Insights into theorizing social exclusion and inequities: A perspective from the Arab World

Objective: To explore the influence of the global structural determinants and theirpathways of action on health disparities and social exclusion, drawing on findings fromresearch with four different population groups in an Arab context. We use a socioecologicalframework to categorise these determinants into levels to allow an in-depthlook into their pathways of action on social exclusion and inequalities.Methods: We use findings from an ethnographic study on Palestinian and Iraqirefugees in Lebanon; a qualitative research study on women’s needs for labour supportin three public hospitals in Egypt, Lebanon and Syria; and counselling experiences withuniversity scholarship recipients in Lebanon. These findings were revisited using asocial exclusion lens.Results: Global forces, such as modernism, inequitable foreign policies of resettlementcountries, over-medicalization of health care, modern educational systems and armedconflicts fueled by global vested interests interact to cause and exacerbate socialexclusion. Palestinian refugees relate their experiences of discrimination in what isperceived to be a hostile society to policies reducing their education and employmentopportunities. Delays in processing resettlement applications of Iraqi refugees and thelack of power over the choice of resettlement countries are a source of reported stressand anxiety. Over-medicalization of maternity care disrupts the traditional ways ofgiving birth surrounded with family through policies and practices restricting labourcompanionship, resulting in the isolation and silencing of women during childbirth.Scholarship students reported inadvertent exclusion from their families, societies andcolleagues. Scrutiny of the findings and re-examination of the data reveals theimportance of global structural determinants in explaining the patterns of exclusionreported for the population groups observed.Conclusion: Expanding the ecological framework of determinants of social exclusion atthe level of wider social/structural determinants is necessary to improve ourunderstanding of social exclusion in impoverished and war affected places around theworld.