It's Not You It's Them: The Impacts of Social Exclusion on Health

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

As the poetCriss Jami once said, “telling an introvert to go to a party is like telling asaint to go to Hell”. There seems to be a general misconception that if you areintroverted then you are somehow excluding yourself from being social. As ifthere has to be some kind of prerequisite that to be an introvert you mustavoid parties like the plague; in reality social exclusion or social inclusionhave nothing to do with how introverted or extraverted you are.

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

Much of theresearch that is dedicated to the impacts of social exclusion (verses socialinclusion) define social exclusion differently as well as analyse it at varyinglevels. Though there are several prevailing themes that can be taken away thatare invariant across all of these studies. That is, there is a positiverelationship between social exclusion and chronic illnesses, disability, lifeexpectancy and mental health problems (including depression and suicide).

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

Overwhelmingevidence shows that there is a strong relationship between social exclusionfactors and the presence of chronic disease as well as limitations in dailyactivity due to chronic health problems. So, it may be the case that part ofthe reason your Grandma might have trouble getting around is due the fact thatthey are experiencing or have experienced some form of social exclusion. Ourpersonal health is a very complex phenomenon indeed. If we expand on theGrandmother scenario to include people with disabilities in general, there havebeen numerous studies that have shown a positive relationship between socialexclusion and the onset and persistent presence of disability. It isinteresting to note that in these studies women with long term illnesses with ahistory of social exclusion were at an increased risk of future economic andsocial exclusion, though there was no significant association between long termillness and social exclusion among men. There are an increasing number ofscientific studies showing there is a relationship between social exclusion,the body and the mind. But just how much does social exclusion impact mentalhealth?

Perhaps thebest way to describe the research that links social exclusion to mental healthis by thinking of social exclusion and mental health in a feedback loop. A loopin which social exclusion can exacerbate an underlying mental health problemand an underlying mental health problem can reinforce certain dimensions ofsocial exclusion in a seeminglynever-ending vicious cycle. Most of the literature seems to look at how mentalhealth impacts social exclusion and not the converse; how social exclusionimpacts mental health. Of the research that exists, scientists have found thatindividuals among socially excluded groups exhibit poorer mental health andhigher suicide rates due to isolation, loneliness and low self-esteem. This isparticularly relevant to those who are unemployed and those that have poorsocial capital. With the impacts of social exclusion severe and plentiful, onemight wonder what is being done about this and what can one do to lessen theimpacts of social exclusion?

The IrelandDepartment of Employment Affairs and Social Protection has developed an UpdatedNational Action Plan to help with poverty and social exclusion by creating aminimum income, inclusive labour markets and access to quality services. In thebest-case scenario for this action plan, it still doesn’t address alldimensions of social exclusion and the ultimate responsibility falls upon theindividual. As for students here at UCD that means reaching out to the StudentHealth Centre for counselling and health services, utilizing UCD’s onlineresources for anxiety and depression through the SISweb, joining that weirdosociety that makes you happier at the end of the day, keeping food on the tableand above all not just reading about these things, but doing them. As thefamous psychologist Maslow would put it, “if the essential core of the personis denied or suppressed, he gets sick sometimes in obvious ways, sometimes insubtle ways, sometimes immediately, sometimes later.”