Poverty and inequality have long been the dominant categories to describe people’s living conditions and they continue to reflect significant problems in Danish society, even though the risk of poverty in Denmark is low compared to other European countries (Kenneth-Hansen, 2010: p. 20). However, from a historical perspective, poverty in Denmark has almost been a lost concept in the language of politicians and researchers for several decades since WW2 (Hansen, 2010: p. 4). Therefore, during the 1990s, social exclusion, as a “new” concept, has in many ways taken attention away from poverty. It was the former president of the European Commission, Jacques Delors, who in the early 1990s particularly helped to promote the use of the concept in connection with the launch of the EU’s poverty programmes (Larsen, 2004: p. 65).
The question is, however, what does this shift of focus from poverty to social exclusion mean? Not only have politicians in individual EU countries increasingly made it a central topic, but also in the scientific community there is a growing interest in topics such as “social separation” and “marginalisation”, as the new way of discussing misery and deprivation (Abrahamson, 2010: p. 32). Up to the 1980s, practically no one was addressing social exclusion as a topic.
The concept has also gained ground in Denmark, and the term is used for two different and overlapping phenomena (Larsen, 2004). In Denmark, social exclusion has typically been used to refer to the conditions of “socially disadvantaged” or “socially excluded” groups. That is, the problems associated with groups like the homeless, alcoholics, the mentally ill, and those the Council for Socially Marginalised People particularly focus on. The second phenomenon is social exclusion understood in terms of non-participation in key areas of life, which includes studies on the general population. This phenomenon has hardly received any attention in Denmark.
Despite the fact that social separation/exclusion1 has become a more widespread and “popular” concept, it is my mission in this article to question the ambiguity associated with a substantive provision of the concept. This is reflected in the many offerings of a definition of social exclusion that are found in scientific literature in the field. In addition, only few concrete empirical studies have been conducted on social exclusion in Denmark and also relatively few international studies where the results point in different directions. Professor Jørgen Elm Larsen(2004) conducted a study on poverty and social exclusion based on the Danish studies on living standards from 1976, 1986 and 2000. Larsen(2004) used a restrictive measure of social exclusion for non-participation in the general population(more on this later). A recent study “Community Measurement―A study of living conditions and social exclusion in Denmark” from 2017 with 2300 respondents in the age 18 - 70 years showed that about a fifth of the Danes experience to a greater or lesser extent the fact that they stand on the edge of the communities where others meet. These people have problems with e.g. health, finances, psyche or work life and who often feel lonely, not appreciated and out of society (SFI-Rapport 17, 2017: p. 19).
It is my assertion that social exclusion, as a newer concept to describe new and modified forms of social problems/misery, still has to prove its value. This can best be accomplished by carrying out several empirical tests on the operational value of the concept.
A paradox exists, because on the one hand, the scientific discussion on social exclusion as a concept shows a consensus amongst key researchers in the field, that social exclusion is a complex and multidimensional concept affected by objective social circumstances and living conditions. On the other hand, despite the prevalence of such consensus, it still remains the case that relatively few empirical studies actually use direct indicators during empirical measurement of social exclusion.
Therefore, the overall message of the article is that quantitative indicators, which are used in many empirical measurements of social inclusion, often give inaccurate measurements (Bak, 2004a). Not least because indirect indicators are often used to measure social exclusion, when it is highly debatable whether social exclusion is being measured in these studies at all (Bohnke, 2004; Layte, Bertrand, & Whelan, 2010).
In the first part of the article I provide a short account of the origins of social exclusion and the development of the concept in a European context, thereafter introduce, and critically address various scientific definitions of social inclusion, and what distinguishes social exclusion from other concepts such as poverty and social capital. Following this methodological literature on social exclusion will be reviewed through different approaches to its measurement. Mental health is used as a “critical case” to identify gaps in existing approaches towards measuring social exclusion.
2. The Political Origins of the Term in Europe
Social exclusion is a relatively new concept, which emerged as a new paradigm in the 1990s in poverty studies in Europe (Munck, 2004). It is a broader and more dynamic concept than that expressed in traditional understandings of poverty. Amartya Sen(2000)points out that the Frenchman René Lenoir(1974) is likely to be regarded as the true inventor of the concept.
Thus, it is a French invention pertaining to “Les exclus”, which refers to those who fell through the social safety net in the 1970s. For example, the disabled, single parents and the unemployed on benefits (Burchardt, 2000). Later, with the intensification of social problems in the peripheral areas of major French cities, the definition was expanded to include disgruntled young and isolated people. Therefore, social exclusion is closely linked to a French tradition, where “social density” is seen as essential to maintain social cohesion in society (Burchardt, 2000; Silver, 1994).
The concept can also be traced back to French sociologist, Emilé Durkheim(1964), who understood social exclusion in relation to―as well as in opposition to―the question of solidarity and social cohesion in society (Larsen, 2004). However, German sociologist, Max Weber, is generally associated with the concept of social exclusion. Max Weber(1968) used the term “social closure” for a group of people actively trying to maintain or secure a privileged position at the expense of another group. Reference is made to Silver(1994), Room(1995), Levitas(1996, 1998), Byrne(1999) for a more detailed overview of the social conceptions to which exclusion can be related.
The term has been applied to three competing methods in current political debates, which are more or less recognisable in political rhetoric concerning solution models for social exclusion (Levitas, 1998).
1)An integrationist approach(SID, Social Integration Discourse)in which employment is seen as a key factor in integration through earned income, identity, a sense of the “self” and networks.
