Introduction
Social determinants of health have become an integral part of the disease epidemiology and control. The fact that many preventable disease and conditions are finding their origin in the social environment makes this field crucial for policymakers and health care workers. The social determinants of health encompass the social, environmental, and economic conditions which play a role in influencing the overall health of the society. Generally, the determinants mainly reflect the daily life of the people and the structural influences brought unto them (Raphael, 2004, p.1-15).
In the modern world, there has been an increasing rise in social exclusion-related deaths particularly due to the ever-changing market environment that has left the competition at its peak. Social exclusion is generally referred to as the process whereby the people in a certain setting are denied the right to access the economic, cultural, and to a larger extent the political systems that are known to contribute to the whole integration of a citizen into the society (Cappo, 2002). The social networks that are broken mean that the social support and influence combined with access to meaningful resources is not achieved by the excluded individuals (Berkman & Glass, 2000). Working conditions for socially7 excluded individuals have sparked a lot of interest from human rights groups and employees due to its widening implications on the overall health of the individual and the family at large (Chu, Driscoll & Dwyer, 2008, p. 379). This has resulted in much public interest being directed towards the structural inequalities that perpetuate social exclusion in society. There is enormous literature depicting that many countries have acknowledged the need to implement policies on alleviating social exclusion. The paper will describe social exclusion as one of the social determinants of health and suggest the various policies that need to be put into practice to achieve a socially inclusive society.
Social exclusion
This term describes the dynamic as well as the structural processes and elements that are thought to contribute towards societal inequalities. These factors are wholly responsible for the inability of certain individuals and groups to be involved in normal life particularly in the country of residence, be it the social, political, or even economic (Wilkinson & Marmot, 1998, p.1-12). The inequalities have been blamed largely on factors such as gender, disability, or even immigration status and sexual orientation. Religion and race are also known to contribute to social exclusion, particularly in North America.
There are several aspects of social exclusion all over the world. The utilization of policy and legal mechanisms to deny individuals the right to engage in civil societies was rife in the 20th century. There is also the exclusion from social goods, factors of production, and engagement in economic activities. The paper is interested in the economic and social perspectives due to their overall impact on the health status of the society at large. Canada and Australia are among the developed countries that are experiencing social exclusion. According to Galabuzi (2002, p.12), the socially excluded groups in Canada are mainly composed of immigrant aboriginals and other minority groups who are branded based on various factors. The socially excluded groups are believed to be more than 15% of the Canadian population thereby making the situation an urgent political and social issue. According to statistics Canada (2003), more than half of the population in Toronto was mainly composed of racial minorities. On the other hand, Saunders (2003, p.32) asserted that 16 % of the Australian population are incapable of meeting their basic needs and accessing vital basic amenities. The majority of this group is from the indigenous communities and the aboriginals.
Factors and risks associated with the social exclusion
The socially excluded groups have the biggest unemployment rates and poverty levels; the level of poverty among Canadian immigrants is believed to be more than 25%. High birth rates have also been observed in this group (Jackson, 2001, p.6). an increasing trend has been recorded in Canada where there is the spatial concentration of racial minorities and residential segregation particularly in the urban areas (Galabuzi, 2002). Several health risks ranging from mental health to cardiovascular disorders have been reported among the groups in many countries. Unemployment rates have soared while underemployment of the group shave become the norm. According to Reitz (2001, p.32), this scenario leads to the perpetuation of social inequalities in society. The socially excluded groups are then forced to work for long hours to sustain their families. Indeed, this predisposes them to several health risks that have very severe health outcomes. In Canada, the minorities also involve themselves in occupations that are offered in a very unsafe environment. Pathetic working conditions such as lack of control of the schedules, lack of basic amenities, inadequate ventilation, and unsafe water are among the working conditions they work in (de Woff, 2000, p.14-16).
Social exclusion is instrumental in influencing the healthcare-seeking behavior thereby affecting access to medical care and specialized treatment. The majority of the excluded individuals do not take health care as a priority to their lives due to the lack of funds to pay for this service.
Effect of social exclusion on the overall health status of the society
Social exclusion is perpetuated by a constellation of factors that have dire health consequences on society and individuals. More importantly, the effect of deprivation of political and economic power is known to influence society’s ways of living thereby predisposing it to negative healthcare-seeking behaviors. Moreover, the experience associated with the inequality and the concomitant stress has severe and pronounced mental and physical effects that impact in a negative way on the health and life of the individual (Kawachi, Wilkinson & Kennedy, 2002).
