Lillian Loescher looks into the relationship between social exclusion and our health and discovers things are not always what they seem.

As the poet Criss Jami once said, “telling an introvert to go to a party is like telling a saint to go to Hell”. There seems to be a general misconception that if you are introverted then you are somehow excluding yourself from being social. As if there has to be some kind of prerequisite that to be an introvert you must avoid parties like the plague; in reality social exclusion or social inclusion have nothing to do with how introverted or extraverted you are.

The World Health Organization defines social exclusion as a dynamic multidimensional process that is driven by unequal power relationships interacting across 4 main dimensions: economic, political, social and cultural. Given the scientific nature of sociological research these main dimensions are defined broadly. So, the economic dimension refers not only to personal finances and debt, but also to the absence (or presence) of basic goods and services on a larger scale. The political dimension encompasses the access to public and community services, healthcare, proper education, housing and the safety of ones living environment. On a social front, scientists are referring to the level of social isolation as well as personal (or general) participation in formal and informal social networks. Within the cultural sphere the literature analyses the amount of noncompliance with overall core societal values. To say that this is a simple topic would be an understatement. To make things even more complicated, these unequal power relationships can occur at the: individual level, household level, community level, country level and global level.

Much of the research that is dedicated to the impacts of social exclusion (verses social inclusion) define social exclusion differently as well as analyse it at varying levels. Though there are several prevailing themes that can be taken away that are invariant across all of these studies. That is, there is a positive relationship between social exclusion and chronic illnesses, disability, life expectancy and mental health problems (including depression and suicide).

Prevailing scientific literature shows that low social standing, feelings of alienation and lack of belongingness impact health thought a psycho-neuroendocrine mechanism. To put that into other words this quite literally means that social exclusion impacts a person’s psychology, neurochemistry and immune system. For example, two out of three cross sectional studies have supported the notion that a high level of social exclusion is associated with low physical health. One such study found that elderly Japanese women who were excluded in economic and social dimensions were 1.7 times more likely to die earlier. No such correlation was found among elderly Japanese men. The impacts of social exclusion on physical health do not end there.

Overwhelming evidence shows that there is a strong relationship between social exclusion factors and the presence of chronic disease as well as limitations in daily activity due to chronic health problems. So, it may be the case that part of the reason your Grandma might have trouble getting around is due the fact that they are experiencing or have experienced some form of social exclusion. Our personal health is a very complex phenomenon indeed. If we expand on the Grandmother scenario to include people with disabilities in general, there have been numerous studies that have shown a positive relationship between social exclusion and the onset and persistent presence of disability. It is interesting to note that in these studies women with long term illnesses with a history of social exclusion were at an increased risk of future economic and social exclusion, though there was no significant association between long term illness and social exclusion among men. There are an increasing number of scientific studies showing there is a relationship between social exclusion, the body and the mind. But just how much does social exclusion impact mental health?

Perhaps the best way to describe the research that links social exclusion to mental health is by thinking of social exclusion and mental health in a feedback loop. A loop in which social exclusion can exacerbate an underlying mental health problem and an underlying mental health problem can reinforce certain dimensions of social exclusion in a seemingly never-ending vicious cycle. Most of the literature seems to look at how mental health impacts social exclusion and not the converse; how social exclusion impacts mental health. Of the research that exists, scientists have found that individuals among socially excluded groups exhibit poorer mental health and higher suicide rates due to isolation, loneliness and low self-esteem. This is particularly relevant to those who are unemployed and those that have poor social capital. With the impacts of social exclusion severe and plentiful, one might wonder what is being done about this and what can one do to lessen the impacts of social exclusion?

The Ireland Department of Employment Affairs and Social Protection has developed an Updated National Action Plan to help with poverty and social exclusion by creating a minimum income, inclusive labour markets and access to quality services. In the best-case scenario for this action plan, it still doesn’t address all dimensions of social exclusion and the ultimate responsibility falls upon the individual. As for students here at UCD that means reaching out to the Student Health Centre for counselling and health services, utilizing UCD’s online resources for anxiety and depression through the SISweb, joining that weirdo society that makes you happier at the end of the day, keeping food on the table and above all not just reading about these things, but doing them. As the famous psychologist Maslow would put it, “if the essential core of the person is denied or suppressed, he gets sick sometimes in obvious ways, sometimes in subtle ways, sometimes immediately, sometimes later.”