2)A poverty approach(RED, Redistribution Discourse), in which the causes of exclusion are related to low income and lack of material resources. Inclusion will therefore require a redistribution of economic and social resources.
3)A lower class approach(MUD, Moral Underclass Discourse), in which the excluded are seen as deviants from the moral and cultural norms of society, who exhibit a “culture of poverty” or “dependency culture”. Consequently, they are attributed blame for their own poverty and associated social heritage.
These approaches have been summarised as “no work”, “no money” and “no morals”. In this sense, inclusion is about making social exclusion unattractive, and the mechanism of the government is to cut back on the services that make exclusion from the labour market possible (Larsen, Andersen, & Bak, 2012).
New trends in the field are visible, for example, in the 2010 Common European Plan for “Europe 2020” to combat poverty and social exclusion (Larsen, 2010; European Union, 2010, 2011). The main objective of the EU in the plan is to help at least 20 million Europeans out of poverty and social exclusion by 2020. Thus, the fight against poverty and social exclusion is one of the EU’s seven flagship initiatives for its strategy on Europe 2020. The initiative is about securing social and geographical cohesion to enable growth and the creation of jobs for the majority. Concurrently, the aim is that people experiencing poverty and social exclusion will have the opportunity to lead dignified lives and become active participants in society (European Union, 2010: p. 6).
Hence, the EU’s 2020 strategy expresses that the new objectives move more in the direction of applying labour market goals(high employment)and financial goals(reduced poverty). Thus, it can be seen that the predominant discourse of the EU on these topics during the last 20 years has slightly swayed. In this way, the new application of the concept in Europe is largely seen as a continuation of the integrationist approach focusing on job creation and growth as the key to reducing poverty and social exclusion.
2.1. Scientific Definitions of Social Exclusion
The following describes various definitions of social exclusion. Furthermore, it is debated whether(and the extent to which)social exclusion differs from other concepts such as poverty and social capital. The focal point will be a discussion on the theoretical precision of social exclusion as a concept based on a review of various scientific definitions of the concept. The objective is to clarify the ambiguity associated with a substantive provision of the concept and how this ambiguity shows up in the various attempts to operationalise social exclusion as a concept in various empirical studies.
Social exclusion refers generally to non-participation in general social, cultural, economic and political activities in society. Non-participation is central to most definitions (Burchardt, 2000: p. 320). Most definitions of social exclusion also emphasise the multidimensional and dynamic element of exclusion as a concept (Levitas et al., 2007; Burchardt, Le Grand, & Piachaud, 2002). A systematic review study of the literature on social exclusion (Morgan et al., 2007) showed that most studies found the following main characteristics within social exclusion:
1)Non-participation in society in various ways. However, there is disagreement about which aspects of society are important and who can be assigned responsibility for non-participation. Most agree that exclusion is related to the degree of exclusion, as people can participate to a greater or lesser extent.
2)Multidimensionality, in the sense that social exclusion includes income poverty, but it is also broader than this, i.e. other forms of vulnerability that may or may not be associated with low income, such as unemployment, poor self-esteem and mental health also fall under social exclusion.
3)Dynamic, in the sense that by analysing social exclusion, one needs to understand the underlying processes and identify the factors that draw people into poverty and exclusion, and what brings them out of poverty. For example, the level of human participation may vary over time (Larsen, 2004).
4)Multi-levels, in the sense that even though it is individuals who suffer from social exclusion, the causes must be found on many levels, such as the individual, household,(local)community and institutional level.
As Bohnke(2004: p. 2) points out, social exclusion can be described as a comprehensive, multi-dimensional and dynamic concept that generally refers to the limited opportunities of individuals to participate financially, socially, culturally and politically. The concept also refers to the enhanced processes behind the accumulated vulnerability and weakening of social rights (Sen, 2000; Abrahamson, 1998; Room, 1995).
However, many critical questions are raised, albeit with good reason, surrounding social exclusion as a concept. This is because even though there is a general consensus that social exclusion is multidimensional, there is no consensus on which dimensions are(particularly)relevant, and whether it is necessary to include multiple and cumulative vulnerability. Or whether one of several deprivations is sufficient enough to be included as social exclusion (Morgan et al., 2007: p. 479).
In other words, the definitions of social exclusion are immensely ambiguous. It remains unclear exactly what/who is the subject of social exclusion. Is it a matter of an objective condition or an experienced subjective feeling? Some definitions consider social exclusion as an objective condition: “An individual is socially excluded if he/she does not participate” (Burchardt et al., 2002: p. 30). Others focus on the subjective experience of social exclusion (Bohnke, 2004; Whelan & Maitre, 2010; Sayce, 1998, 2001; Sayce & Measey, 1999). In contrast, there are also people who choose not to participate in society. Are they are also socially excluded? Based on the discussion on voluntary/involuntary social exclusion, Barry(2002: p. 1516)stresses that his definition of social exclusion only includes involuntary exclusion: “Individuals and groups are socially excluded if they are denied the opportunity to participate, regardless of whether they want to participate or not.”
However, one of the leading researchers in the field, Ruth Levitas et al.(2007), offers clarity in an alternative way. According to Levitas, social exclusion is primarily about people that are highly disadvantaged(excluded)from a number of key living conditions, who have, for example, a low income, no job, an immigrant background, lack of qualifications or poor health.