The social inequalities mainly in the living conditions and employment also have severe effects on the health of an individual and the immediate family. Workers who work for long hours are also indirectly linked to the adoption of risky behaviors likely to result in chronic illness. Smoking, overindulgence in alcohol, and unhealthy diets are reflected in the personal lives of these workers. The Institute for Work and Health noted that unpredictability in the working hours leads to a stressful life characterized by family conflict, sleep disturbances, and sometimes unhealthy behaviors (2002, p. 1-10). The effect of long working hours on health is underscored by the statistics of related diseases. For instance, working for long hours has been greatly linked to cases of high blood pressure and cardiovascular disorders particularly in physically demanding jobs. According to Statistic Canada (1999), the shift from a job that requires more hours could result in many negative impacts especially in taking up behaviors known to have higher risks. Shields (1999, p. 33), asserted that women requiring more hours of work are at higher risk of having depression. Moreover, a shift in the number of working hours resulted in unhealthy weight gains and indulgence in smoking and depression.
Immigrants who take up temporary and low-income jobs are exposed to many health risks that undermine their enjoyment of a healthy lifestyle. Their failure to enjoy the employer-sponsored insurance schemes and Medicare means that they cannot access specialized medical services such as dental care. These workers also suffer from emotional setbacks caused by the fear of losing their job (Polanyi, 2002, p. 1). Jackson asserted that the increasing levels of stress especially in the workplace are directly related to the high numbers of work-related diseases and conditions. The work-related is mainly evident in the immigrants and the other minorities since they form the bulk of employees in these job categories.
The families of the minorities live a very stressful life that is driven by uncertainties in the acquisition of basic amenities such as food and shelter. The indulgence in risky behaviors such as smoking and drinking also affects their mental capacity thereby making them vulnerable to undue stress and depression. The emotional turmoil may lead to lowering of immunity thereby predisposing the individuals to several forms of infection. In addition, injuries resulting from the unsafe physical environment may lead to the loss of breadwinner thus depriving the family of economic and social power (Virtanen et al, 2007, p. 190-192). Today, the world faces many prominent public health issues and hypertension is considered one of them. Nearly, 50 million people in the United States alone have been affected by high blood pressure (BP) (Virtanen et al., 2007). Moreover, death and disability are related directly to high blood pressure. As a result, high BP plays a role in the risk of heart attack, kidney diseases, strokes, and coronary heart disease. The loss of productivity has triggered the enactment of several legislations aimed at regulating social exclusion. The economic cost to the nations coupled with the morality in the society has been the major driver in the establishment of these policies. Economic cost generally encompasses the social security and the medical costs for the treatment and care of the uninsured population. Rehabilitation costs of the drug addicts have ensured that the government’s budget on health care is always strained. More importantly, the overall cost of caring for the health care of the socially excluded could be avoided if legislation or incentives favoring them are put in place. Much improvement in the productivity of a country and companies could be achieved if the integration of these policies is implemented in society. This could lead to the tapping of the potential in terms of the productivity provided by them (Lin et al, 2000).
Several types of research and case studies have found a big link between social exclusion and the health status of individuals. Whiteford, Cullen & Bangaina have indicated that social isolation is a major contributor to unhappiness and illnesses that result in low life expectancy (2004). They noted that involvement in a social group such as religious services has always led to positive health outcomes among the individuals. However, susceptibility to stress and depression was common in people who faced a massive breakdown in their social life. This was mostly driven by instability in relationships, low economic and social standing, and unemployment. This relation is well explained in high cases of Alzheimer’s disease witnessed in socially excluded elderly people particularly in homes. A study conducted in Victoria found that people with fewer social networks experienced fairly low health outcomes that include mental distress (Whiteford, Cullen & Bangaina, 2004).
Policies to be implemented
It has been argued that policy development is the best way to address the inequalities brought by social exclusion. However, many governments and organizations have failed to walk the talk due to the economic implications of enacting such policies. The need for a social framework that recognizes the greater responsibility of ensuring social justice lies with the society rather than the individuals. Labonte asserted that the solution to this inequality requires a paradigm shift by addressing the rules and the politics that encourage the perpetuation of social exclusion (2002).
