Ensuring that services are inclusive and responsive is a key aspect of population health care, contributing to improved overall health of the public. This requires breaking down the barriers people face as they access or try to engage with health and social care, with those most vulnerable in our society, for whatever reason, often having the greatest healthcare needs. Research indicates that, on average, these people will have shorter life spans and experience significantly poorer health outcomes.
The causes of exclusion may stem from a variety of factors, such as unemployment, financial struggles, age, physical or mental illness, substance abuse, discrimination based on race, disability, ethnicity, religion/belief, sexual orientation or gender identity, inadequate educational attainment or skills, relationship breakdown, poor housing, and crime (as victim or former offender reintegrating into society).
The assessment of inequality is a crucial initial phase in addressing disparities in life expectancy and health outcomes. Quantifying differences in life expectancy among nations enables the identification of areas where interventions can be targeted to promote health equity.
Individuals encountering multiple disadvantages often have to contend with the long-term effects of deprivation, trauma and neglect. Furthermore, many face systemic injustices such as racism and homophobia. These structural inequalities come together in different ways, giving rise to experiences such as homelessness, substance misuse, domestic abuse and mental illness. Services and systems are primarily designed to address singular issues and can frequently fail individuals requiring support. It is imperative to recognise multiple disadvantages as a systemic rather than an individual issue (Making Every Adult Matter, 2023). When services and systems emphasise singular issues, it is challenging for individuals to address their problems, lead fulfilling lives and participate fully in their communities.
Nurses are part of the system that can disadvantage people facing such challenges day in, day out. They play a key role in promoting inclusion health and addressing the healthcare needs of marginalised and vulnerable populations. They promote inclusion health by advocating for the rights and needs of these populations, working collaboratively to address the underlying social determinants of health. Through their expertise, nurses contribute to building healthier, more equitable communities for all individuals, regardless of background or circumstances. When nurses mobilise their own resources and those of others, this places individuals from inclusion health populations in a better position to improve their health outcomes and live longer, healthier lives. But to do this they must receive timely, easily accessible and responsive health and care services (Waterall et al, 2021).
Taking steps to address inclusion health requires nurses to be aware of the health and social requirements of various groups within their locality. They must facilitate individuals' access to primary care and assist them in navigating the often intricate and convoluted healthcare systems. Nurses should also demonstrate confidence in delivering culturally competent care.
Furthermore, they need to be prepared to respond to and refer individuals with immediate safeguarding needs, such as victims of domestic violence, modern slavery and human trafficking. They should also be proficient in identifying and referring individuals who require local housing and health services. In all these endeavours, it is essential that nurses understand and implement the principles of health literacy, communicating in a way that is easily understandable and actionable, ensuring every interaction is impactful.
Inclusion health represents a commitment to social justice and health equity by ensuring that everyone, regardless of background or circumstances, has the opportunity to achieve peak health and wellbeing. By addressing the root causes of health disparities and promoting equity in health care and other sectors, inclusion health aims to build healthier, more resilient communities for all members of society – and, as nurses, we all have a key role to play.