It has also been pointed out that the core elements of social exclusion include the following:
The excluded suffer from a degree of multidimensional under privilegement of such duration and magnitude of material and cultural degradation in the local area in which they live, that their relational connection to the surrounding community is disrupted to such an extent that it is practically irreversible (Room, 1999: p. 171).
Similarly, in 1997 researchers from the Social Exclusion Unit(SEU)2 defined social exclusion in the following way:
An abstract for what can happen when people or areas suffer from a combination of interconnected problems, such as unemployment, poor skills, low incomes, poor housing, high crime rates, bad health and family breakdowns (Bradshaw et al., 2004: p. 5).
This definition includes “multiple disadvantages/risk factors”, but at the same time, I consider it to be rather vague, as it does not specify what the actual impact of social exclusion is(“what can happen”). It is multidimensional(“a combination of interconnected problems”), and it has an important spatial component(“ people or areas”).
In my view, one of the better ideas that is closer to the empirical way of defining social exclusion has been formulated by David Miliband(2006), who distinguishes between the breadth, depth and concentration of social exclusion. The breadth of exclusion covers the portion of individuals affected by exclusion on various individual levels. The concentration of social exclusion deals with how complex exclusion is in any area, for example, a local or “ghetto area” with a higher concentration of socially vulnerable individuals, and the depth of social exclusion deals with how exclusion occurs in multiple and overlapping areas for each individual. This will often be the case for socially vulnerable people who have been unemployed, poor and whom frequently endure poor mental, and physical health. Thus, deep social exclusion refers to exclusion on several levels and the existence of risk factors that have accumulated within several areas of a person’s life. The different pressures of everyday life and vulnerability towards them often means that particularly socially vulnerable individuals may find it difficult to motivate themselves in changing their lifestyle, finding a job and getting out of a “vicious circle” (Larsen, Andersen, & Bak, 2012).
As I have explained, the different scientific definitions of social exclusion reveal a wide range of content. Therefore, it is important to stress that many factors clearly play a role when attempting to understand the causes of social exclusion whilst at the same time attempting to describe the various effects of social exclusion on the individual. Jørgen Elm Larsen points out, for example, that social exclusion is driven by complex interaction between demographic, financial, social and behavioural factors, and that these may be interrelated and mutually reinforcing (Larsen, 2004: p. 21).
Therefore, it is evident that the more issues an individual must deal with in everyday life(e.g., no or few qualifications, abuse issues, etc.), the harder it is, for example, to get an ordinary job. At the same time, the different mix of risk factors at different levels enhances the risk of both poverty and social exclusion. Thus, the consequences of social exclusion also reflect the breadth and depth of the social exclusion(see Miliband’s definition).
Overall, the various scientific definitions of social exclusion show the ambiguity associated with a substantive provision of the concept. What differs is the elements involved and the special weight given. The theoretical ambiguity of the definitions can also open up for the use of quite different indicators for measuring social exclusion in empirical studies. In the next section, I will discuss another element that contributes to the ambiguities surrounding a substantive provision of social exclusion, i.e. overlapping between other similar concepts.
2.2. Poverty and Social Exclusion
In empirical studies, it is crucial that overlapping between concepts is kept to a minimum. In this context, for example, if poverty and social exclusion as a concept overlap, questions could be raised about the actual topic being studied.
With his broad definition of poverty(understood as “relative deprivation”), poverty researcher Peter Townsend(1979) has played a central role in the development of social exclusion as a concept. Not at least because relative deprivation/hardship beyond the material core of distress and poverty, also includes “participation in general social activities”.
Individuals, families and groups in the population can be said to be poor when [...] their resources are so far below the average of other individuals or families that they are excluded from ordinary living conditions, habits and activities (Townsend, 1979: p. 32).
Consequently, social exclusion is largely used to capture the impact of material hardship/deprivation that is demonstrated by limited opportunities to participate in broad social and cultural activities (Levitas, 2006). It can be said that social exclusion is connected to the issue of participation and non-participation(much more so than the traditional concept of poverty)in areas that require the production of various types of resources, and/or those that are perceived as meaningful and essential for an individual’s or group’s quality of life. Thus, there is a clear difference between poverty and social exclusion. The primary difference is that poverty concerns limited financial and material resources, and the deprivation that ensues thereof, whilst social exclusion also covers other types of social problems that obstruct or hinder an individual or group from participating in one or more core areas of society (Larsen, 2004). However, even though a difference exists between poverty and social exclusion on the conceptual level it is not always adequately reflected(as previously mentioned)in the indicators used in various empirical studies (Hallerod & Larsson, 2008; Bradshaw & Finch, 2003).
Compared to German and Scandinavian sociology (Abrahamson, 2010), which was inspired by Ulrich Beck’s thesis on the individualisation and democratisation of poverty( Bak, 2004a, b), focus is primarily placed on poverty as a relatively short-term and passing phenomenon, whilst French and American sociology concentrates on the development of more polarising societies that lead to marginalisation and social exclusion (Abrahamson, 2010: p. 39).
Abrahamson(2010 )has provided a good schematic presentation of the most important differences between poverty and social exclusion(see Table 1). Whilst poverty mainly focuses on the distribution of resources in terms of income and the lack of ability to meet one’s needs, social exclusion focuses on the lack of the rights of the individual owing to the discrimination of various institutions in society(e.g., the labour market, education system, etc.). Another key difference is that social exclusion focuses on the processes that lead to a situation of exclusion from normal society.
