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Social exclusion/inclusion


Over the last decade, health-financing reforms have included a gamut of social health protection arrangements to tackle inequitable access and inequity in health. Despite all efforts, inequitable access and health inequities are still widespread, as has been evidenced by the 2008 Final Report on the Commission on Social Determinants of Health (CSDH).

Commission on Social Determinants of Health (2008) Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization.


The CSDH’s Knowledge Network on Social Exclusion (SEKN) recommended – among other things – research on the relationships between processes of exclusion and the creation and maintenance of health inequity. Social exclusion is defined by the SEKN as “dynamic, multi-dimensional processes driven by unequal power relationships. These operate along and interact across four dimensionscultural, economic, political and social – and at different levels including individuals, groups, households, communities, countries and global regions”.

Popay J, Escorel S, Hernández M, Johnston H, Mathieson J, Rispel L (2008) Understanding and tackling social exclusion. Final report to the WHO Commission on Social Determinants of Health from the Social Exclusion Knowledge Network. Lancaster: Social Exclusion Knowledge Network.


Socially excluded people themselves have identified five gaps in the processes of exclusion:

  1. A structural gap, referring to discrepancies in terms of satisfaction of fundamental rights;
  2. A participation gap, referring to inhibitors to genuine participation in society;
  3. A feeling gap, referring to psychological ans social traumas, shame and mistrust;
  4. A knowledge gap, referring to limited knowledge on e.g. administrative regulations;
  5. An aptitude gap, referring to deficient social end relational skills.


Casman M-T, Vranken J, Dierckx D, Deflandre D, Campaert G (2010) Experts by experience in poverty and social exclusion: innovative players in the Belgian federal public services. Antwerp-Apeldoorn: Garant.


In the health systems framework, social exclusion overlaps with the interface between population, health system, and context.



The Health Inc research project – Financing healthcare for Inclusion, Socially inclusive healthcare financing in West Africa and India – puts forward the hypothesis that social exclusion is an important cause of the limited success of recent health-financing reforms. In four countries/states (Ghana, Senegal, Maharashtra and Karnataka) Health Inc will analyse whether different types of financing arrangements not only overcome social exclusion to successfully cover poorer population groups, but – crucially – also increase social inclusion by empowering socially marginalized groups.

Health Inc is a 36-months (2011-2014) research project funded by the European Commission’s 7th Framework Programme (FP7). The Health Inc research consortium consists of two European, two African and two Indian research institutions: the London School of Economics and Political Science’s Health Centre (LSE Health), the Antwerp Institute of Tropical Medicine (ITM), the Accra University of Ghana’s Institute of Statistical, Social and Economic Research (ISSER), the Dakar Centre de Recherche sur les Politiques Sociales (CREPOS), the Mumbai Tata Institute of Social Sciences (TISS) and the Bangalore Institute of Public Health (IPH).

Within the Health Inc consortium, the Antwerp ITM team is responsible for a capacity building & research network. A Health Inc NEWSLETTER is part of its package of support and training, and is shared on this website.