In some places, there are cards for young people such as the Mi Card in Barnsley offering free off-peak bus travel and free swimming which also acts as a library card to enable them to participate in more activities (pteg, 2010).
One initiative that was set up especially to address socialexclusion was the concessionary travel pass which offers free off-peak bus travel for people over the female state pension age and disabled people (Mackett, 2014b). There is some direct evidence of health benefits. For example, Whitley and Prince (2005) in their study in the Gospel Oak neighbourhood in North London found that, for residents with a common mental disorder, the pass allowed them to access services, facilities and social support outside the neighbourhood which appeared to ameliorate some of the symptoms of their condition and prevent deterioration. This is in addition to all the benefits from improved access, reduced social isolation and improvements to wellbeing (Mackett, 2014a).
Some links between transport and health are widely known, such as active travel, physical (in)activity, air pollution and injuries. Others are not as apparent and are much less studied, for example social interactions. This article reviews the evidence that transport impacts on social interactions, and that social interactions impact on health. It is an updated version of part of chapter 5 from Health on the Move 2. There is growing evidence that aspects of transport influence socialexclusion, social capital, social cohesion and social networks. Numerous studies have identified associations between these aspects of social interaction and morbidity and mortality. Community severance – where transport infrastructure or the speed or volume of traffic act as a physical or psychological barrier– impacts on individuals’ travel, social networks, and the accessibility of goods, services and facilities, and has scope to influence health through a number of routes. With the development of more
This new territorial organisation defined municipalities as the basic territorial unit and granted them functions related with provision of basic household services, education and health, infrastructure and regulation of transport services, social housing and other development-related works. Such an administrative division required the creation of local government systems that responded to the objectives of financial and political decentralisation. Colombia’s 1986 municipal reform legislation introduced “the most comprehensive range of mechanisms in Latin America for promoting citizen participation in local governance” (Nickson, 2011, p. 15), which was ratified in the new Constitution. As a result, each municipality has a local council elected by universal vote, which exerts legislative functions over its territory and is subject to the Constitution and the law (Government of Colombia, 1991). Such functions include regulation and efficient delivery of services by the municipality; adoption of appropriate plans and programmes for economic and social development and plans for public works; authorising the mayor to enter into contracts and perform functions that belong to the Council under special circumstances; approving local taxes and expenditure in accordance with the constitution and the law; issuing an annual budget of revenues and expenditures; determining the structure of the municipal administration and distribution of functions between its offices, salary scales for public servants, and authorise the creation of mixed companies and state-owned enterprises; regulating land use and monitor and control activities of construction and retail of housing units within the limits of the law; appointing the Personero 32 for the period prescribed by the law; and issue rules for control and protection of the ecological and cultural heritage of the municipality. These
countries where the majority of people are poor”. Framing indigence as more than extreme poverty, Stierle and col- leagues kept clear of the widespread confusion between the two notions. The authors also distinguished two fundamen- tally different approaches–which they termed ‘technical’ and ‘political’–for improving access to health care for the African indigents. On the one hand, the (more common) technical approach–within a depoliticised conceptualisation of indigence/poverty–reduces the challenge of indigents’ ac- cess to technical tasks, specifically to the identification of the indigents and effectively targeting services to them. On the other hand, the (less common) political approach seeks to reduce inequalities and to address the causes of poverty and exclusion, in order to improve the health status of the indigents . Eventually–spelling out indigence as “the ad- vanced state of poverty and socialexclusion” and taking stock of the limited success of a segregated technical ap- proach that had been unable to break the circle of poverty and to counteract socialexclusion–Stierle and colleagues made a case for the integration of the technical and the pol- itical approaches .
In considering the implications of an ageing rural population, it could be argued that, for many, the need for greater and growing mobility is limited as a problem by access to cars. However, the rising economic cost of car use may not be affordable for all. Incomes are often inflexible for older people; for example if they are pension-related. Moreover, as a result of physiological change, the physiological capacity to move the body and operate machines will often be subject to some decline, affecting capabilities to walk, drive personal vehicles and access public transport. Hence, the remainder of this paper will focus on older rural residents‟ abilities to access the necessities in life, such as health services, shops, or even cultural facilities, and their inclusion in their immediate local communities through participation in social activities.