Table 1 provides a good overview of the key differences, but it may be somewhat too general to say that poverty is also dynamic. In this respect, it is important to have an understanding of the processes that lead to poverty in the long or short-term. By this, I mean that the division of the schema for the key differences between poverty and social exclusion is too simplified and the basis is built on the misunderstanding of the concept of poverty as static. More recent research on poverty characterises the concept of poverty as more dynamic, e.g., it focuses on the importance of the duration of poverty compared to financial deprivation and social exclusion, which can indeed result from poverty (Bak, 2004a, b).
2.3. Poverty as Capability Deprivation
Nobel prize winner, Amartya Sen(2000), argues that we can better understand
Table 1. Comparison of poverty and social exclusion.
Source: Abrahamson(2010: p. 39). Translated from Danish.
the contribution of newer literature on social exclusion by placing it within a broader framework where poverty is understood as “capability deprivation”, i.e., an individual’s lack of skills and competencies. Sen points out that low income is a primary cause of a low standard of living, therefore income is vital in order for people to lead lives without poverty. However, other factors also come into play (Bak, 2004a: p. 31).
Sen stresses that we should take an interest in “impoverished lives” and not just “empty wallets”. In this way, it is interesting to compare Sen’s concept of capability poverty with social exclusion, because “impoverished lives”(with reference to Aristotle)is just a life without freedom to participate in activities that are important to an individual. Sen therefore recommends reading literature on social exclusion with the application of a broad Aristotle inspired approach. Firstly, social exclusion can form part of poverty as understood in terms of insufficient skills and competencies on the part of the individual(capability deprivation). For example, the lack of ability to freely integrate with others is an important type of deprivation in itself(e.g., the homeless). The consequence of this is that some types of social exclusion must be considered as components of the very idea of poverty.
Secondly, exclusion from social relationships leads to other types of deprivation, which further narrows one’s options in life(life chances). For example, being excluded from the opportunity to work or borrow money can lead to financial distress, which in turn can lead to other types of deprivation. It is worth noting that Sen’s inspiration was supposedly drawn from Nordic welfare studies (Bak, 2004a: p. 69). Sen’s concepts of “doings” and “beings”3 is similar to the confusion surrounding Finnish sociologist Erik Allardt’s known formulations in the book Att ha, Att alska, Att vara (Allardt, 1975). Sen writes, inter alia, about his concepts with reference to the Nordic welfare studies in a footnote (Sen, 1992: Chapter 3).
In the so-called Stiglite-Sen-Fitoussi Report4 from 2009 , one of the recommendations is that multidimensional definitions should be used in studies on human “well-being”, and that more central key dimensions should be included at the same time. The report concerns the following dimensions (Stiglite, Sen, & Fittousi, 2009: pp. 14-15):
• Material living standards(income, consumption, and welfare)
• Personal activities, including work
• Political “voice” and management
• Social connections and relationships
• Environment(present and future conditions)
• Uncertainties of a financial and physical nature
The point here is that all of these dimensions help to create human well-being, but despite this, many of them are omitted in the frequently used conventional income measurements. The same tendency to focus on the multidimensional and non-material aspects of social exclusion as a concept is seen in the latest European Commission reports (European Union, 2011).
Thus, the ambiguity of the theoretical level is supported by the overlap that simultaneously exists in other concepts such as poverty and social exclusion.
2.4. Social Capital
In many definitions of social exclusion, social relationships and networks are significant key components of active participation and an inclusive life. This clearly overlaps with the concept of social capital, which is also a complex and controversial term with many meanings. A network of social relationships that potentially amount to valuable resources that people can draw on, and which also constitute capital, are central to social capital. Putnam defines(1996: p. 56) social capital as features of social life, i.e. networks, norms and trust that enable participants to act efficiently to pursue shared objectives and as relations between individuals.
The clear overlap between social capital and social exclusion emerges from their shared, but varying focus on participation. Social exclusion, however, is a broader concept than social capital. In simpler terms, it can be said that access to social capital is all about access to valuable contacts within a social network. As such, social capital potentially promotes social inclusion by connecting individuals within wider communities (Morgan et al., 2007). Consequently, a lack of social capital may contribute to social exclusion.
The overlap between the concepts of social exclusion and social capital, and to a lesser extent poverty, are not the only concepts that overlap. Other overlapping concepts include social integration and social networks for the study of social processes, etc. However, in combination, overlapping between the concepts contributes to the question of whether social exclusion as a concept has substantially contributed with anything new compared to previous concepts, and whether social exclusion as a concept offers more potential.
3. Measurement Issues
Now that I have reviewed and discussed the ambiguities associated with the substantive provision of social exclusion on the theoretical level in this section, I will demonstrate how such theoretical ambiguity is reflected in the various attempts to operationalise social exclusion in empirical studies.
For a long time, there has been a significant gap between the conceptual discussion of social exclusion as a concept and empirical analyses of the phenomenon. As Bohnke(2004: p. 5) stresses, even though there is a consensus amongst several researchers about the multidimensional and dynamic nature of social exclusion it has not resulted in many empirical studies hereto(with a few exceptions, such as Hallerod & Heikkilå, 1999; Hallerod & Larsson, 2008; Burchardt, 2000; Larsen, 2004 ). The many elements and indicators that form part of a broad concept such as social exclusion make it difficult to accurately define and “measure” the empirical evidence (Bak, 2004a; Bradshaw et al., 2004; Larsen, 2004). Some researchers (Room, 1999; Burchardt, 2002; Byrne, 1999) have argued that it is not possible nor desirable to develop a measure of social exclusion, as the concept itself is qualitative and dynamic or it could even stigmatise those who are identified as “the excluded”. Levitas(2000: p. 356) believes that social exclusion is neither a state nor a process, which is often claimed by different researchers. Conversely, the concept of social exclusion could indeed be more or less productive in describing reality.
