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Across the globe, people are not equitably included or respected by health services. This results in some people being 'hardly reached' and having less access to safe and appropriate care. While some health services have adopted specific agendas to increase inclusion, these services can struggle to implement such strategies because the underlying reasons for exclusion have not been addressed. This calls for preparation prior to implementation of inclusion approaches that deconstructs discourses and practices of exclusion. This paper presents a pre-inclusion framework that seeks to deconstruct exclusion in health services. Authors developed this framework from action research in four 'mainstream' regional health services in southeast Australia over five years. Research identified dominant discourses of exclusion among staff in these services. The study also identified common experiences of residents hardly reached by these services. Following, a range of change activities were undertaken within these services to deconstruct exclusion. Researchers also kept journals, reflected on their impact, and identified lessons learned from trying to deconstruct exclusion. Triangulating these analyses, researchers developed an interdisciplinary framework that weaves together Foucauldian theory on power/discourse with continuous quality improvement processes to embed cultural humility and voices of the hardly reached in health care. The framework outlines five foundational concepts (power as productive, deconstruction, use of continuous quality improvement processes, cultural humility and voices of service users), followed by six principles (a journey, expect resistance, whole of service approach, make visible the reasons for change, we are all cultural beings and people centred care) and six actions undertaken within health services (commitment, assessment of exclusion, action plans, structural change, reflective discussions and engagement). Until such approaches to deconstruct exclusion are implemented, inclusive agendas are likely to be ineffective. • Before inclusion can be achieved, reasons for exclusion must be challenged. • Pre-inclusion readies a health service for engagement with those hardly reached. • This framework weaves Foucault, cultural humility, those hardly reached and CQI. • The framework aims to rupture power relations to privilege discourses of service users. • Health practitioners learn about their privilege and actions of exclusion. [ABSTRACT FROM AUTHOR]

Natural disasters, such as what are known in English as 'floods' and 'wildfires', are increasingly a topic of concern due to the climate emergency, and their vocabulary and public discourses hold much to be explored through linguistics. This article inaugurates the examination of public discourse about extreme weather events through semantically-enhanced discourse studies, an approach which is based on Natural Semantic Metalanguage (NSM) and developed herein. Taking the example of floods in the particular geographic, cultural and historical environment of the Australian state of Queensland in 2011, this transtextual study draws on a public inquiry into the event and English as spoken in Australia, more broadly, along with media reports, and literature from humanities and social sciences. Five case studies of vocabulary and discourse patterns are presented to cast cultural and semantic spotlights on the public discourses. It is demonstrated that this approach can provide high resolution analysis of discourse and bring out cultural and historical factors at play in extreme weather language thereby contributing to disaster linguistics, climate change semantics and public discourse studies. • The meanings of words for natural disasters and extreme weather events, like flood , are culturally constructed. • Discourse of 2011 Queensland floods reveal geographic, cultural and historical aspects of English spoken in Australia. • Semantically-enhanced discourse studies is a novel method of public discourse studies based on NSM approach. • Semantically-enhanced discourse studies can provide high resolution analysis of vocabulary and discourse patterns. [ABSTRACT FROM AUTHOR]