a vida é curta, mais ainda para alguns…

SOCIAL DETERMINANTS OF HEALTH

Social exclusion

Life is short where its quality is poor. By causing hardship and resentment, poverty, social exclusion and discrimination cost lives.

What is known

Poverty, relative deprivation and social exclusion have a major impact on health and premature death, and the chances of living in poverty are loaded heavily against some social groups.

Absolute poverty – a lack of the basic material necessities of life – continues to exist, even in the richest countries of Europe. The unemployed, manyethnic minority groups, guest workers, disabled people, refugees and homeless people are at particular risk. Those living on the streets suffer the highest rates of premature death. Relative poverty means being much poorer than most people in society and is often defined as livingm on less than 60% of the national median income. It denies people access to decent housing, education, transport and other factors vital to full participation in life. Being excluded from the life of society and treated as less than equal leads to worse health and greater risks of premature death. The stresses of living in poverty are particularly harmful during pregnancy, to babies, children and old people. In some countries, as much as one quarter of the total population – and a higher proportion of children – live in relative poverty.

Social exclusion also results from racism,discrimination, stigmatization, hostility and unemployment. These processes prevent people from participating in education or training, and gaining access to services and citizenship activities. They are socially and psychologically damaging, materially costly, and harmful to health. People who live in, or have left, institutions, such as prisons, children’s homes and psychiatric hospitals, are particularly vulnerable. The greater the length of time that people live in disadvantaged circumstances, the more likely they are to suffer from a range of health problems, particularly cardiovascular disease. People move in and out of poverty during their lives, so the number of people who experience poverty and social exclusion during their lifetime is far higher than the current number of socially excluded people.

Poverty and social exclusion increase the risks of divorce and separation, disability, illness, addiction and social isolation and vice versa, forming vicious circles that deepen the predicament people face. As well as the direct effects of being poor, health can also be compromised indirectly by living in neighbourhoods blighted by concentrations of deprivation, high unemployment, poor quality housing, limited access to services and a poor quality environment.

Policy implications

Through policies on taxes, benefits, employment, education, economic management, and many other areas of activity, no government can avoid having a major impact on the distribution of income. The indisputable evidence of the effects of such policies on rates of death and disease imposes a public duty to eliminate absolute poverty and reduce material inequalities.

• All citizens should be protected by minimum income guarantees, minimum wages legislation and access to services.

• Interventions to reduce poverty and social exclusion are needed at both the individual and the neighbourhood levels.

• Legislation can help protect minority and vulnerable groups from discrimination and social exclusion.

• Public health policies should remove barriers to health care, social services and affordable housing.

• Labour market, education and family welfare policies should aim to reduce social stratification.

 (by Richard Wilkinson and Michael Marmot. WHO Library Cataloguing in Publication Data Social determinants of health, 2nd edition / 2003)

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