In a review study of social exclusion and mental health problems, Morgan et al.(2007: p. 480) concluded that the lack of conceptual clarification in general literature was reflected in their review. The vast majority of studies on mental health problems either did not have a definition of social exclusion or they used existing definitions in a rather uncritical fashion. In the following, I will discuss selected quantitative and qualitative approaches to examine social exclusion in studies on mental health.
Research shows that individuals with mental health problems are especially prone to social exclusion in several key dimensions(e.g., discrimination, employment, education, housing, stigmatisation)and therefore provide an explicit “critical case” for discussing which type of indicators should be used in the measurement of social exclusion (Social Exclusion Unit, 2004; Morgan et al., 2007). My objective is to contribute with a nuance of what both quantitative and qualitative approaches towards examining social exclusion can contribute with.
3.1. Quantitative Measurements of Social Exclusion-Dimensions and Indicators
In general, the most common way to measure social exclusion is to use a list of the different indicators available (Bradshaw & Finch, 2003; Morgan et al., 2007: p. 480). Often available survey data from previously collected data sets are used. Various attempts to quantitatively measure social exclusion based on various indicators have often been problematic, as they are based on the assumption that the indicators used in studies on poverty, unemployment and multiple deprivation/hardship, will also be able to capture social exclusion as a concept within all its dimensions (Bohnke, 2004: p. 5). For example, this is seen in the report that the Social Exclusion Unit(SEU, 2004) used to measure the connection between social exclusion and mental health. Even though many indicators are often used, it is not entirely clear which indicators, for example, measure “poverty” and which ones are suitable measures for “social exclusion”. This is a recurring problem. Especially when only a few indicators directly related to participation in social and cultural life are used, which is frequently the case (Morgan et al., 2007: p. 480).
Levitas(2006) points out that many of the main indicators on the list lack the social dimension that is unique to the concept of social exclusion and which distinguishes it from the concept of poverty. This is crucial with regard to how individuals with mental health problems experience discrimination and stigmatisation. Poverty often plays a role in this, but poverty is not always the main element when it comes to understanding how people with mental health problems experience and put into words social exclusion. For example, Sayce(2001) argues that in relation to mental health disorders, social exclusion is more easily explained than poverty and other related concepts, because attention is directed towards the non-material aspects of social vulnerability (Saunders et al., 2008; Ravallion, 2011). The latter are more likely to stem from discrimination from other people and institutions. It is also important to stress that there is rarely a distinction between direct and indirect indicators and risk factors. For example, should indicators such as unemployment and income be regarded as risk factors for social exclusion in the form of indirect or direct measurements? In my view, this distinction should be addressed if social exclusion is to be more accurately defined and the prevalence of social exclusion in different countries is to be documented, as well as the main causes of social exclusion.
An example of the lack of distinction between indicators for measuring social exclusion is found in the Social Exclusion Unit’s Report(2004), in which stigmatisation is described as a core element of exclusion and improved human attitudes are used as indicators of social inclusion. This says something about the thinking behind this, as it immediately becomes more logical to consider stigmatisation and discrimination as reasons for social exclusion rather than as core elements of the concept (Morgan et al., 2007: p. 480). It stresses the importance of not mixing the cause and effect of social exclusion with the importance of creating more transparency around the suitability of indicators when measuring social exclusion.
3.2. Direct Measuring of Poverty and Social Exclusion in Denmark
In Denmark, Jørgen Elm Larsen(2004: p. 17) is the only person who has tried to apply a restrictive, operational definition of social exclusion. This reads as follows:
An individual is socially excluded if three, four or all five of the following characteristics apply: He/she is relatively poor financially(in the year 2000 the measurement of relatively poor was included); has few or no social relationships; does not/only slightly participates in professional and political activities; does not/rarely participates in few leisure activities and/or has poor health).
The studies on living conditions provide an excellent basis for highlighting the development of social exclusion, and as Larsen(2004: p. 18) points out, the last study in year 2000 was particularly designed to illuminate aspects of social exclusion.
The definition of social exclusion that was applied looks upon the individual as a unit. It is relative and also weights participation. Thus, an individual is defined as socially excluded if he/she does not participate in activities that are considered as central to the society in which he/she is a part (Larsen, 2004: p. 89). As a result, many opportunities exist for inclusion or exclusion. Larsen chooses to limit himself to a few main core areas, i.e.: 1)finances and consumption(relative poverty), 2)social relations, 3)professional and political participation, 4)recreational activities and 5)health. From these, Larsen constructed a number of indices to measure inclusion and exclusion within the general population. Naturally, these choices are not objective and other areas could have been selected. However, they do constitute the core areas of the measurement of social exclusion, as well as the core areas of participation.
The study’s strength lies within the use of several different measurements/indices for social exclusion, and it also carried out cross-sectional cohort studies. There is not enough space here for a more detailed description, therefore reference is made to Larsen(2004) for a thorough review of the various indices for measuring social exclusion, and the results that he obtained.
