Linking social exclusion and health: explorations in contrasting neighbourhoods in Hamilton, Ontario.(Report)

Abstract

While a substantial body of literature in the UK focuses on social exclusion, attention to this complex relationship is gaining some momentum in the Canadian context. "[his paper contributes to this growing area of research by examining differences in social exclusion and its impact on health between two adjacent but socially contrasting neighbourhoods in Hamilton, Ontario Canada. Data for the study were collected through a cross-sectional household survey, which contained questions on attitudes towards the neighbourhoods in which people live, social and community networks, health status, as well as socioeconomic and demographic characteristics. In addition, in-depth interviews were conducted with residents living in both neighbourhoods. The results reveal differences in both the characteristics and level of social exclusion between the neighbourhoods. The interviews also suggest that local-level social inclusion/exclusion may have an effect on health. The findings suggest the need for more policy and research attention directed towards social exclusion at local levels.

Keywords: social exclusion, neighbourhoods, mixed methods

Resume

Tandis qu'un corps substantiel de la litterature aux Etats-Unis se concentre sur l'exclusion sociale au local-niveau (c.-a-d.,voisinages), l'attention a ce rapport complexe s'accelere certain dans le contexte canadien. Cet article contribue a ce domaine de recherche croissant en examinant l'exclusion sociale dans deux voisinages urbains a Hamilton, Ontario Canada. Des donnees pour l'etude ont ete rassemblees par une enquete de voisinage, qui a contenu des questions sur des attitudes envers les voisinages dans lesquels les gens vivent, les reseaux sociaux et de la communaute, etat de sante, comportements de sante, exposition environnementale, aussi bien que des caracteristiques socio-economiques et demographiques. En outre, des entrevues detaillees ont ete conduites dans les deux voisinages. Les resultats indiquent la complexite des les deux exclusion sociale et les liens entre l'exclusion et les voisinages. Les entrevues suggerent egalement que le voisinageniveau inclusion/exclusion social puisse avoir un effet sur la sante. Les resultats suggerent le besoin de politiques de niveau locales qui adressent l'exclusion sociale dans les voisinages.

Mots cles: exclusion sociale, quartiers, methodes mixtes

Introduction

Policies and programs related to social exclusion, while relatively recent in Canada, have a lengthier history elsewhere. Contemporary use of the term social exclusion was first employed in policy debates in France during the 1970s, amid growing concerns that certain segments of society were 'excluded' from the welfare state (Guildford 2000). In Canada more attention has perhaps been focused on social cohesion as the way to lessen the impacts of social exclusion by building a more socially inclusive society (Beauvais and Jenson 2002; Jenson 1998). It is increasingly recognized that social inclusion/exclusion represents an important social determinant of health (Galabuzi 2002; Raphael 2001). Yet, there have been few empirical investigations of this determinant within the Canadian context. Thus the purpose of this paper is to examine social exclusion and health at the local level in an industrial city in Canada. In the following section we provide an overview of the development of 'social exclusion' in policy terms and discuss its importance as a determinant of health. The third section describes the geographic setting for the research and the use of mixed-methods (i.e., quantitative household survey and qualitative in-depth interviews) for data collection. In the fourth section we present the results. This is followed by the discussion and conclusion, which provide commentary on the research findings, directions for further research and the relevance of social exclusion within the context of local level policy development.

Background

While initially grounded in issues related to income, poverty, and unemployment, since the 1970s the concept of social exclusion has been adopted and expanded to include social and political participation. The increased usage and popularity of the term social exclusion are attributed to dissatisfaction with the narrow focus of such concepts as poverty, deprivation and material welfare (Littlewood and Herkhammer 1999). While social exclusion is related to poverty and unemployment, Atkinson (1998, p.v) cautions against equating these terms: "People may be poor without being socially excluded; and others may be socially excluded without being poor." Atkinson asserts that people are excluded not only because they lack income or employment. In fact, social exclusion focuses on the processes that prevent individuals from participating in economic, social, and political dimensions of society. Of course social exclusion is related to other attempts to understand the nature of social divisions, inequalities, deprivation and the consequences for social life and the enjoyment of material and social resources. It has long been recognized that rewards and resources are systematically and unequally distributed within and between societies (see Bendix and Lipset 1966). Interest in the patterning (e.g., do all inequalities cohere?) and consequences (e.g., what effects on daily living?) have led to the almost continuous refinement of these ideas. Thus, these inequalities are not merely economic (i.e., they are more than poverty--see Sen 1982) and they involve perceptions of the difference between what one group has compared with another as well as the actual distribution of goods and services.

Davies (1962) and Runciman (1966) write of the importance of relative deprivation in understanding the responses towards and consequences of inequality and poverty. But it is perhaps in the work of Townsend (1979) that the idea of relative deprivation for conceptualizing low income and poverty as more than a lack of money came to the fore: for him poverty involved people lacking the capacity to obtain the type of resources, participate in the activities and have the living conditions and amenities that are customary or at least widely enjoyed and/or available in the society to which they belong. Since Townsend, there has been serious attention paid to 'activities and conditions' (see Wilkinson 1996), especially with respect to social relations and capital, and participation in society in general (see Wilkinson 1999). Thus a complex of issues has been identified that try to assist understanding of comparative or relative social status and its consequences for action and well-being that includes but is not limited to income inequalities (see Hou and Myles 2004). Furthermore, following Harvey (1973) and Townsend (1979) the local level is seen as key with recent investigation in a variety of Canadian cities (Chappell and Funk 2004; Roos et al., 2004; Wilson et al., 2004) attesting to this. Social exclusion/inclusion may thus be seen as an attempt to bring these issues into conceptual coherence.

Social exclusion has been defined as "a shorthand term for what can happen when people or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime, bad health and family breakdown" (Social Exclusion Unir 2001, p. 11) and "the problem field determined by the link between low income position, bad labour market position and disadvantages concerning non-monetary aspects of life" (Eurostat 2000, p.33). Glennerster et al. (1999, p. 10) define social exclusion as the "exclusion of individuals and groups from the mainstream activities of society" and similarly, Burchardt et al. (2002a, p.31) argue that "an individual is socially excluded if he or she does not participate in key activities of the society in which he or she lives". In fact, it is in the notion of lack of participation that the differences between exclusion and other similar concepts may be seen. Social capital, for example, "refers to the institutions, relationships, and the norms that shape the quality and quantity of a society's social interactions" (World Bank 2002). Social cohesion is seen as comprising a sense of belonging (Council of Europe 1999) and the process by which a community of shared values is created for a society based on "trust, hope and reciprocity" (Jeannotte 2000). Social capital and social cohesion are therefore seen as general social processes aimed at developing a strong community. On the other hand, social exclusion emphasizes the resources and networks individuals and groups require for full participation in society. The existence of social exclusion is then a threat to both social cohesion (see Jeannotte 2000) and social capital (World Bank 2002).

Many Governments have used social exclusion to …