Abstract
Objective: To explore the influence of the global structural determinants and their
pathways of action on health disparities and social exclusion, drawing on findings from
research with four different population groups in an Arab context. We use a socioecological
framework to categorise these determinants into levels to allow an in-depth
look into their pathways of action on social exclusion and inequalities.
Methods: We use findings from an ethnographic study on Palestinian and Iraqi
refugees in Lebanon; a qualitative research study on women’s needs for labour support
in three public hospitals in Egypt, Lebanon and Syria; and counselling experiences with
university scholarship recipients in Lebanon. These findings were revisited using a
social exclusion lens.
Results: Global forces, such as modernism, inequitable foreign policies of resettlement
countries, over-medicalization of health care, modern educational systems and armed
conflicts fueled by global vested interests interact to cause and exacerbate social
exclusion. Palestinian refugees relate their experiences of discrimination in what is
perceived to be a hostile society to policies reducing their education and employment
opportunities. Delays in processing resettlement applications of Iraqi refugees and the
lack of power over the choice of resettlement countries are a source of reported stress
and anxiety. Over-medicalization of maternity care disrupts the traditional ways of
giving birth surrounded with family through policies and practices restricting labour
companionship, resulting in the isolation and silencing of women during childbirth.
Scholarship students reported inadvertent exclusion from their families, societies and
colleagues. Scrutiny of the findings and re-examination of the data reveals the
importance of global structural determinants in explaining the patterns of exclusion
reported for the population groups observed.
Conclusion: Expanding the ecological framework of determinants of social exclusion at
the level of wider social/structural determinants is necessary to improve our
understanding of social exclusion in impoverished and war affected places around the
world.
Published on
13 Sep 2019.
Peer Reviewed