Exclusion, cohesion and health and to measure changes in health status associated with different levels of social exclusion. To gener- ate documentation of relationships between social exclusion and health, social scientists need to be in- creasingly engaged in the design, implementation, monitoring, and evaluation of interventions and processes—from multiple sectors—that are meant to or have the potential to enhance individual or community capabilities and resources, thereby al- tering relationships between these individuals and communities and the larger structures of society and, in turn, perhaps impacting health equity. Health is an essential component of individual and societal livelihood. While the negative relation- ships between deprivation and health have been demonstrated, relatively few studies have explored relationships between the structural processes that contribute to deprivation and health status. Health is not a dimension typically included in social ex- clusion analysis. In reviewing interventions and actions that are meant to or have the potential to change the relationships between people and the social, economic, political and cultural structures that shape society, this analysis finds that health status is too often tangential. The impact of actions and interventions meant to enhance capabilities and resources, and the impact of changed capabilities and resources on health often go unmeasured. For example, the Hathay Bunano project works with marginalized women to develop new income-generating skills. The company brings women together giving them a social network; women receive salaries, enhanc- ing their economic resources. However, the impact of joining Hathay Bunano on employees’ social, economic, political and cultural capabilities and re- sources is unmeasured, as is the health impact of engaging in private-sector employment, having a regular income and strengthened social network and other associated gains in resources. Similarly, micro-insurance interventions have increased the abilities of clients to access and use formal health- care services; however, the intermediary factors have not been measured, and assessments of the health impact of participating in micro-insurance programmes in Bangladesh could not be found. There are a few exceptions. Numerous studies, including Ahmed’s analysis of targeting the ultra- poor (28) and Schurmann and Johnston’s study of microcredit (19) both published in this issue of the Journal, have explored the impact of participation in microcredit programmes on social, human and financial capital. Mohindra and Haddad (54) and Volume 27 | Number 4 | August 2009 Johnston HB Schurmann and Johnston begin to disentangle the processes through which different social, political, economic and cultural forces associated with participation in a microcredit programme operate to influence health expectations and func- tioning (19). The challenge remains to measure the variables and the strength of their relationship with health. CONCLUSION The right to the conditions necessary to achieve the highest attainable standard of health is univer- sal as stated in the Universal Declaration of Hu- man Rights (55). The Constitution of Bangladesh recognizes the responsibility of the state to provide essential services to enable Bangladeshi citizens to enjoy a basic standard of living. With continued population growth, increased landlessness, fewer agricultural opportunities, and rapid urbanization, the inequalities evident in modern Bangladesh society are predicted to grow and translate into increased health inequity. There is an urgent need to identify and promote process- es that can reduce social exclusion. This paper has identified several policies, actions, and players in addition to the state that have potential to reduce exclusion. However, for most policies and actions, adequate data are not available to provide evidence of impact on changes in levels of exclusion or on health status. In this context, the assessments upon which this paper is based demonstrate the need for the deve- lopment and implementation of indicators that can be used in measuring degrees of social, eco- nomic, political and cultural exclusion; implemen- tation of a system of measuring the impact of poli- cies and actions that have the potential to mitigate exclusionary processes; systematic measurement of relationships between exclusion and health status; and promotion of processes that reduce exclusion and improve health equity. These actions will sup- port evidence-based planning to address societal and health inequities. Ideally, such actions would re-invigorate the concepts of social inclusion and health equity as essential elements of good govern- ance in Bangladesh. ACKNOWLEDGEMENTS This work was made possible through funding pro- vided by the World Health Organization (WHO) through Lancaster University and undertaken as work for the Social Exclusion Knowledge Network established as part of the WHO Commission on 437