2001 28



 July )

From www.bmj.com

Editor's choice

Social exclusion: old problem, new name



In 1842 the BMJ published an editorial deploring that "a professional man, a
gentleman, or the family of such living in Bath" could expect to live into their
50s, whereas labourers and their families in Liverpool could expect no more than
15 years of life. In 1865 the Lancet set up a special commission to inquire into
London workhouse infirmaries. The commission was instigated by Ernest Hart, who
later became the greatest editor of the BMJ. He helped to start the Association
for the Improvement of Workhouse Infirmaries, which included Charles Dickens and
John Stuart Mill as members. The principal feature of the BMJ during the three
decades of Hart's editorship was its emphasis on social medicine.

More than a century later the BMJ is concerned with the same issues, but we seem
to lack the vision, vigour, and optimism of Hart. This is not a theme issue that
we planned a year ago. This issue has arisen because we noticed that we had
accepted for publication many studies that related to social exclusion. Rather
than scatter the studies through several issues we decided to bring them
together. Why are there so many studies? One answer is the huge increase in
social inequity that occurred in Britain in the 1980s. The number of children
living in poverty tripled during the '80s, "catapaulting the UK to the highest
rates of any country in the European Union" (p 175). These increases were partly
the result of global forces and partly the result of political choices. Then
came a change of government, with a new emphasis on social exclusion. Among
other initiatives, it funded research into social exclusion.

Social exclusion is defined as "the inability of our society to keep all groups
and individuals within reach of what we expect as a society and the tendency to
push vulnerable and difficult individuals into the least popular places." The
result is that children living in poverty may enter a cycle of poor educational
achievement, unmanageable behaviour, drug misuse, unemployment, teenage
pregnancy, homelessness, crime, and suicide. This is hugely expensive for
society, not only in human but also in economic terms (p 191). It can also lead
to a society that is unpleasant for all. These problems are not uniquely
British<Picture: --->and some studies (p 207) and commentaries (p 197) are from
outside Britain<Picture: --->but Britain leads the world in this research,
because it has both severe problems and a long history of studying them.

What might depress Hart if he were to return would not be so much the
continuation of the problems, but the failure of a great social
experiment<Picture: --->the NHS<Picture: --->to make important inroads into them
(pp 177 and 179).





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Policies to tackle social exclusion.

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Social capital.

Tom Welsh and Mike Pringle
BMJ 2001 323: 177-178. [Full text]



One Bristol, but there could have been many.

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