One of the most important key findings of the survey is that there is no indication that social exclusion affects large numbers of certain socioeconomic groups in the population nor does it rule out that it is contingent on specific individual circumstances. Only a small portion of “risk groups” are actually exposed to social exclusion, but on the other hand, these groups have a much higher proportion of excluded individuals than other groups (Larsen, 2004: p. 23).
Some of the objections that could be directed at Larsen’s(2004)operational objectives include, for example, the question of whether professional/political participation is widespread in the Danish population. He mentions this caveat himself. Another caveat is that the most vulnerable groups have not participated in the study on living conditions. This could be problematic, as in these groups the prevalence of the highest degree of social exclusion is likely to be seen in a number of the categories for living conditions. It is also stressed that the study indicates that the status of unskilled worker, single parent, unemployed, early retiree or connection to an ethnic minority group are all factors that lead to a higher likelihood of social exclusion. However, there is no direct link to social exclusion as such. The probability of actual or acute social exclusion is only seen in cases where there is a particular combination of risk factors(e.g., unemployment, poor health, alcohol abuse), as Larsen(2004: p. 23)puts it. It is important to stress that social exclusion results from long-term processes connected to education, employment and family responsibilities. Therefore, it also stressed that it makes little sense to talk about a rough division into a large majority of included individuals and a small minority of excluded individuals.
Based on selected results from Larsen(2004) and register-based income analyses (Bak, 2004a, b), Bak & Larsen(2015) have later tested theories of social exclusion and the individualisation of poverty(see Ulrich Beck’s theses on individualisation and democratisation of poverty). Amongst other things, the results show the immense significance of the degree to which narrow or broad definitions of social inclusion are applied. For example, in their definition of social exclusion in a comparable European study, Tsakloglou & Papadopoulos(2002)only used “social relationships” as an indicator of income and various material assets. In one area of Danish society, and for specific individuals over time, general positive developments have been seen.
Firstly, this shows how important it is to select indicators for social inclusion that are valid and meaningful in all the countries, and which can also be used to compare the countries. Secondly, depending on how narrow and broad perspectives on social exclusion are applied, different types of groups and subgroups, for example, excluded and included groups are pointed out and classified( Bak & Larsen, 2015).
Therefore, the overlap between poverty and social exclusion depends on the operational definitions of poverty and social exclusion, because in a logical sense the operational definition must follow the theoretical definition. In this way, inaccuracies that appear on the theoretical level will also be reflected in the overlapping operational definitions, which are problematic for the reliability of empirical measurement of social exclusion.
However, an interesting shift in focus occurs in the qualitative studies (Dunn, 1999; Jacobsen et al., 2010; Sayce, 2001; Parr et al., 2004 ), that seeks to highlight the correlations between mental health problems and social exclusion. The reason being that there is a desire to obtain more insight into the indicators to understand the processes that lead to certain individuals and groups feeling stigmatised and socially excluded.
4. Qualitative Studies on Stigmatisation and Processes Behind Social Exclusion
Subjective experience of social exclusion focuses on experiences being relative and alterable, and not a condition that can be measured in objective terms (Morgan et al., 2007: p. 481).
The Canadian-American sociologist Erving Goffman(1963) has made a significant contribution in relation to this with his sociological work on “stigma”. Some of Goffmanns successors have particularly focused on individual self-experience and micro-levels of interpersonal relationships instead of broad social exclusion from a financial and social life (Sayce, 1998: p. 331). According to Goffman(1963), stigmata aredefined as characteristics that are deeply discrediting and which reduce the stigmatised individual from being a whole and normal human being to a burdened and excluded one. Stigma arise from social interaction when social groups possess characteristics that are different to the norm, for example, “people who work” and “those who do not” (Larsen, Andersen, & Bak, 2012: p. 15).
The stigmatisation of individuals with mental health problems is reflected in many different ways when people interact. Often, it may be the case that individuals are blamed for their mental health problems, i.e. they are made to feel ashamed; people do not want to get to know them; people are afraid of them; they are exposed to name calling; people talk about them behind their backs; they feel sorry for them, etc. (Scotland, 2008: p. 3).
Stigmatisation and social exclusion leads to poor mental health and can exacerbate mental disorders and diseases. Individuals with mental health problems continually meet negative attitudes in their surroundings. This does not only prevail within the general population, but are also amongst health professionals. The various elements of stigmatisation create social distance and reduces the likelihood that individuals with mental health problems will adapt to the labour market or seek out relevant health and drug treatment (McDaid, 2008).
As it has been endeavoured to show in Figure 1, even a brief period of mental health problems can have a long-lasting effect on an individual’s life, social relationships and employment opportunities. Admission to hospital or sick leave from work can lead to unemployment, homelessness, debt and social isolation. This in turn can lead to poor mental health and a cycle of social exclusion. This underlines the importance of focusing on the processes and causal factors leading to social exclusion, as well as the inadequacy of limiting the measurement of social exclusion to a few and available indicators in quantitative studies (Social Exclusion Unit, 2004: p. 20).
In some of the qualitative studies on the relationship between mental health
Figure 1. Cycles of Social Exclusion.
problems, social exclusion, and stigma (Sayce, 2001; Parr et al., 2004; Watkins & Jacobi, 2007 ), emphasis is placed on two main aspects of social exclusion, i.e., process and means. Within this perspective, inclusion and exclusion are understood as subjective states of belonging and involvement in local communities, and they are also determined by the actions of others in the immediate social environment. Therefore, individuals may feel more or less included at different times. Being excluded is not something static, which can be measured objectively, but a fluid process.