This series of incidents and clinical mishaps ended in her death from sepsis and colitis, about which Rosemary Mander comments that protocols are disregarded or may not even exist (Mander 2011). Moreover, given the changes in healthcare provision and the needs that existing health care structures no longer meet, many responsibilities for their own care are being shifted on to the shoulders of women themselves (Mander 2011). If there is any degree of vulnerability or lack of resources or personal support, women may be unable to cope with any additional burden. Yet it may be very hard indeed for practitioners to comprehend why in their view, women are not ‘complying’ with their instructions (Mander 2011:256). Too few clinicians understand the intricacies of living with deep socialexclusion. The 2010 NICE Guideline on Pregnancy and Complex Social Factors seeks to help clinicians identify women in need of additional support, including women who misuse substances, women under twenty years of age, women who experience domestic abuse and women who are recent migrants (National Collaborating Centre for Women’s and Children’s Health 2010) and proposes additional service provision, improved service organisation and better delivery of care. The authors do not comment at all on where the political will is to be harnessed to promote better services for vulnerable women.
Historically, transport has not been analysed within social science research and policy makers have an inadequate understanding of the impact of transport disadvantage. Equally its social effects have tended to be overlooked by the transport professionals (Lucas, 2004a; Hine and Mitchell, 2001). Grieco et al (2000) feel that in the same way that transport planners had not taken adequate account of factors such as gender differences, they are also socialexclusion- biased. Thus, they concentrate on certain work journeys to certain locations (city centres) and they view some transport problems (congestion) more seriously than others (for example, lack of access to health services and fresh food). They also argue that transport as a profession and perspective has had an engineering focus which has failed to identify the user needs of deprived communities and to incorporate feedback mechanisms and the integration of the excluded into governance structures which would keep services on track. Social policy as a profession and perspective has been time/space naive: there have been very few analyses of the scheduling difficulties experienced by low income individuals and communities within a social and national context of decreasing accessibility to primary services. Transport planners have traditionally approached transport problems from a mobility view, rather than from an accessibility perspective (Barton, 1999). Whitelegg also states:
Therefore, the current paper draws upon various theoretical perspectives on social capital and explores how they can strengthen the theoretical basis of research about transport and socialexclusion. Social capital has been one of the most widely used concepts in the social sciences since the 1990s (Woolcock, 2010), and it has been discussed in past research on the links between transport and socialexclusion (Gray et al., 2006; Currie and Stanley, 2008; Stanley et al., 2011, 2012). However, the concept’s full potential has not yet been realised in relation to thinking on transport and socialexclusion. This is in part because previous research has gravitated too strongly towards understandings of social capital that are informed by the writings of James Coleman (1988, 1993) and particularly Robert Putnam (1993, 2000) who tend to privilege the benign impacts of social capital on individual and communal wellbeing over the more questionable effects. Research into the linkages between socialexclusion and transport disadvantage would benefit from more fully appreciating the Janus-faced character of social capital: it helps us understand the dynamics in the interactions between mobility and socialexclusion because it is both a medium for social change and can reinforce existing inequalities.
Through access to information, individuals could also become empowered to shape their own future, including their own health and social care and support (Burrows et al, 2000). Through access to self help and support groups, especially with regard to healthcare 12 , people could become aware of choices through being more informed, without having to have the skills, confidence or mobility to access libraries or meet with officials. Through virtual mobility, some physical and mental health impairments which act as constraints upon physical mobility and thus access to social networks 13 , goods and services can be overcome. The discrimination that is inherent in social attitudes, affecting equality, could be masked by recourse to virtual mobility (Baym, 1995). Online learning 14 can allow people to improve their educational achievement and skills, without having to travel or meet in person, a potential barrier to learning because of lack of confidence, transport difficulties, personal circumstances (Robson, 2001; Shearman, 1999).
