Inclusion Health Framework

Why inclusion health matters

People affected by social exclusion experience significantly poorer health outcomes, earlier onset of illness, and reduced life expectancy. Barriers such as homelessness, addiction, forced migration, limited health literacy, and discrimination can delay access to care, complicate diagnosis, and disrupt treatment and follow-up. 

An Inclusion Health approach to healthcare recognises how social context directly shapes clinical presentation, engagement with services, and health outcomes. Delivering high-quality medical care requires doctors to recognise and respond to the circumstances affecting a patient’s ability to access, understand, and benefit from care. 

This framework supports doctors to integrate socially informed and person-centred clinical decision-making into everyday practice, helping to improve safety, trust, and continuity of care across healthcare settings. 

Clinical excellence in Inclusion Health refers to delivering high-quality, evidence-based medical care that is also equitable, person-centred, and responsive to social vulnerability. It combines the standards of good clinical practice – accurate diagnosis, effective treatment, safety, and professionalism - with a deep understanding of the social determinants of health, marginalisation, and barriers to access. 

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About the framework

Applicable across specialties and stages of training, the framework addresses situations where exclusion, stigma, and systemic barriers contribute to inequitable health outcomes. It outlines the interpersonal and clinical capabilities required to recognise and respond to the health impacts of marginalisation in everyday practice. The framework supports doctors in delivering safe, equitable, and person-centred care for people experiencing social exclusion and serves as a practical resource for reflection, learning, and action within clinical practice. It is organised into three interconnected units:

Unit one: Interpersonal professional skills

Focuses on the relational foundations of safe, equitable care. Supports doctors in building trust through transparency, reliability, and respect, especially with patients who have experienced exclusion or trauma. Covers trauma-informed communication, shared decision-making, accessible language, and continuity through responsive documentation. 

Unit two: Clinical skills 

Outlines an inclusive approach to core clinical competencies. Emphasises history taking, examination, diagnosis, prescribing, and discharge planning that account for barriers to access and follow-up. Promotes psychological safety, diagnostic vigilance, and treatment plans alignd to the person's context and capacity. 

Unit three: Specific scenarios

Applies Inclusion Health principles to high-risk clinical contexts. Covers injecting-related complications, frailty in homelessness, infection risks, migration linked presentations, women's health, and paediatric to adult transitions. Highlights trauma-informed communication, culturally safe care, and prescribing for access to reduce avoidable harm and exclusion.

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Access the full Inclusion Health Education Framework

Using the framework

This framework is designed as a practical resource for use across clinical practice, teaching, and postgraduate training. It can support: 

• Clinical learning and reflection:
  Supporting doctors to consider how social context influences assessment, decision-making, and patient engagement. 
• Teaching and training activities: 
  Informing tutorials, case discussions, simulation, and workplace-based learning. 
• Clinical supervision and mentoring: 
  Enabling structured discussion of complex encounters and professional judgement. 
• Educational design: 
  Supporting the integration of Inclusion Health principles within postgraduate programmes. 
• Quality improvement and service development: 
  Identifying opportunities to strengthen safety, access, and continuity of care. 

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How the framework was developed

The framework was developed through a co-design process led by RCPI. People with experience of social exclusion, clinicians, educators, and community and organisational partners contributed throughout the project – from identifying priorities to shaping interpretation and developing educational content. This collaborative approach brought together diverse perspectives to identify practical needs, challenges, and opportunities within healthcare settings.

Co-Design Partners

This framework was developed through collaboration with community organisations, clinicians, educators, and people with lived experience of social exclusion. Co-design partners, including members of the RCPI Inclusion Medicine Working Group (IMWG) and representatives from partner organisations, contributed throughout the project, helping to identify priorities, interpret findings, and shape the educational content. Partner organisations included: 

• Safetynet Primary Care
• Deep End Ireland
• UISCE
• MASI (Movement of Asylum Seekers in Ireland)
• AkiDwA
• Depaul
• EPIC (Empowering People in Care)
• TENI (Transgender Equality Network Ireland) 

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Acknowledgements

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Citation

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