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Social Inclusion And Exclusion Essay Scholarships

Abstract

The last decade has seen many of the ‘community’ concepts in health (community empowerment, community capacity) replaced by ‘social’ concepts (social capital, social cohesion). The continuous re-labelling of roughly similar phenomena may be a necessary stratagem to attract attention to the economic and power inequalities that arise from undisciplined markets. Social concepts also have an advantage over community ones by directing that attention to higher orders of political systems. The latest construct being wielded by health practitioners, researchers and policy-makers are the twinned concepts of social inclusion and social exclusion. These represent a conceptual sophistication over social capital and social cohesion. Like their predecessors, however, there are risks in their adoption without a critical examination of the premises that underpin them. For example, how can one ‘include’ people and groups into structured systems that have systematically ‘excluded’ them in the first place? The cautions expressed in this article do not dissuade use of the concepts. Their utility, however, particularly at a time when not only inequalities, but also their rate of growth, is increasing, requires careful questioning.

material inequalities, social exclusion, social inclusion

INTRODUCTION

Thirty years ago, bristling with newly employed activists from the new social movements of the 1960s and the 1970s, governments re-discovered community. From processes (community participation, community development) to attributes (community competence, community capacity) to services (community health, community education), it seemed that all we had to do was to drop the adjective of gemeinschaft (community) in front of the noun of our particular preoccupation and the impersonal structures of gesellschaft (mass society) disappeared. Of course, we quickly learned it was more complex than this. We confronted the vagaries of power: in our workplaces, which supported communities when they weren't threatening; in our assumptions, which often imposed a romantic localism on poorer people who simply wanted some of the same networked privileges we enjoyed; and in communities themselves, which were far from the loving, homogenous, always wise and self-knowing entities we contrasted with our own organizational hierarchies. [There is a long history of critique of the romanticized community: good overviews are provided by Lyon (Lyon, 1989), who points out that every century produces its own laments for the lost halcyon community of earlier, simpler times. Hunter and Staggenborg (Hunter and Staggenborg, 1988) chided many community workers for failing to distinguish between ‘communities of limited liabilities’, our de-centered opportunity networks, and ‘communities of enforced locality’, the ghettoes into which we would like to lock up the threatening poor. Finally, Friedmann (Friedmann, 1992) urged a development paradigm in which state/civil society, globalism/localism and many of the other dualities encountered in community theory and practice literature (such as inclusion/exclusion) are problematised rather than dichotomized.] More fundamentally, we bumped against the lesson best opined in the 1989 Worldwatch Institute report: small may be beautiful, but it may also be insignificant (Durning, 1989). Decisions conditioning and constraining the possibilities of local empowerment were drifting further and higher away from the purview of, and accountability to, the places where, as health promoters like to say, ‘people live, work and play’.

In the 1990s, our view widened to broader social phenomena, with a new, appropriately social lexicon. Community competence and capacity gave way to social capital. Community participation and development yielded to social inclusion. Social cohesion became the unstated aim of diminishing state programs and services, to patch back together communities unravelling with digitized, marketized and globalized inequalities. Even as a ‘new’ population health research—concerned not with reproductive health in the narrow sense, but with the social production of health in the broadest sense—broached a new government slogan: ‘WARNING: inequalities may be bad for your health. Avoid excessive greed, intolerance and poor parents’.

Neo-liberal economic assumptions continued their global domination, cementing their gospel of liberalization, privatization, de-regulation and welfare minimalism in the policies of the International Financial Institutions and the rules of the World Trade Organization. It is in this brave, new, ‘history-ending’ world that we need to consider how the twinned concepts of social inclusion/social exclusion help or hinder our development of actions that will shrink the preventable differences in health, well-being and quality of life that still demarcate and segregate our communities and nations.