This dissertation is organized in an integrated article format (as regulated by the School of Graduate and Postdoctoral Studies at Western University, London, Ontario) containing six chapters, three of which are stand-alone manuscripts to be submitted for publication. Chapter One serves as a brief introduction to this study with a summary of research purpose and approach, as well as a background to the context of homelessness in Canada. Chapter Two continues to serve as a background chapter, but is a stand alone chapter, focused on the concept of socialexclusion and health and has been accepted for publication in the Canadian Journal of Nursing Research. In Chapter Three, relevant literature is reviewed pertaining to study purpose and an in-depth examination of this study’s theoretical and methodological underpinnings are provided. Chapter Four is a stand-alone article of study findings from the first phase of this study. This article will be submitted to Qualitative Health Research for publication. Chapter Five is also a stand- alone article and the second phase of this study. In this article, a critical discourse analysis is employed to examine Realizing Our Potential: Ontario’s Poverty Reduction Strategy (2014-2019) (Government of Ontario, 2014). Chapter Six provides a synthesis of the entire research study, with implications for nursing practice, policy, education, and research outlined. At times, there is repetition between chapters because of the integrated article format, particularly pertaining to the study purpose, literature review, and
Socialexclusion is generally considered as one of the social determinants of health and a major factor in the causation and maintenance health inequalities [1–3]. Socialexclusion is a broad term that refers to the inability of certain groups or individuals to participate fully in society. The World Health Organization defines socialexclusion as ‘‘dynamic multidimensional processes driven by unequal power relationships interacting across four main dimensions - economic, political, social and cultural - and at different levels including individual, household, group, communi- ty, country and global levels’’ . Important features of socialexclusion are multi-dimensionality, relativity (i.e. socialexclusion is context specific) and agency . Agency refers to the fact that the excluding is done by someone or something, which can be the government or private institutions, the social environment or the individual itself. It is common that exclusion processes in one dimension affect those in other dimensions [2,6,7]. For example the loss of paid employment may lead to loss of social contacts and loss of income, which in turn may result in debts, poor housing, insecure living environment or reduced access to health care . All these factors increase the risk of health problems directly or indirectly. In addition the experience of being excluded affects
28. The report from the SocialExclusion Unit marks the start of a sustained programme of change to challenge discriminatory attitudes and significantly improve opportunities and outcomes for adults with mental health problems. This will mean people with mental health problems regaining hope and recovering control of their lives, whatever their diagnosis or ongoing symptoms. Government has an important role to play, but the active involvement of the voluntary and community sector, employers and, crucially, people with personal experience of mental health problems will be essential to achieve real change.
12. Broadly speaking, it is only in recent years that mental health trusts have started to consider employment as a realistic option for people with mental health problems. There is still great variation in available support. 35 per cent of respondents to the SocialExclusion Unit consultation felt that health and social care services placed a low priority on employment, and only 6 per cent felt it was a high priority. Even now, ‘vocational services’ can too often include a succession of training courses that are designed to fill people’s time but do not provide a platform for moving into open employment. However, the best projects bring together key partners to meet clients’ health, employment and other needs. They can have a critical role in persuading clients to interact with Jobcentre Plus and overcome fears about benefit loss, both of which can be barriers to work (discussed in more detail in Chapter 6).
social environment but lower in traffic than the respondents from other walkable neighbourhoods. In terms of transport disadvantage, the difference between the four neighbourhoods was only marginally significant, but overall the neighbourhoods with walkable environment and/or good public transport experienced less transport disadvantage than the car-dependent neighbourhood. In terms of social inclusion, none of the three variables were significantly different in means between the four neighbourhoods, suggesting that the role of built environment on social inclusion/exclusion might be weak. For personal health, only physical health was significantly different between neighbourhoods, and respondents from Harris Park (characterised as very walkable with good public transport) identified much better physical health conditions than respondents from other neighbourhoods. Finally, the differences in SWB between the four neighbourhoods were not statistically significant. Having said all this, it must be noted that these are results relating to very small samples, particularly in the case of Harris Park and Hillsdale.