Thus, these qualitative studies imply that a very different approach towards the analysis of social exclusion should be applied when looking at the approach that is actually applied in most studies of social exclusion. The point here is that the boundary between inclusion or exclusion is more fluid than that in the objective indicators of social exclusion. This approach shares many “common advantages” of ethnographic studies that have contributed with documentation on how people live their lives with mental health problems. Even though the studies are not based on social exclusion frameworks, they have contributed with important information on how society’s response to individuals with mental health problems helps to exclude the latter from various activities and public domains (Morgan et al., 2007: p. 480).
As far as I am aware, a Danish study has not been conducted on the links between social exclusion and mental health. However, in 2010 the first major Danish study was conducted on public attitudes towards individuals with mental health disorders and the perception of stigmatisation. The study consisted of both a quantitative questionnaire survey and supplementary qualitative interviews. The results of the survey showed that stigmatisation has explicit effects on individuals with mental health disorders in the form of categorical discrimination, degradation of their abilities and opportunities, and social exclusion (Jacobsen et al., 2010).
The study also showed that there is a marked hierarchy of mental disorders in Danish society and that they occur in many different contexts. In addition, the investigation showed that schizophrenia is undoubtedly the most stigmatised disorder. Everyday language and the images of schizophrenia that are in circulation, distort the disorder, and individuals with schizophrenia continually face the distorted images. Consequently, they use a considerable amount of resources to manage and control the communication of their disorder. They hide it or call it something else, distance themselves from the diagnosis and constantly assess who they can tell and when (Jacobsen et al., 2010).
Inclusion and Exclusion in Everyday Life
In the following, I will present a few examples from qualitative ethnographic studies on how the experiences of inclusion and exclusion amongst users of psychiatric services contribute to a different approach towards the study of social exclusion.
In a Scottish study on complex relationships between mental health and the experience of inclusion and exclusion amongst individuals living in the country(the Scottish Highlands), scientists conducted over 100 in-depth interviews with users of psychiatric services. Focus was placed on the descriptions provided by the users pertaining to their experience of inclusion and exclusion in everyday life (Parr et al., 2004: p. 405). Their results show a complex picture in which feelings of inclusion and exclusion constantly change, and depend on continuous interaction with others in the private and public spheres. In this study, “inclusion” describes the relationships and types of practices that individuals with mental health problems perceive as an expression of positive involvement in and sense of belonging to a local social environment. Conversely, “exclusion” describes negative conditions, for example, rejection, avoidance and dissociation from other individuals in the village community. This is done in a way that classifies individuals as “different” through somewhat more or less conscious social actions with reference to their severe mental health condition. The boundary between inclusion and exclusion are therefore depicted as quite vague. This is particularly true, as elements of superficial inclusion cannot be perceived as a sign of proneness towards more in-depth inclusion (Parr et al., 2004: p. 405). Parr et al. 2004, came up with what they describe as fairly contradictory results in their study where relationships on the one hand reflect inclusion through acceptance and tolerance, whilst on the other relationships were excluded through rejection and intolerance.
Watkins & Jacoby(2007) came up with similar results in their ethnographic study on the village of Stonycroft. Here the “location” was equally ambiguous and contradictory as in Parr’s et al.(2004) study. On the one hand, the interviewees represented a positive image of the village as idyllic, whilst on the other the latter was not always reflected in their more informal comments and communication with the researcher. Overall, the qualitative studies focus on subjective experiences and weight the relative and alterable aspect of the concept. This helps to clarify that social exclusion within this perspective cannot be understood as a measurable state. In addition, the spatial/geographic aspect of social exclusion is weighted. Therefore, the location(village or, for example, the exposed residential area in a city)can to a great extent form a significant framework for understanding why interaction between individuals in certain social environments may seem excluding. However, studies also show that it can be difficult to accurately and distinctly separate inclusion and exclusion. They tend to be fluid and transformable.
5. Concluding Comments
The article has provided a broad overview and review of selected conceptual and methodological aspects of social exclusion, which is a more recent concept to examine new types of hardship.
On the one hand, it has been demonstrated that considerable consensus exists amongst researchers in the belief that social exclusion is a complex, multidimensional and dynamic concept influenced by objective social circumstances and living conditions, whilst on the other it still remains the case that relatively few empirical studies actually use direct indicators during empirical measurement of social exclusion despite the prevalence of such consensus.
Objective quantitative indicators have often proved to give inaccurate measurements, and in some studies collected data is used for other purposes. With the supplement of indicators for subjective experiences of the social exclusion of individuals, several EU reports( Bohnke, 2004; Layte, Bertrand, & Whelan, 2010) have managed to develop more reliable and direct measurements and indicators for social inclusion and social contacts. However, it seems that more research into the development of more reliable indicators of social exclusion is needed.
The qualitative studies focusing on the stigmatisation and discrimination of individuals with mental health problems provide important research information on the attitudes and reactions that individuals with mental health problems encounter when meeting other people. They contribute in giving a better and more detailed understanding of the actual processes and circumstances, that lead to the feeling of stigmatisation and social exclusion, and why some elect to abstain from social contact with other people, i.e. self-stigmatisation and the division of “them” and “us”.
For many, social exclusion remains a problematic concept (Hall, 2004: p. 299) associated with participation in all areas of society with special focus on those related to financial inactivity. In this way, non-paid social, cultural and political activities are more easily overlooked.