AN ADVANCE ON SOCIAL COHESION AND SOCIAL CAPITAL

The twinned concept of social inclusion/exclusion is more helpful than its other ‘social’ cousins, social cohesion and social capital. Social cohesion resides more in the realm of moral philosophy than in the grit of human relations. It is a counterfactual ideal, and perhaps even a dangerous one if we ever forget its essential idealism and let it become the driver for how we approach social change. I confess to being influenced by that peculiar school of thought known as conflict sociology, which holds on the basis a few thousand years of cumulative empirical evidence that societies have always been a tenuous arrangement of fluid groupings in some degree of conflict with one another: for resources, for authority, for legitimacy; in a word, for power. Where there is no conflict, Ralf Dahrendorf once offered, there is suppression (Dahrendorf, 1959). This does not mean we should espouse or tolerate civil or any other form of war. But we need to accept some degree of social conflict as healthy, albeit in discomforting ways. I recall how a health intervention in a poor black community contributing to ‘community competency’ was judged partly unsuccessful because of the ensuing conflicts the community experienced with politicians and neighbouring white communities. But could this conflict not as easily be interpreted as a sign of a competent community engaged in another necessary confrontation with racism? We need to retain a healthy scepticism of concepts that direct us towards a wishful desire for social harmony. They can blunt the sharp edges of mobilized criticism that has always been one of the necessary fuels for social reform.

Social capital fares little better. For one, no one can settle on a definition of what it is or what it does, apart from describing a pot pourri of psychosocial variables of variable interest to different researchers—trust, reciprocity, participation, and social network density. More fundamentally, individuals and organizations with quite different visions of how societies should govern themselves can become conceptual bedfellows, although perhaps with a means/end twist. To the World Bank, social capital is the means to the end of economic growth, the necessary social glue that allows unfettered markets to work the magic of their invisible hands (Labonte, 1999). Its absence, it is conjectured, explains why liberalized market reforms (with a few Asian exceptions) have had a dismal record of delivering on their promises in Africa, Latin America and the so-called ‘transition economies’. To others, economic growth is the sometimes-necessary means to the end of building social capital. It provides a sufficiency of wealth required by states for universal programs and resource redistribution which, in turn, are essential to what Sen describes as the foundations for the capabilities that allow people ‘to live a life they have reason to value’ (Sen, 2000). To its credit, social capital builds a linguistic bridge between those in the market and those in civil society. To its detriment, and I borrow here from how a disgruntled environmentalist once lamented the concept of sustainable development: ‘they got the noun, which defines, while we got the adjective, which merely modifies’. Note that I am sympathetic to the aim of many of today's social capital and health researchers, who should not take my critique of the construct as undermining the importance of understanding better why, ceteris paribus (which they never are), some communities are healthier than others. But rather than working towards a better theorization and operationalization of social capital to study how or why it is a determinant of health, I would urge studies that examine the cultural history and political economy of nations and communities to understand better the determinants of social capital.

SOCIAL INCLUSION/EXCLUSION: THE EMBEDDED CONTRADICTION

Social inclusion/exclusion is more interesting and dynamic than either social cohesion or social capital, for it is poised on the very contradiction evinced by all of these terms: how does one go about including individuals and groups in a set of structured social relationships responsible for excluding them in the first place? Or, put another way, to what extent do efforts at social inclusion accommodate people to relative powerlessness rather than challenge the hierarchies that create it? To what degree might we consider willful social exclusion by groups an important moment of conflict, an empowered act of resistance to socio-economic systems that, by their logic and rules, continue to replicate and heighten the material hierarchies of inequality? I pose these questions because many who embrace the concept of social inclusion emphasize how it goes beyond simple matters of income or material inequalities and their state-enforced redistribution (Barata, 2000), or even of securing basic human rights (Bach, 2002). Rights and redistribution, it is argued, are necessary but not sufficient conditions for people ‘to be accepted and to participate fully within our families, our communities, and our society’, as one definition of social inclusion stakes the territory [(Guildford, 2000), p. 1]. I fully agree. But are there risks in pursuing policies and programs that assume a priori that income redistribution and human rights are solidly in place, when most of the evidence for much of the world is that they are not?

WHO ARE THE EXCLUDED, AND WHY?

Consider, first, the list of the excluded in need of greater inclusion: women, racial minorities, the poor and the sick, those with disabilities, children and youth. Like members of our previously designated ‘high risk groups’, our attention turns to anyone who is not a white, middle-aged, middle-incomed male. Conceptually, social exclusion is an improvement over its predecessor; it defines disadvantage as an outcome of social processes, rather than as a group trait. But in attempting to take us away from a narrow focus on material or income inequality, the concept can falter on an even more subtle form of victim blaming. People are no longer at fault for their disadvantage. But their disadvantage is seen to lie in their exclusion, rather than in excluding structures; for which the solution is targeted efforts at remedial inclusion rather than more systemic reform of economic practices predicated on inequality. Let me explain.

