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Introduction
Inclusion health is an emergent approach that aims to address extreme health and social inequities. Target populations have common adverse life experiences and risk factors such as poverty and childhood trauma that lead to social exclusion.1 Consequently, these populations have extremely poor health, multiple morbidity, and early mortality.2 Compounding these problems are numerous barriers to accessing health services.3 The key aims of the inclusion health agenda are to highlight the magnitude and consequences of extreme inequity, the need for preventive and early intervention approaches, and improved access to essential services for individuals harmed by exclusion.
An agreed conceptual framework for inclusion health has not yet been developed.2 In this Review, we employ existing social exclusion,4 intersectionality,5,6 and life-course epidemiology7 perspectives, which examine how factors accumulate and intersect over time and affect health. Risk factors such as substance use, rough sleeping, imprisonment, and exchanging sex for money or drugs are known to overlap among populations that are socially excluded1 and lead to extremely poor health outcomes.2 This underscores the need to better understand what interventions can effectively address and prevent the multiple and complex needs of socially excluded populations as a whole, rather than focusing on subpopulations defined by singular risk factors. Our Review aims to provide an overview of which individual and structural interventions are effective to tackle the extreme health needs of inclusion health target populations.
We defined the Review operationally using the populations, interventions, comparators, outcomes8 method. Populations with histories of substance use disorders (excluding alcohol, cannabis, and tobacco), imprisonment, sex work, and homelessness in high-income countries were identified as target populations on the basis of previous research in the UK, which showed a high degree of overlap between these groups1,6 and the need to coordinate services for them.9 Other important excluded groups, such as migrants and transgender populations, were beyond the scope of this Review. Full search terms are shown in the appendix. Additionally, we report a public engagement workshop that included people with experience of social exclusion, which aided the interpretation of the review findings (panel 1).
People who are excluded from mainstream society, such as those experiencing homelessness, imprisonment, drug addiction, and sex work,...