The health sector may help in the alleviation of inequality by adopting policies that give universal access to basic medical services to racial minorities. Provision of culturally sensitive services by incorporating language-specific products that would ensure that all the health needs of these groups are met would be a good step towards the achievement of this goal. The economic cost to the hospitals would be greatly reduced because emergency treatment of patients from these groups would be greatly reduced. In this regard, many people would seek early treatment and care thereby saving money that would otherwise go in offering specialized care.
Another policy measure would involve the enactment of national rules that criminalizes racism. When legal restrictions are put in place, discrimination in accessing social amenities has been found to improve (Labonte, 2002). Increasing trends in employment have been observed in countries where anti-racist policies are put in place. These policies would indirectly lead to the decrease of mental distress that ensues from lack of meaningful employment and social exclusion. Stress-related conditions would also reduce drastically thereby saving the economy a lot of money while at the same time improving the productivity of the individuals and their families. Policy measures aimed at setting reasonable working conditions are another step in sustaining the productivity and health of the marginalized groups. This helps in improving the productivity of these groups while ensuring they are cushioned from the negative health effects of working in an unsafe environment (Polanyi, 2002).
Moreover, the international labor organization proposed the embracement of wide-reaching positive changes in the initiation of part-time that is of high quality. Guidelines on the development were contained in the ILO Part-Time Work Convention, 1994 (No. 175). The measures stipulate that there must be comparable benefits with the full-time employees and gender considerations must be observed. The comparable benefits should provide similar maternity protection and terms on the termination of employment. Sick leave and guarantee of paid annual leave are also some of the measures meant to encourage the development of an employee’s social life (ILO, 1994). Shift work should also be regulated to ensure that workers do not work for more than 12 hours per day. Gender equality and fairness in employment will be promoted through the embracement and enforcement of the measures in workplaces (Lee, Mcmann, and Messenger, 2007, p.12-16). The policy measures will be imperative in addressing social exclusion since most of the part-time workers are usually from the minority population. The marginalized groups would thus be protected from work environments that expose them to health risks.
Other measures would entail the hiring of health works from the socially excluded groups for them to feel like part of the larger society. This would enhance the initiation and development of social networks that would be vital in addressing the gaps in society. The health workers would offer friendly services that would eventually improve the health-seeking behavior. The change would impact positively society due to the reduction of hospital visits and a greater appreciation of the need to access health care.
Public health policies that entitle all citizens to affordable housing and social services must be embraced. Decent housing should be a priority for all governments. The policy would ensure that the costs of acquiring housing are drastically reduced so that the marginalized groups can afford to own or let a house. Furthermore, reduction of the stratification of the society should be carried out by removing social barriers. Access to education and fairness in the labor market must go together with improvements in the social welfare of the excluded groups. The concerted application of these policies would mean that the vicious cycle is broken thereby creating homogeneity in the society (Wilkinson & Marmot, 2003, p.13).
Health care stakeholders should embark on researching the underlying and long-term impacts of social exclusion on the overall health status of the individuals and the larger society. Policy measures based on this evidence would capture the opinions of the groups thus ensuring a long-lasting solution is found. Active involvement of the marginalized groups would also help them to accept their situation thereby making them initiate policy changes in their residences (Townsend & Gordon, 2002).
Conclusion
Social determinants of health have continued to play an important role in influencing health outcomes. More than 50 % of preventable diseases can be traced to the social environment. Sexual exclusion has become instrumental in influencing access to social amenities. The exclusion has resulted in negative health outcomes that have far-reaching consequences in society. Increase cases of psychological stress and mental disorders have been observed in marginalized communities. This has been caused mostly by the uncertainties in employment and access to basic amenities. Moreover, the involvement in discriminative occupations especially in unsafe work environments has compounded the effects of social exclusion in society. The governments are therefore obliged to come up with policies that ensure that the rights of these groups are upheld and respected at all times. In doing this, the socially excluded population will gain access to social amenities thereby improving minimizing the predisposing factors. More importantly, the overall health status of the individuals and the society will be greatly improved. Concerted efforts from all stakeholders are vital in the achievement of a socially inclusive environment that acknowledges the rights of the minority.
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