Striding alongside social inclusion's references to acceptance by and participation in family, community and society is social exclusion's complaint that people ‘do not have the opportunity for full participation in the economic and social benefits of society’ [(Guildford, 2000), p. 1]. People are excluded from these benefits, we are told, because they are poor. But people are poor because they lack these benefits. They lack these benefits because capital and state structures allow wealth to accumulate unequally, and powerful others benefit directly and immediately from this. People are excluded from these benefits, we are also told, because they are women. But women for the past two centuries have been cast economically as a source of cheap and surplus wage labour, and of free reproductive labour. Powerful others benefit directly and immediately from women's relative exclusion from economic and social benefits. This has changed tremendously in the world's wealthier nations over the past half century. But the identical script, directed by the same cast of scriptwriters, is now being enacted globally; and even in wealthier nations, the cost of social reproduction (the family) that used to be borne by one wage-earner now requires two people to bring home the equivalent bacon.

People are excluded from these benefits, we are finally told, because they are black, or yellow, or red, or at least ‘not white’. But contemporary racism, though its roots may be obscured in historic competition over resources, is firmly planted in contemporary capitalism. As Brazilian writer, Eduardo Galeano, showed 30 years ago in his brilliant essay, Open Veins of Latin America (Galeano, 1973), only the wealth of the exploited colonies—their resources, their peoples, and their enslavement and the racist beliefs that arose as self-justification for the first major wave of global rape—allowed Western capitalism to depose feudalism. As British novelist Barry Unsworth recounts vividly in his Booker prize winning novel, A Sacred Hunger (Unsworth, 1993), African slavery was the fuel of both England's early capitalist wealth, and of the American colonial wealth that gave birth to our southern neighbour. Slavery collapsed when it was no longer economically efficient, not without a bloody civil war, but not because of it either. Its undertow remains. Internationally, ethnic conflicts from the tribalism of Africa to the cleansings in the Balkans have powerful roots in the economic structures and political systems that allow wealth to accumulate unequally, and powerful others to benefit directly and immediately from this.

I am not saying that the complexities of gender and race exclusion can be reduced to a simple stock of class and materialism. Patriarchal practices and racial exclusions predate feudal societies, much less capitalism. I am saying that every example of contemporary social exclusion based on gendered or racialized difference will also have a material and class-based component, with some people deriving benefit from it. When a recent Canadian study tells us that, all other things being equal, workers of colour earn 16% less than white workers, this is not only racism. This is also an economic advantage for employers (Globe and Mail, 29 November 2002, B2).

Uncritical use of social inclusion can blind us to the use, abuse and distribution of power. Power has non-zero sum elements—the win/win empowerment of trusting, respectful relationships. So, too, does social inclusion. But power has distinctly non-zero sum aspects—the win/lose of dominance, exploitation and hegemony. This is manifest in social inclusion's obverse of exclusion. We should not let the warmth of our inclusive ideal smother our anger over exclusivity's unfairness. Anger is often the magnet of mobilization, and mobilization is often the tool for social transformation that shifts power relations in ways that allow societies to become more inclusive.

ADAPTING PEOPLE TO THE NEEDS OF THE MARKET, OR REGULATING THE MARKET TO THE NEEDS OF PEOPLE?

This problem of who benefits most by an emphasis on inclusion, rather than a critique of exclusion, becomes more apparent when we examine the different ways its advocates define its end. The first major policy shift based on the concept was in France, in 1988.

As with many of the economically advanced countries, France was faced with high unemployment, particularly amongst its traditional semi-skilled manufacturing workers. This was due to capitalism's transformation to a digital economy and its liberalized ability to locate more labour-intensive production in low-wage countries. Fearing a loss in social cohesion, the centre-right government adopted a Revenue Minimum d'Insertion, a guaranteed minimum income, but only if people ‘inserted’ themselves into economic or civil life through training and work programs with the private sector, government and voluntary associations (Guildford, 2000). A slightly more nuanced form of ‘workfare’ programs, this was not the first time France attempted a project of social reintegration necessitated by fundamental changes in capitalist production. A century earlier, rural farmers and craftspersons, economically marginalized by the development of factory production, drank more and killed themselves quite regularly. This led French sociologist, Emile Durkheim, to coin the term anomie, a concept describing loss of personal meaning and values that arise with deep tears in the social fabric that binds people together. His policy recommendation was the creation of ‘corporative organizations’, or community betterment groups, whose purpose would be to change how people thought of themselves, essentially adjusting their social identities to conform with how the economy had changed. This is a gloss of Durkheim's sociological thought, but it makes my point: that social inclusion or social integration tends to adapt people to the needs of markets, rather than regulate markets to the needs of people.

