1 Conclusions and reflections
Within this book we have not set out to provide an all encompassing grand theory that can account for exclusion and connectedness in all their complex and dynamic forms. Rather we have tried to illustrate how exploring the processes that lie behind exclusion and connectedness helps us understand how these arise, and are played out in everyday life. This knowledge helps us understand how practitioners in professions concerned with improving health and wellbeing, and in particular reducing inequities in these, might better shape practice to the achievement of these ends. Our theorising is not produced from some abstract exercise carried out in the academy, as the quote from Adrienne Rich above alludes, it arises from our practice and reﬂection on that practice, from research into that practice, andwe value that mode of production. We have noted the many diﬀerent understandings about social exclusion
present in the academic literature and within policy discourses. Diﬀerent deﬁnitions of social exclusion exist, each produced in diﬀerent circumstances, and to some extent, each meeting diﬀerent needs. Our purpose has not been to craft a detailed genealogy of the term, but rather to illustrate its variety and the necessity of paying close attention to the particular deﬁnition(s) that come into play in diﬀerent policy and practice situations. We have also introduced a number of diﬀerent theoretical approaches to understanding exclusion and the factors that produce it, and presented the framework that we have found useful in this connection. The framework we set out in Part 1 has a number of distinctive features in
its approach to social exclusion. First, it emphasises social exclusion as: dynamic, multiple and contingent. Individuals, groups and communities usually will experience diﬀerent degrees of exclusion and connectedness in diﬀerent spheres of life, and these change through time as external and internal factors change. This complexity demands a nuanced and sophisticated approach to
tackling exclusion in both policy and practice. All too often however, responses are situated within the silo of a particular sector, rather than being intersectoral or multisectoral, and are based on a binary distinction between excluded and included. Second, we have emphasised the importance of language in the creation and recreation of exclusion and connectedness. Third, we have emphasised that we ﬁnd a focus on connectedness (rather than inclusion or participation) as the reverse of exclusion more appropriate in terms of understanding people’s experiences. In this short concluding chapter, we consider these features further, exploring some of the implications for policy and practice, drawing on the chapters and research studies presented in Part 2 of the book. We also consider brieﬂy a research agenda for the future.
We have emphasised the importance of a focus on the privileged, as a distinct group within the broader category of the included. In Chapter 2.1, Pease addressed those of us who beneﬁt most from existing social divisions and inequalities, speaking particularly to white, middle-class, heterosexual, ‘ablebodied’ men; the chapter illustrated how these inequalities are reproduced by and through the daily practices and life-style pursuits of privileged groups. In Chapter 2.2, Crisp continued this type of analysis in reﬂecting on her own practice as a social work educator in selecting new students into the social work degree or making determinations about current students. She illustrates how she attempts, through the exercise of professional discretion, to improve social connectedness into spheres of education and ultimately employment for certain groups in the population, such as those with a criminal record. She also identiﬁes how the exercise of such discretion depends crucially on the institutional norms and policies within which she exercises such discretion. Individual action, interaction and identity are constrained by the operation
of institutional norms, practices and policies in ways which can act as exclusionary. Chapters 2.3 by Cook and 2.15 by Taket, Foster and Cook include examples of this in operation in the welfare beneﬁt system and health systems. Chapter 2.10 by Carey et al. explores the exclusionary processes applying to voluntarily childless women, illustrating the exclusionary eﬀects of societal norms and discourses about childless women on the experience of those who have elected to be childless. We have also shown how the experiences of exclusion and connectedness
are mediated by diﬀerent social and cultural factors, whose operation varies across the diﬀerent levels we have considered: individual, community/local, societal. Some chapters have taken as their focus diﬀerent communities of interest: carers, considered by Savage and Carvill in Chapter 2.6; immigrants, considered by Renzaho in Chapter 2.9; older people, considered by Nevill in Chapter 2.11; and bisexual young people, considered in Chapter 2.12 by Martin and Pallotta-Chiarolli in relation to mental health and substance abuse. Chapter 2.5 by Owens considers people with disabilities and analyses
the issue of access. Although there is a growing awareness of facilitators of access and societal responsibilities associated with these, considerable access issues prevail for people with disabilities. Access is inﬂuenced by the processes through which participation is achieved and by the numerous social and structural barriers that compromise participation. A common feature in all of these chapters is the demonstration that the experience of exclusion is a dynamic, rather than a static, phenomenon, and that it can be experienced in a variety of ways – it can be social, ﬁnancial, educational, employment or service related, or indeed any combination thereof. Exclusion and connectedness can also operate diﬀerently in diﬀerent
spheres of life. Chapter 2.4 by Henderson-Wilson illustrates this with the case of inner city high rise living in Australia, exploring how this particular form of housing can result in both exclusion and connectedness for the residents concerned, and considers the diﬀerent aspects of the built environment and community activities that can foster connectedness. Eﬀects of exclusion produced in important areas of health and wellbeing
can sometimes be positive and sometimes negative. In Chapter 2.9, Renzaho considers the complexities of the relationship between acculturation and its long-term eﬀect of social exclusion for migrants, producing in some cases deleterious health and social outcomes, whilst in other cases the opposite. In Chapter 2.14, two contrasting examples of ‘othering’ and marginalisation through being ‘the other’, were explored. In one case, othering acted as an inclusionary process while in the other it was exclusionary. Our framework can be viewed as adopting an intersectional approach
(Sloop 2005). Intersectionality theory originated in the writings of AfricanAmerican and third world feminists, concerned to counter Western feminist theory’s insuﬃcient attention to women of colour by providing a more appropriately complex and nuanced analysis that incorporated attention to other social-demographic characteristics and the relations of inequality associated with them alongside gender relations (Collins 1991; Mohanty 1991). The main premise that is pertinent here is that any particular form of inequality or oppression is modiﬁed by its interactions with other forms or inequality or oppression, and that thus the patterns of exclusion linked to these are similarly modiﬁed by interaction. In Chapter 2.1, Pease articulates an intersectional theory of privilege, and shows how this links to the creation and recreation of exclusion. Cant and Taket (2006), in an exploration of lesbian and gay experiences of primary care, showed how a consideration of the intersections of gender, race, class and occupation, together with sexuality was required. They demonstrated how the heterosexist assumptions and systems in relation to sexual health operated with quite diﬀerent exclusionary eﬀects for lesbians and gay men, and how concerns around mental health resulted in rather diﬀerent presentations of self for black lesbian and gay men in comparison to those who were white. A failure to recognise the particularity of the experience of diﬀerent groups
runs the risk of giving rise to what Martin and Pallotta-Chiarolli call ‘exclusion
by inclusion’ where notions of overlap are deployed as signifying inclusion while in reality meaning continued exclusion, through neglect of the nonhomogeneous nature of the group and their experiences. An important part of our understanding of social exclusion is that, rather than a dichotomy of included or excluded, there is recognition of long-term processes, grounded in social dynamics and individual experiences that create diﬀerent patterns of inclusion and exclusion.