Academic journal article Health Sociology Review

Left Out: Perspectives on Social Exclusion and Inclusion across Income Groups

Academic journal article Health Sociology Review

Left Out: Perspectives on Social Exclusion and Inclusion across Income Groups

Article excerpt


Social exclusion' refers to deeply embedded societal processes whereby certain groups are unable to fully participate in and benefit from major societal institutions (Galabuzi 2004, 2005; Labonte 2004), and experience economic, political and social deprivations and inequalities (UNICEF 2006; Stickley 2005; Stevens et al 2003). Social exclusion may be linked to experiences of stigma and discrimination in the associational life of civil society as well as in occupational, educational, political and justice spheres (Stickley 2005). Among other effects, experiences of social exclusion can generate low self-esteem, internalisation of blame, and powerlessness that can often lead people to avoid engagement with community life.

Although there is undoubtedly wide variation in the processes and experiences of social exclusion across national and other contexts, women, ethnic minorities, refugees, the elderly, disabled people and homeless people appear to be particularly vulnerable to social exclusion (Abbott and Sapsford 2005; Crombie et al 2005). Poverty is an important cause and product of social exclusion (Galabuzi 2004, 2005; Labonte 2004). Material deprivation can generate experiences of social exclusion and isolation because of limited available resources for engaging in community, leisure and family activities and accessing health and social services. In turn, processes of stigma and discrimination can limit opportunities in the workplace and the labour market that can lead to material deprivation. Importantly, such deprivation, the related non-participation in community activities, and social isolation, have all been linked to poor health outcomes. The social capital and health literature has demonstrated quite convincingly that meaningful participation in formal and informal community activities and organisations is linked to good health (Mohan and Mohan 2002; Kawachi et al 2005; Veenstra 2006). In addition, significant links have been demonstrated in many international contexts between low socioeconomic status and poor health (Raphael 2007; Yngwe et al 2005; Reutter et al 2005; Cattell 2001; Wilkinson 1996). Poverty and poor health are also thought to be mutually reinforcing problems which prevent many people from participating meaningfully in the community and wider society (Yngwe et al 2005; Mowafi and Khawaja 2005; Santana 2002; Wagstaff 2002; Cattell 2001).

The complex interconnectedness of material deprivation and experiences of social exclusion warrants thorough exploration from a Social Determinants of Health theoretical framework (Marmot 2007). Accordingly, this research investigated perceptions and experiences pertaining to participation in community life, reasons for low levels of social inclusion, and the role of material deprivation in two urban centres in Canada. The research aims to provide further insight into the interconnectedness of these social determinants of health, towards the ultimate goal of better understanding and eventually ameliorating health disparities in Canada and elsewhere.


The overall poverty rate for Canadians is 14.4%, marginally lower than it was two decades ago (National Council of Welfare 2004). Welfare incomes across Canada fall well below the poverty line, possibly because of welfare cuts and inflation (Thompson 2004). Almost 25% of Canadian fulltime workers earn less than two-thirds of the median earnings, compared with 13% in Germany and only 5% in Sweden (Myles 2005). Those most at risk of falling below the poverty line include single parents, older unattached people, people with work-limiting disabilities and recent immigrants to the country (Hatfield 2004; Papillon 2002). The poverty rate has increased in large Canadian cities (Lee 2000), accompanied by the separation of neighbourhoods and people according to income (Seguin and Divay 2002). As is the case elsewhere (Kawachi and Kennedy 1997), the income gap has also increased in Canada (Raphael 2007; Picot and Myles 2004). …

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