We see this even more sharply in the UK, where social inclusion has been truncated to labour market attachment (Lister, 2000). If you have a job, you're OK and more likely to display socially inclusive and nicely cohesive attitudes and behaviours. If you don't, you're more likely to be poor, a drain on social welfare and prone to ‘anti-social’ drug abuse, hooliganism and crime. I don't want to understate the importance of work to people's lives. Work satisfies far more dimensions of our being than simply the monthly wage packet. Rather than neighbourhoods, workplaces are where people form many of their enduring friendships. But we also know the bleaker side of work: its physical hazards, its psychosocial threats and, subsequent to today's liberalized capital and episodic encounter with a crisis of over-production, its increasing non-standard form in which regular hours, living wages, extended benefits and longer-term security are being swept away as uncompetitive relics of a bygone era— ‘labour market rigidities’ that constrain our domestic productivity.

It is naïve, then, to claim, as some have that ‘policies to combat social exclusion offer the hope of increasing employment opportunities and reducing poverty’ [(Guildford, 2000), p. 16]. These poverty-reducing jobs will be created in one of three sectors: the public, the private, or the informal/underground. The informal sector work is highly insecure, private sector employment is increasingly so, and the public sector has been under two decades of right-wing attack to reduce its expenditures by trimming its labour force. Only ‘strong state’ regulatory and redistributive policies might re-allocate employment opportunities in some more durably inclusive way. Yet it is these very policy instruments that are being traded away in free-trade negotiations, in such accords as the General Agreement on Trade in Services (which could lock-in privatized public services, and under foreign ownership and even provision), the Agreement on Trade-Related Investment Measures (which prevents governments from putting equity-oriented ‘performance requirements’ on foreign investment) and the Agreement on Government Procurement (which could bind government contracting-out to purely commercial criteria, including ‘national treatment’ of foreign bidders).

SOCIAL JUSTICE: EQUALITY OF OPPORTUNITY OR EQUALITY OF OUTCOME?

What pulls these concepts of social inclusion/exclusion in sometimes different directions, strange as it might first appear, is social justice. This is because there are two broad norms of social justice, defined by their emphases on equality of opportunity or equality of outcome. Both norms are ideal types. There can never be equality of opportunity because different individuals or groups have vastly differing resources or capacities that automatically disadvantage the less well endowed. There can never be equality of outcomes because there are differences between people that cannot be, or should not be, bludgeoned into similitude. But equality of opportunity, the mantra of neo-liberalism and, it seems, many countries' approach to social inclusion, is a grossly insufficient norm if some degree of distributive fairness is our goal. Ten years ago, when Aotearoa/New Zealand began its radical dismantling of labour and welfare rights and entitlements, one of the newspapers published a cartoon showing a massive giant and a small ‘pip-squeak’ in a wrestling ring. The match evidently pitched the rich and powerful against the poor and powerless. But as one of the ringside commentators enthused: ‘It should be a good match. They're playing on a level playing field’. Equality in outcome demands inequalities in opportunity. Full stop. ‘Inequalities in opportunity’ does not mean targeted programs at the expense of universal programs. But universal programs without some targeting within them (some deference to greater disparity, greater need, greater historic exclusion) can heighten inequalities in outcome because of who is better able to avail of such programs.

THE NEED FOR A GLOBAL LENS

Consider, finally, that social inclusion/exclusion requires a global and not simply a national or local lens. Does success in including one group come at the expense of excluding another? Are we at risk, not of redistributing wealth and opportunity, but of redistributing poverty and marginalization?

