Including ‘inclusion health’? A discourse analysis of health inequalities policy reviews

Abstract

The 'inclusion health' agenda aims to draw attention to health disadvantages accompanying experiences putatively characterised by social exclusion, such as homelessness, problem substance use, or imprisonment. However, its increasing prominence has surfaced conceptual uncertainties and potential tensions with other understandings of health inequalities.We undertook a discourse analysis of how recent health inequalities policy documents describe, explain, and make recommendations relating to inclusion health. Using the UK as a case study, and with reference to public health accounts of multi-level governance theory, we selected five recent health inequalities policy reviews covering Scotland, UK, European Union, and the World Health Organisation.All documents referred to some inclusion health concerns, though their relative emphasis differed between documents. Terms like inclusion, exclusion, and vulnerability were commonly used, but ill-defined and often ambiguous. Explanatory discourses were diverse, with a particular focus on intergenerational cycles and disproportionate exposure to risk, with a varying emphasis on individual versus structural factors. Few documents provided coherent explanatory accounts for the relationship between the issues of interest to inclusion health, their associations with poor health, and other axes of inequality.Our results suggest that health inequalities policymaking in a multilevel context may benefit from comprehensive conceptual frameworks which encompass diverse forms of social stratification, advantage, and disadvantage, and acknowledge potential tensions and trade-offs between different understandings. This may necessitate further theoretical and empirical work for inclusion health on its definitions, bounds, and how its scope of interest interacts with other forms of social and health inequality.

Conceptualisation of health inequalities by local healthcare systems: A document analysis

“…This is reflective of findings that migrant health is highly politicised, so health agencies are hesitant to prioritise and allocate resources to this group (Staniforth & Such, 2019 ). Additionally, there is a little discussion within health inequality policy documents of the relationship between inclusion health groups and the social determinants that lead to their poor health (Tweed et al., 2021 ). Moving forward, policies to reduce health inequalities would achieve more progress by containing comprehensive conceptual frameworks that take into account social stratification, advantage and disadvantage Tweed et al., 2021 ).…”

AI Through Ethical Lenses: A Discourse Analysis of Guidelines for AI in Healthcare

“…Policy and social researchers have used Critical Discourse Analysis (CDA) to understand public health documents, albeit this methodology has yet to be applied to AI-guiding documents. However, the usability of CDA has been visible in other domains, for example, by using CDA to examine how health policy documents constructed chronically ill patients' roles or how inclusion policies framed health inequalities (Tweed et al, 2022 ; Walton & Lazzaro-Salazar, 2016 ). Other researchers used CDA to analyze the discourse surrounding AI in social media and the academic discussion on artificial general intelligence (Graham, 2022 ; Mao & Shi-Kupfer, 2021 ; Singler, 2020 ).…”

Preface

“…In section two we describe some examples of inequalities in respiratory disease. Some of the chapters in this section discuss specific conditions, such as cystic fibrosis [7], lung cancer [8] and asthma [9]; others discuss more broad and societal issues, such as antimicrobial resistance [10] and inclusion health [11]. What becomes clear from reading these chapters is that even though diseases have their own particular issues, there are themes common to all.…”