Critical Overview of Social Exclusion and Its Effects on Health

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The article, entitled ‘Spatial Analysis of Social Exclusion from a Transportation Perspective: A Case Study of Ankara Metropolitan Area’ by Fahriye Nihan, Özdemir, and Sönmezb, defines social exclusion as the state where different groups of individuals cannot fit into the community or the society due to political, social or economical disadvantages. One example of social exclusion in today’s society would have to be uneven wealth distribution based on class. This essay will discuss in depth several aspects of social exclusion as well as some factors being affected by social exclusion in today’s society in relation to an individual’s health. The first effect being analyzed in this essay will be the changes to social behavior (mentally vs physically) as a result of bullying. This part of the paper will discuss ways in which mental illness can have a negative effect when it comes down to social exclusion and an individual’s health per say. The second factor being discussed in this essay will be poverty in relation to social exclusion and health. Poverty has been seen in reports and studies to have a downwards spiral effect in terms of social exclusion as well as a risk factor in terms of less intimate social relationships anywhere. Social exclusion has been seen to only have negative effects on an individual’s health physically and mentally. Stigma caused by being poor or being treated unequally during your childhood, can have increased negative risks of developing social exclusion and the negative effects that come with it. Social exclusion in the form of bullying, poverty, inequality and stigma causes permanent mental and physical damage to an individual’s health.

Studies have shown that social rejection such as bullying even in the mild form, can cause long term health damage. DeWall explains, “Social rejection also is a complex construct, consisting of behaviors that can range from ignoring another person’s presence to actively expelling him or her from a group or existing relationship”. These behaviors always cause emotional distress for the victim at whom they are directed. “In terms of emotional responses, social rejection tends to increase various types of negative emotions. Hurt feelings are the core emotional marker of social rejection, but rejection also increases anxiety, anger, sadness, depression, and jealousy (Leary, 2010). Social rejection also diminishes self-esteem, defined as temporary feelings of self-worth’ (Williams et al., 2000). These emotional changes can be quite serious on their own but they also cause physical and behavioral changes. Bullying causes some physical changes to a person’s behavior after experiencing it. One example of this would be personal isolation and anger/sadness caused from social situations creating more of a social exclusion prone atmosphere. Personal and or social isolation is defined to be the insufficient interaction between an individual and the society around them. Individuals experiencing this, may be distant and want to for example hide indoors and avoid attending any sort of social events, for example dinners with family friends. But if people always stay indoors, one may lack fresh air/ exercise alongside social interactions to develop and maintain their mental health. It may also weaken the person’s immune system, making them more prone to infections when they encounter foreign outside bacteria resulting in a frequent sickness. These physical effects of bullying are often overlooked by schools when dealing with the problem. Another example of social isolation would be lack of social networks and support. Immigrants are a great example of such individuals. During times of stress and social exclusion, one may have no one or very few people to rely on for support and guidance during hard times. This would affect immigrant children to become victims of bullying more often. Health wise, isolation and its outcomes would cause this individual physical pain (suffering) and would increase the body’s physical stress responses resulting in the worsening of their health status. Physical health barriers caused by bullying would worsen the individual’s state of being healthy.

In addition to the physical effects of bullying, there are also mental changes that come along with being bullied and isolated. “Social rejection influences cognitive processes in two main ways. First, it reduces performance on challenging intellectual tasks, resulting in decreased performance” (Baumeister, Twenge, & Nuss, 2002). This can impact the individual’s self-esteem as a result of poor performance. Second, social rejection causes people to become cognitively attuned to potential sources of social acceptance and to potential threats, presumably as a means of gaining acceptance from others” (Williams et al., 2000). This drive to gain acceptance reduces an individual’s concentration and promotes self-doubt. But most importantly it can cause unhealthy behaviors in order to get accepted such as social drinking and smoking. “Rejected people can also be hypersensitive to signs of threat” (DeWall, Twenge, Gitter, & Baumeister, 2009). Anxiety is another serious mental health disorder, because it prevents individuals from functioning normally. An example of this would be hiding indoors and avoiding social contact during outdoor recess based on the anxiety that you will get bullied outside. This may linger with the individual’s health preventing them from getting enough fresh air and exercise and increasing the risk of germs. There are even reports of elementary school students eating their lunch in the washroom to avoid social situations. Anxiety is not the only mental issue resulting from social rejection, depression is also a factor. Depression is a condition categorized by unwanted feeling of sadness, preventing normally functioning individuals from daily activities. There are reports that claim 31 percent of people who were bullied as children ended up looking for treatment for depression in the ages of 16 to 29. Depression has physical effects on the brain. The brain produces a hormone called cortisol during times of stress and depression. When too much of this hormone is produced and sent to the brain, this can lead to memory problems associated with the shrinking of neuron production. Mental illness serves as a barrier in terms of an individual’s health and being socially active for those individuals suffering from it.