This has led to two consequences: 1)Individuals who do not participate in the labour market are deemed as “others” and do not form part of “society on the whole” and 2)inclusion in the labour market per definition is only associated with advantages. Thus, the discrimination that takes place in the labour market and the fact that people living in marginal locations will to a larger degree have lower paid and unsatisfactory jobs (Hall, 2004: p. 299), is overlooked.
In my opinion, the main difference between the concept of material deprivation/hardship and social exclusion in Townsend’s(1979) classic study on poverty, which includes a multidimensional definition (Townsend, 1979: p. 915), lies within the identified causes of vulnerability.
The concept of material deprivation/hardship focuses on non-participation due to a lack of resources, whilst social inclusion, as shown, is a broader umbrella term that opens up many causes of vulnerability other than lack of financial resources(e.g., poor health, discrimination).
Do we need social exclusion as a concept when Townsend’s dual definition already incorporates the broader picture in which poverty is a subgroup of deprivation/hardship caused by a lack of financial resources?
We have unquestionably obtained a different direction in which to move forward with social exclusion as a concept, but with a different focus, because existing definitions are already broad enough to include non-material aspects. They are also dynamic(longitudinal)and already open up for causes of social vulnerability other than low income. The problem is rather that the research did not adequately manage to include all these elements, and therefore social exclusion helps to remind us of this potential in the broader sphere.
1The article uses “social separation” and “social exclusion” as synonymous terms.
2The Social Exclusion Unit(SEU)was established in 1997 by the former Labour Government in England. The unit particularly contributes with strategic advice and analysis aimed at combating social exclusion in England.
3With Sen’s concepts “doings”(to do)and “beings”(to be)he wanted to show that he does not exclusively focus on the consumption or income of individuals. Consumption and income are only means towards the achievement of good well-being, therefore it is important to focus on “inner values”, i.e. an individual’s skills and competencies. Sen’s interest changes, therefore, from products and services to how the “benefits” can be used as a basis for “doings” and “beings”. The most central aspect of Sen’s approach is that all individuals are different. We have different needs and abilities to realise our needs. This will create differences in relation to which real opportunities individuals have to expend on an equal amount of resources for well-being (Bak, 2004a: p. 69).
4In 2008, the former French President, Nicholas Sarkozy, appointed the “Commission on the Measurement of Economic Performance and Social Progress”(CMEPSP), which aimed to identify the limitations of GNP as an indicator of economic and social growth, including problems with measuring these indicators. The commission was to offer other and more relevant indicators for social growth. Joseph Stiglite was foreman of the commission, Professor Amartya Sen, the adviser and Jean Paul Fitoussi functioned as the coordinator of the commission’s work.
 Barry, B. (2002). Social Exclusion, Social Isolation, and the Distribution of Income. In J. Hills, Le Grand, & D. Piachaud (Eds.), Understanding Social Exclusion (pp. 13-29). Oxford: Oxford University Press.
 Bohnke, P. (2004). Perceptions of Social Integration and Exclusion in an Enlarged Europe. Dublin: European Foundation for the Improvement of Living and Working Conditions.
 Burchardt, T., Le Grand, J., & Piachaud, D. (2002). Degrees of Exclusion: Developing a Dynamic, Multidimensional Measure. In Understanding Social Exclusion (pp. 30-43). Oxford: Oxford University Press.
 Hallerod, B., & Heikkila, M. (1999). Poverty and Social Exclusion in the Nordic Countries. In M. Kautto, M. Heikkila, B. Hvinden, S. Marklund, & N. Ploug (Eds.), Nordic Social Policy. Changing Welfare States. London: Routledge.
 Jacobsen, C. B., Martin, H. M., Andersen, S. L., Christensen, R. N., & Bengtsson, S. (2010). Stigma og psykiske lidelser, som det opleves og opfattes af mennesker med psykiske lidelser og borgere i Danmark. Kobenhavn: Det Nationale Forskningscenter for Velfærd (SFI).
 Larsen, E., Andersen, P. T., & Bak, C. K. (2012). Fortællinger om et liv som arbejdslos og ekskluderet. Tidsskrift for Forskning i Sygdom og Samfund (nr. 16). Afd. for Antropologi og Etnografi: Arhus Universitet.
 Levitas, R., Pantazis, C., Fahmy, E., Gordon, D., Lloyd, E., & Patsios, D. (2007). The Multi-Dimensional Analysis of Social Exclusion. Bristol: Department of Sociology and School for Social Policy, Bristol Institute for Public Affairs, University of Bristol.
 Room, G. (1995). Poverty and Social Exclusion: The European Agenda for Policy and Research. In G. Room (Ed.), Beyond the Threshold—The Measurement and Analysis of Social Exclusion. Bristol: The Policy Press.
 Saunders, P., Naidoo, Y., & Griffiths, M. (2008). Towards New Indicators of Disadvantage: Deprivation and Social Exclusion in Australia. Australian Journal of Social Issues, 43, 175-194.
 Tsakloglou, P., & Papadopoulos, F. (2002). Poverty, Material Deprivation and Multidimensional Disadvantage during Four Life Stages: Evidence from the ECHP. In Poverty and Social Exclusion in Europe. Edward Elgar.
 Whelan, C.T. and Maitre, B. (2010). Welfare Regime and Social Class Variation in Poverty and Economic Vulnerabilities in Europe—An Analysis of EU-SILC. Journal of European Social Policy, 20, 316.