Intended for healthcare professionals


Policies to tackle social exclusion

BMJ 2001; 323 doi: (Published 28 July 2001) Cite this as: BMJ 2001;323:175

Must deal with the iceberg and not just its tip: this is an issue for all society

  1. Graham Watt, professor of general practice (
  1. Department of General Practice, University of Glasgow, Glasgow G12 0RR

    Papers pp 187-209 Primary care pp 210-7

    In the past 20 years the United Kingdom has become a more unequal society in which many people have prospered while many others have not. 1 2 This issue includes several examples of the adverse health and social effects for groups that have been excluded from general prosperity (and some attempts to ameliorate these effects). But the consequences of social exclusion provide too narrow a focus. Society as whole is also affected and needs to be engaged in supporting solutions to the problem.

    Differences in life expectancy between socioeconomic groups have widened, mainly as a result of faster rates of improvement in affluent groups. 1 3 Socially patterned premature mortality is the most stark form of social exclusion, but it occurs late in the process, usually after several decades of living in adversity. 4 5 It is not known to what extent this pattern is being repeated in later generations, whose early life circumstances have been generally more favourable. Nevertheless, the proportion of children born and brought up in households with less than half of average income tripled during the 1980s, catapulting the UK to the highest rates of any country in the European Union. 6 7 This generation is now reaching …

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