Give out session notes from Unit 3 and pick up on any points for clarification or any thoughts that participants have had about the subject. Ask participants to refer to their learning logs and identify something (topic, idea or issue) that was new to them.

1.       Give out programme for Unit 4.

2.       So far on the course we have been talking about the social influences on health and in Unit 3 we looked at the effects that low income and the way that income is distributed can have on our health.  In this unit we are going to look at how this affects us. Do they affect everyone in the same way or are they experienced differently depending on your social situation?

In this unit we will be exploring different groups’ experiences of health or indeed ill health.  We will ask whether there are any similarities or differences amongst these particular groups, and if so, why? We will also be looking at what needs to be done to address why certain groups of people are ‘excluded’ and what would be involved in developing a process of social inclusion. You will also be doing some more work for the Group Project.



1.       Give out Handout A.

2.       Read through the scenario slowly and clearly and then ask the group the following questions noting responses on the flipchart.


  • How would you deal with this situation with your child?
  • Would you approach the school and if so how would you do this?
  • How would you deal with the problems that exist outside school?
  • Could you do anything to develop better relationships with the local people? And if so what would it be?
  • What kind of effects on your health and the health of your family would there be as a result of this situation?
  • Some other members of your family are considering moving to
  •  Prejudicia, what would you tell them?

3. Draw out a general discussion about the scenario, what parallels do people see for immigrants or  refugees living in this country? Do different groups of people experience things differently? Explain that we will now be looking at the experience of some other groups of people who live in this country.

Discussion points:

You will find that the group will have many points to discuss after watching the film.

Some of the discussion points you might want to raise are:

  • Do children instinctively hate those that are different to them?
  • Where do lessons on being different come from?
  • Were people surprised at the speed with which differences were taken up?
  • What about the teachers’ authority? Do WE believe what those in authority tell us?
  • How did the impact on performance strike people?
  •  What are the implications of discrimination for community health?



This exercise involves reading through a few long pieces of writing. Participants generally enjoy the reading but not the short time pressure. You may wish to give out the handouts for reading the week before and/or be available while groups are reading their pieces.

However, it is worthwhile persisting with the reading as one of the outcomes of HIIC is to develop study skills. This exercise will help with skills on taking in information, reflecting on information, relating them to personal experiences and drawing insights on the circumstances of people who might be ‘different’ to us

1. Work in small groups of two, three or four people.

2. Give each group one of the case studies from Handouts B - E and the attached questions. The task is to read the article for information and then fill in the answers on the sheet. When the group has finalised the first one, give them a second one. Try to select the material so that people get something they might be familiar with and something that will be outside their experience. Some groups might try a third study if there is time.

Although some people may find the longer pieces harder to read encourage them to ask about any words or phrases they don’t understand. The important thing is that they understand what is being written.  People can help each other with this as well.

3. Work as the whole group. Taking each case study in turn, describe the group being studied and the source of the information, for the benefit of those who looked at other material.

Ask those people who have studied each group to pick out what they felt were the most important points and give some facts and figures. They are not required to feed back all the details of their answers. You might decide to concentrate on a few of the case studies in more depth, or run through more, with less time for each. Ask for some quick feedback from the rest of the group - you will need to move swiftly through all the different bits of material.

4.  Draw out a more general discussion about different experiences and common problems.

  • Although these groups are very different, are there any similarities amongst them? Would they have any similar experiences?  How does the rest of society view them?  What kind of status or power do they have? Write up ideas on a flipchart.

Discussion points

  • What other groups might also be excluded? Young homeless people? Refugees or asylum seekers?  People who are perceived as ‘different’? People with any kind of impairment?
  • The tension between the emphasis on groups’ unique experience and the common cause they might share (perhaps with particular relevance to funding and competition).
  • Whether there is a need for people to come together, even temporarily, to form alliances in order to explore areas of common experience and gain a more powerful voice.
  • The link between people’s position in society and their health.

5. People often feel strongly about these issues so the discussion may become animated and take its own direction.  It is important, however, that at some point the focus is brought back to social justice, equity and challenging prejudice and discrimination since these are important dimensions of tackling health issues and key values within community development.



1. Introduction to the concept.

Many people think that the idea of equity is more helpful than that of equality. Equality gives the impression that everyone should be treated in exactly the same way. While in one sense this sounds right, in another sense, it assumes that everyone starts from an equal position.

2. To illustrate the point use the following exercise. You will need a packet of biscuits or some other alternative for distribution and some prepared role cards. The cards should contain statements describing different levels of need. Some suggestions are:

  •  I haven’t eaten for a week.
  •  I don’t like biscuits.
  • I am tall and require a lot of food.
  • I have a small appetite.
  • I am allergic to biscuits.
  • I love biscuits but I’m on a strict ‘no biscuit’ diet.
  • I only eat biscuits therefore I need them to survive.
  • I’ve just eaten a four-course meal.

(You can also make up some of your own)

3. Ensure that you have exactly the same amount of biscuits as there are people in the group. Ask for a volunteer to distribute the biscuits equally amongst group members.

4. Now hand each group member a card and tell them to hold it up so that the volunteer and other group members can see what’s written on it.

5. Now ask your volunteer to distribute the biscuits equitably, in other words, taking account of the ‘needs’ of the group members.

6. Once this has been done ask the volunteer to explain why they distributed the biscuits in the way that they did. Ask for comments from the group and try to make connections with distribution of resources in general.

Give out Handout F and allow each course member a few minutes to read through this.



In today’s jargon, the groups of people that we have been talking about so far are quite often described as being socially excluded. If we want to reach a position of social justice where society is fair and just we need to look at how we can include all groups who face social exclusion.

1. Split into small groups.

2. Each group needs to identify a group of people in society (perhaps in their own area) who they feel are excluded and discriminated against.

Some examples of excluded groups are:

  • Refugee and asylum seekers
  • Immigrant groups in the local area – who are visually different e.g. colour of skin, clothes worn
  • Single parents, young and old
  • People addicted to drugs and/or alcohol
  • People living with a mental illness
  • People with chronic diseases
  • People with disabilities – learning and physical

3. Each group now has to come up with 5 measures that could be taken (by Government, local Councils, Health Boards, fellow community members, neighbours, etc.) that would help their identified group to have as good a chance as the rest of the population of keeping healthy (remembering all the different factors that affect health).

4. Each small group should write their measures up on a flipchart which should then be pinned up for all to see.

5. Have a brief discussion about the measures they have identified and highlight that these could form part of a process of social inclusion with the end goal being a fairer and more just society. Give out Handout G and read through it with the group.


THE GROUP PROJECT (45 minutes [+ approx. 1 hour ‘homework’ if required])

1. Drafting Ideas

Each group should now begin to develop their ideas. Encourage them to sketch out roughly how they are going to present their topic. Provide flipchart sheets (stuck together if needed) for those doing collage work.

2. If they are going to present material in another way, check that they are not being too ambitious for the time available.  What material and equipment might be needed? (Coloured paper, audio recording equipment, cameras etc.)

3. Remind people that they have only two more sessions to complete the work.

At this stage, however, if they need more time to research their topic and work on preparation you should help them to arrange this outwith the course sessions.


RECAP AND SUMMARY (15 minutes)

1. Go over the main points you have covered in today’s session – refer to flipcharts if necessary.

  • Living with racism
  • Different groups’ experiences of health
  • Equity in health
  • Social Exclusion to Social Justice

2. Give out the Unit 4 Learning Log. Because it involves a little bit more writing people may prefer to take it away and fill it in at home. Remind participants that you will be gathering in Learning Logs at the next session to have a look at them.