Social Inclusion Health Indicators: A Framework for Addressing the Social Determinants of Health

Social inclusion has been widely recognized as a key social determinant of health. The concept of social inclusion provides a useful means of better understanding how the social determinants of health (SDOH), such as low income, poor housing and food insecurity, are interrelated and negatively affect health (Raphael, 2003). Decades of research have shown that social exclusion impacts health and is aggravated by health status (World Health Organization, 2005). Social exclusion and a lack of participation in decision-making arising from deficits in the SDOH are major contributors to premature morbidity and death from chronic diseases, such as heart disease, stroke and diabetes (Wilkinson and Marmot, 1998). Research undertaken on behalf of the Laidlaw Foundation identified social inclusion as a normative, values-based concept. It is a way of identifying what kind of society we want to live in and what needs to change to build that society. These changes make up a transformative agenda in society as they require fundamental changes in attitudes, public policies and institutional practices. Since social inclusion is conceptually grounded in the real life experiences of people, it can be utilized to identify strategies that create bonds among people of varying identities and conditions (Freiler, 2001). The Inclusive Cities Canada (ICC) initiative developed five dimensions of social inclusion – institutional recognition of diversity, opportunities for human development, quality of civic engagement, cohesiveness of living conditions, and adequacy of community services. Based on these dimensions, the five partner cities conducted social inclusion inquiries which documented local residents’ experiences and perceptions of inclusion. The partner cities then developed recommendations to strengthen their capacity to create and sustain inclusive communities. Social inclusion is being examined in this paper from a population health perspective for practical and strategic reasons. Social inclusion is a key SDOH and focusing on inclusion is critically important in addressing social and health inequalities which also negatively affect health. There is growing public recognition of the need to increase our public investment in disease prevention and health promotion. This presents an opportunity to reframe social inclusion and SDOH as public health issues and advocate for public policies and the necessary resources to effectively address them. This paper will explore the close conceptual link between the five ICC dimensions of social inclusion and SDOH. It will draw on the national ICC research and the results of the social inclusion inquiry in Edmonton. The paper will show the degree to which the ICC dimensions and SDOH are integrated and mutually supportive. In essence, the ICC dimensions provide a framework for both clustering and addressing the SDOH. The paper ends with suggested social inclusion health indicators for Edmonton that are based on the ICC research and our knowledge about the SDOH. Key outcomes and lead indicators will be identified for each of the ICC dimensions of social inclusion, which will point to recommendations for public policy and community practice.

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