Poverty is commonly defined as a lack of economic resources that have negative social consequences, but surprisingly little is known about the impact of economic hardship on social determinants of health such as social exclusion. Poverty does not only prevent a healthy lifestyle through the inability to afford things, but it also prevents people from participating in social events where they could be labeled. An example of this can be when people avoid shopping for vitamins at health food stores or even signing their children up for team sports such as dancing where you may be able to afford lessons, but the clothing needed for competitions is expensive. “Our finding of negative effects of poverty on civic and political participation relates to the fears of a ‘downward spiral of social exclusion’, as there is a risk that the loss of less intimate social relations shrinks social networks and decreases the available social capital in terms of contacts that can be important for outcomes such as finding a job” (Lin, 2001; Granovetter, 1974). The social stigma of poverty is another factor. “To be poor has, almost throughout human history, entailed a particular vulnerability and imposition of shameful identities. Stigma of poverty does not just cause painful emotions to the individuals on the receiving end. It leads to social isolation as people try to avoid situations where they might be labelled”. Being poor, has never been seen to have any positive impacts on an individual’s health.

Stigma associated with social exclusion results in a negative impact on health. Goffman refers to stigma as an attribute that is significantly discrediting. A stigmatized person is one who is thought to be not quite human or normal. Stigma is, therefore, “the negative perceptions and behaviors of so-called normal people to all individuals who are different from themselves”. Stigma relates to social exclusion and illnesses ultimately leading to an individual feeling not healthy or not themselves. A great example of this are people having HIV/Aids and the stigma doctors and/or medical professionals created by not wanting to treat infected patients. This creates even more health problems on top of the already existing HIV contributing to the worsening health condition of the patient. Other sources claim stigmatization around people who are mentally ill may also be attributed to social exclusion and lack of resources, employment and income. “Prominent among the indicators of social exclusion in the community is poverty. The close association between poverty and mental illness is mediated by a host of interweaving factors (Kuruvilla & Jacob, 2007). Stigmatizing attitudes towards the mentally ill thus excludes them from equal opportunities and meaningful employment leading onto poverty”. “Generally, people want to keep greater social distance from a person with schizophrenia than from someone with depression. One possible reason might be that the process of deinstitutionalization increased public discussions about community psychiatry and associated perceptions of risk. When looking at the most common stereotypes about ¾ of the population have a negative attitude about 2/3 towards alcohol dependence and schizophrenia, whereas depression finds more sympathy, presumably because more people are familiar with it”. Psychologists and other community physicians/members may perceive people with this diagnosis as psychopaths or decreased need for physiological security due to the fact they cannot express and perceive emotions being expressed in social situations. So, treatment options and care may be denied to those individuals. Also, studies have claimed and proven that having schizophrenia may lead to developing other mental illnesses such as depression or anxiety. Stigma around mental illnesses causes individuals to behave in an isolated manner and contributes to discrimination around all life’s aspects which can limit an individual’s access of healthcare facilities, ultimately resulting in decreased health for that individual.

All these effects related to having a diagnosis of a mental illness have allowed health professionals to conclude that people diagnosed with this or other mental illnesses feel discouraged from seeking things such as employment or some sort of stable income, leading them to reinforce or increase their own social rejection to avoid situations including being stigmatized. This leads to social isolation and rejection with further impacts on health.

An individual’s well-being including their physical and mental health can suffer due to social exclusion. Disgrace brought about by being poor or being mistreated during youth, can have lasting negative impacts on a person. Social rejection propelled by bullying or stigma more often than not causes further complications in a person’s behavior which impacts their health. Bullying results in long-lasting mental and physical health issues such as anxiety, depression, and increased infections. Poverty leads to avoidance of health promoting activities for the fear of being labelled and judged. Stigma based on being poor, mentally ill or different in any other way, has been seen to have impacts on social inclusion reducing one’s access to proper healthcare. Overall, social exclusion leads an individual to search for acceptance from others often causing them to engage in unhealthy behaviors. Understanding how social exclusion impacts health is crucial in building and maintaining a healthy society.

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