Globally, for example, increasing numbers of women in developing countries are now being ‘included’ in the economic wage–labour system, partly because capital has ‘excluded’ from the same system the semi-skilled, blue collar, primarily male, primarily white labour force in developed countries. For many women, this foreshadows a shift in their empowerment. Yet much of women's employment remains low-paid, unhealthy and insecure in ‘free-trade’ export zones that often prohibit any form of labour organization and employ only single women. Often, the income they earn still goes to male household members. Women are favoured in such employment because they can be paid less. Most developing countries lack pay equity laws, and the gender income gap in many countries is widening (Gyebi et al., 2002). Public caring supports for young children have been declining in many trade-opened countries, portending future health inequalities. There is also evidence of a global ‘hierarchy of care’. Increasing numbers of women from developing nations are finding employment as domestic workers or other service providers in wealthy countries, and therefore become ‘socially included’, at least in an economic sense. They send much valued currency back home to their families, which helps in their social inclusion back home. Some of this money is used to employ poorer rural women in their home countries to look after the children they have left behind. These rural women, in turn, leave their eldest daughter (often still quite young and ill-educated) to care for the family they left behind in the village (Hochschild, 2000). In the absence of changes to the rules by which we trade and govern, the process of including some will almost inevitably exclude others.

CONCLUSION

Our concern, then, should not be with the groups or conditions that are excluded, but with the socio-economic rules and political powers that create excluded groups and conditions, and the social groups who benefit by this. Borrowing from similar cautionary statements I made regarding last season's first blush with social capital (Labonte, 1999), I offer a focal question for practitioners, researchers and policy makers.

For practitioners, social inclusion/exclusion may be a useful idea in their ongoing struggles to keep some resources flowing into that part of their work that aims to see the less powerful become more powerful, the disorganized more organized, the less capable more resourced and confident in their capacities. Like ideas of community empowerment and capacity before it, social exclusion should give practitioners pause to question: how has their work improved the situation for the least well off within the ambit of their communities? And how has it avoided ‘excluding’ others, who are perhaps almost as least well off, from the support and resource access they might require?

For researchers, social inclusion/exclusion could represent a new opportunity for research funding grants, peer-reviewed publications, theoretical refinements and invitations to health determinants conferences in nice places around the world. The problem is that the term becomes more a vehicle for career advancement than for social change. The question for those in the academy then is: how will theorizing and researching social inclusion/exclusion create different new knowledge and argument useful to community workers and citizens, media sound-biters and policy makers in redirecting public governance towards the end of a ‘good life’ for all, to which the market is necessarily subordinate? That is, does this idea prompt us to pose important questions for which we do not already have adequate answers?

For policy makers, those unenviably straddling political discourses that have captured the noun by eroding the adjective, the question may be: how can the arguments elicited by social inclusion/exclusion convince the free market ideologues of the necessity of disciplining economic practices towards fairness in the distribution of wealth and sustainability in the use of natural resources? Can a social inclusion argument be extended to what we know are important health determinants residing in our economic practices (adequate income and its equitable distribution, access to education and health care), forcing the evidence-based policy conclusion that these conditions require a return to the strong, redistributive state policies we have seen eroded over the past 20 years? Can a social exclusion argument be used to challenge the orthodoxy of equal opportunity with the ideal of equal outcome?

I sow these questions as seeds rather than transplanted agendas. I encourage debate around them, since disagreement is usually more enlightening than prescription.

I conclude this commentary by drawing attention to its title: ‘dancing the dialectic’. I don't want to discard the hopefulness that infuses the social inclusion/social exclusion concept. The dialectic dances between seeking to include more people into social systems stratified by exclusion even while trying to transform these systems. It's an old dialectic, one that never fully resolves but remains at best a grapple-able task; one that straddles the imperatives of revolution with the pragmatics of reform. It would be hubris to deny that many excluded groups simply want the same chance to climb the ladders of wealth and power as others have before them. It would be unethical to criticize the existence of such ladders in the first place, or to join in struggles to shrink their height.

I also like the idea of dancing. I recently returned from Brazil, where I learned the Samba and where every year during Carnival the social in-cohesion of that country's skewed wealth distribution—rivalling South Africa's as the worst on the planet—is momentarily obliterated in the world's biggest dance festival. Or as Emma Goldman, the early 20th century anarchist, feminist, and trade union syndicalist, inspirationally aphorised: ‘If I can't dance then it's not my revolution’.

This paper was based on a presentation to the Social Determinants Across the Life-Span Conference (York University, Toronto, 29/30 November 2002). The author wishes to thank the two anonymous reviewers of the manuscript for helpful insights.

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Author notes

Saskatchewan Population Health and Evaluation Research Unit, Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada and Faculty of Kinesiology and Health Studies, University of Regina, Canada

© Oxford University Press 2004. All rights reserved

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