Social inclusion/exclusion: dancing the dialectic

The last decade has seen many of the 'community' concepts in health (community empowerment, community capacity) replaced by 'social' concepts (social capital, social cohesion). The continuous re-labelling of roughly similar phenomena may be a necessary stratagem to attract attention to the economic and power inequalities that arise from undisciplined markets. Social concepts also have an advantage over community ones by directing that attention to higher orders of political systems. The latest construct being wielded by health practitioners, researchers and policy-makers are the twinned concepts of social inclusion and social exclusion. These represent a conceptual sophistication over social capital and social cohesion. Like their predecessors, however, there are risks in their adoption without a critical examination of the premises that underpin them. For example, how can one 'include' people and groups into structured systems that have systematically 'excluded' them in the first place? The cautions expressed in this article do not dissuade use of the concepts. Their utility, however, particularly at a time when not only inequalities, but also their rate of growth, is increasing, requires careful questioning.