusion and Cohesion with Health: The Case of Bangladesh

Academic journal article Journal of Health Population and Nutrition

Relationships of Exclusion and Cohesion with Health: The Case of Bangladesh

Article excerpt


The concept of social exclusion is a relatively new tool for analyzing social disparities in South Asia (1). The concept has its modern origins in France in the 1970s, referring to breakdowns of individuals from society and the state. The concept adapted as it was applied in a more individualistic England and the European Union where a concern with fundamental human rights prevails. In these adaptations, the relationships between the individual and the established welfare state remain fundamental (2). In the South Asian context, relationships between the individual and the state are far less central. Does the concept of social exclusion have sufficient resilience to maintain its value in such contexts?

With the question of widespread applicability in mind, the Social Exclusion Knowledge Network of the World Health Organization Commission on Social Determinants of Health reviewed and adapted the social exclusion concept to enhance its applicability and analytical potential. This paper applies this modified social exclusion concept in an analysis of different policies and actions implemented in Bangladesh that are meant to or do enhance livelihoods. Drawing from these multiple analyses, this paper (a) assesses the applicability of the concept of social exclusion to the Bangladesh context, (b) questions the benefits of introducing a new concept for analyzing policies and actions meant to promote development, and (c) explores the documented relationships between increasing capabilities and resources (i.e. diminishing exclusion) and health status.

Social exclusion: an evolving concept

As applied in this paper, the fundamental characteristics of the social exclusion framework are three-fold. First, social exclusion is relational, recognizing an interplay between agency and structure (3), acknowledging that social relations are fixed in formal and informal political, economic, social and cultural institutions in society that are dynamic (1,4). This dynamic and relational approach directs the analyst to investigate not only the excluded but also those who exclude and the processes of exclusion (5). The approach furthermore acknowledges the importance of agency--relating to participation, a critical and longstanding concept in development discourse. The conceptualization of interplay between agency and structure rather than state suggests that institutions of power and authority beyond the state influence position in society. This adaptation is essential for the social exclusion concept to have salience beyond the strong welfare states, such as those in northern Europe.

Second, social exclusion is multidimensional, acknowledging that forces that exclude people from full participation in society can be social, cultural, political, and economic. Beall and Piron describe economic exclusion as "exclusion from labor markets, employment, and enterprise opportunities and a wide range of livelihood strategies" (5); exclusion from social participation is described as "exclusion from access to infrastructure and services, social security and protection, public safety and social cohesion." Exclusion from political participation includes "restricted access to organization, decisionmaking, and the rights and responsibilities of citizenship." The processes or dynamics of social exclusion are power-based, operating through social relations and social, political, cultural and economic institutions (5). And third, social exclusion takes a longitudinal perspective, with an emphasis on transitions through the life course and intergenerational processes (6).

Is this representation of the essentials of the social exclusion concept transferable from its origins in northern Europe to countries with weak public welfare programmes? Previous scholarship on social exclusion in developing countries provides promising results. For example, in her analysis of progress towards the Millennium Development Goals (MDGs) in Asian countries, Kabeer reviewed existing evidence and demonstrated the applicability and advantages of a social exclusion framework to better understand the social dimensions of poverty and the processes associated with inequality (7). …

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