This section begins with an explanation of what is meant by an inclusive community and society, and how these concepts are integral to primary health care (PHC). Social inclusion and social exclusion lie at two ends of the same continuum. Along this continuum, people have varying opportunities to achieve health. Social exclusion leaves many members of society without the support and resources they need for health and well-being. Social inclusion creates social capital, trust, norms of reciprocity and cohesion; the essence of a healthy community. These vital elements of community life are important to any discussion of the power relations that exist in society. Gender, race, ethnicity and other issues that impact on social participation are fundamental elements of the social determinants of health. Gender has been identified as a separate social determinant of health, yet the gender relationships in a family and community may be intensified by the intersection of racial or ethnic issues, family conflict or societal norms of behaviour. In Chapter 10, we focus on healthy men and healthy women in the context of these social determinants of health, and in relation to the PHC tenets of empowerment, equity, and equality.

Too often, gender issues have tended to polarise health services and health promotion activities towards either females or males, sometimes at the expense of the other. In discussing these issues within the same chapter, distinctions and areas of congruence are illuminated. This helps our understanding of how approaches to improving women’s health, for example, can be used to improve men’s health. Although their history differs, parallels can be drawn between men’s health and women’s health. Both intersect boundaries between various diseases and states of health. Each has issues of sensitivity that both men and women look for in service provision, to retain the personal, private issues that they choose not to share with one another. Discussing men’s and women’s health from a distinct, but common conceptual framework, such as social inclusion, provides opportunities to identify areas of differentiation and similarity in experiences of health and illness, which often can be relevant to treatment and health promotion strategies.

The feminist movement has experienced almost 30 years of visibility, whereas the nature of the men’s movement remains idiosyncratic. A substantial base of research evidence has now been generated to inform strategies for women-friendly service provision, and to preserve the health and wellbeing of women and their children. Despite this relative historical advantage, we continue to live in an inequitable world. Women and children are more vulnerable than men for longer periods of their life span, by virtue of their greater longevity compared with men. They continue to earn less, and undertake most of the domestic work surrounding family life. Women are also excluded from aspects of social life, especially in the developing world, where male infants are privileged over female infants, and deprived of the education and resources that would help them reach their potential. Men, on the other hand, suffer disadvantages because of their socially sanctioned behaviours and attitudes, from risk-taking, to ignoring threats to health. The central theme of this chapter is inequity and exclusion, and the need to draw health professionals’ attention to the special needs of men and women respectively, and to the gendered nature of health, and its social determinants. The ultimate objective for society is to ensure equity of access to education, social supports and the environmental structures within which women and men can achieve the level of health to which they aspire.