Authors:

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.