Embedding social inclusion in general practice: time for action

social exclusion and health inequalitiesOver 40 years ago, Julian Tudor Hart formulated the inverse care law, stating that 'the availability of good medical or social care tends to vary inversely to the need for it in the population served'. 1 This still applies today, and the gap in life expectancy is widening between different social groups.2 Social exclusion is 'the inability of an individual, group, or community to participate effectively in economic, social, political, and cultural life, alienation, and distance from the mainstream society'.3 This broad definition refers to people who are suffering multiple and enduring disadvantage and who do not have the opportunities that many of us enjoy.There are many social groups that are facing substantial health inequalities, and this issue highlights some of them.As outlined by Watton, 4 the average life expectancy for single homeless men is still 47 years, a whole 30 years below the national average, whereas for people with intellectual disability, the gap is 16 years.5 While social exclusion is often regarded as a predominantly urban issue, since the highest concentrations of some of those groups are usually found in cities, 6 there are specific aspects of exclusion affecting rural populations.The editorial by Osborne, 7 for example, highlights the staggering statistics on suicide among isolated farmers, which is twice the general population, as well as a high incidence of depression.The underlying reasons for these striking inequalities arise from a complex interaction of factors including housing, income, education, social isolation, and disability. 2 This requires an integrated approach between different bodies and agencies at both national and local level.