San Francisco Burden of Disease & Injury Study:
Determinants of Health
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Social Exclusion/Institutional Racism

Exclusion from participation in institutional, social, cultural and political ties in society or from the access to societal resources available to the average person. It implies exclusion from the notion of full citizenship, defined in terms of income, health, housing, social contacts, education and paid work. Racism, sexism, homophobia, xenophobia and poverty are all included in social exclusion.

Immigrants, ethnic minority groups, guest workers, refugees, the homeless, people who are ill, disabled or emotionally vulnerable, such as former residents of children’s homes, prisons and psychiatric hospitals are particularly vulnerable to social exclusion. Their children are likely to be at special risk. The racism, discrimination and hostility that they often face may harm their health. Those with physical or mental health problems often have difficulty gaining an adequate education or earning a living. Disabled children are most likely to live in poverty. Stigmatizing conditions such as mental illness, physical disability or diseases such as AIDS makes matters worse. Homeless people, who may experience a combination of these problems, suffer the highest rates of premature death. Material deprivation and the social and psychological problems of living in poverty are considered a form of social exclusion (see also, low SES).

As described above, social exclusion can take a variety of forms. The Work Group decided that prevention efforts should be focused on institutional racism. Institutional racism is the collective and historical failure of an organization to provide an appropriate and professional service to people because of their color, culture or ethnic origin.



Contribution to overall disease burden in SF

Downstream (Health Consequences)

What can be done?

Web resources

MEDLINE strategies

Updated May 9, 2003• Please send feedback to Brian Katcher

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