The discussions corroborated hypotheses in the transport and socialexclusion literature. There is strong evidence to suggest that modal choices, that is, the modes available for use and the modes used by the participant, are restricted by the following characteristics: economic status; location; and age. There was little evidence to suggest that other characteristics, although significantly influencing the likelihood of experiencing poverty, were significant in influencing modal choice. Indeed, each of these characteristics is seen by participants to remove the element of choice from their transport decisions. For many people, primarily but not exclusively those on low incomes, not only is car ownership beyond their means, but making a journey by car, or by public transport – bus, taxi and train – and as a passenger in a friend or family member’s car (an important source of mobility for many participants) is often unaffordable and/or unavailable. It emerged strongly that the choice of whether or not to travel is often determined by finances. If participants cannot afford to travel, the journey will either be made on foot, or not made at all. If a journey by motorised transport is necessary, sacrifices are made in other areas of life and journeys are prioritised, in order that the essential journeys can be made. It is not only the cost of transport that is exclusionary. The routings, timings and accessibility of public transport in particular, strongly influenced by location and participant needs – with more people on lower incomes, people outside of employment (linked to age) and with children travelling off-peak or on non-radial journeys – are seen to contribute towards exclusion, affecting participants’ access to activities.
Although it is not the main hypothesis of this paper, the results also demonstrated that welfare resources did not reduce the risk of socialexclusion among disadvantaged groups also in relative terms. To the contrary, our analysis demonstrated that the most advantaged groups, in terms of good health, employment and high educational attain- ment, benefitted equally and in some instances more than disadvantaged groups in terms of informal social participa- tion. These findings contradict recent studies that demon- strated that welfare generosity compensated disadvantaged individuals more [21,39]. One interpretation of these results is that individuals who are disadvantaged in health combined with other social disadvantages benefit the most from financial resources (benefits). Individuals who do not face these disadvantages in health and social position on the other hand, have sufficient financial resources, and thus profit more from certain services; for example, child- care services, freeing up additional time and opportunity to participate . In sum, all social groups benefit from welfare generosity, but there are different mechanisms underlying the associations for different social groups. When the most advantaged individuals benefit more than the disadvantaged, the already strong inclination to participate in generous welfare states might be additionally boosted by the same mechanism.
The 21 participants experienced high levels of stress on a daily basis. The daily need to satisfy basic life requirements consumed a large portion of the day. This included having to eat at soup kitchens, obtain food from food banks, risk incarceration, “hustle” to feed addictions and experience personal disrespect in many forms. The lack of housing, education, employment and a stable income contributed to socialexclusion which impacted physical, psychological and socialhealth status. As P-5 stated, the reason he did not have permanent housing was due to “no finances...it’s hard to get on social assistance...it’s kind a like once you’re down you gotta stay down.” P-5 was a 26 year old male who had been couch surfing for 9 months, was the father of two children and reported his health as poor. He reported he had two previous myocardial infarctions and suffered with depression and anxiety. As reported earlier, according to McEwan (2008) constant exposure to daily threats contributes to allostatic overload increasing susceptibility to chronic illness and poor health status.
Another aspect to take into account, given our study re- sults, is the paradoxical increase in the physical but not in the mental QL of the participants after the program. Two factors might explain this observation: differing cultural concepts of “health” and the complexity and multidimen- sional definition of QL. In some cultures, mental health problems stigmatize the affected person . As a result, people tend to “unconsciously hide” their mental discom- fort, with a somatization into physical discomfort . In this sense, the increased physical QL perceived by young adults such as our participants could be attributed to their improvement in self-esteem and reduction of stress, which they perceived as an improvement in their physical QL. Second, the inclusion of physical, psychic and social as- pects, and also subjective and objective facets of each par- ticipant, in defining QL  makes it particularly difficult to assess the changes in each dimension separately.
dependent areas rely much more on the car. Fig.3 shows the average annual travel distance by transport mode, across different types of area. Overall, it appears that the degree of urbanity does not make much difference to travel distance: this stands in stark contrast with corresponding figures for members of car-owning households (Fig. online 2) showing that London residents travel on average much less than their rural counterparts. However, this stability for carless individuals is the result of two diverging trends: indeed, while the distance covered as a car passenger increases steadily as the degree of urbanity decreases in Fig.3, the opposite is true for public transport. As a result, the modal split is very different across types of area, with London carless individuals covering 73% of their travel distance by public transport and only 13% as car passengers, while the corresponding figures in rural areas are 41% and 40%. This pattern might be explained by the better provision of public transport in larger cities; yet, the changing composition of the carless group across different types of area illustrated in the previous section is probably not unconnected to these differences in modal behaviour.