Measuring social exclusion in routine public health surveys

Bergen, A.P.L. van (2022)

Doctoral Thesis

The main aim of this dissertation is to develop a reliable and valid instrument to measure the multidimensional concept of social exclusion (SE) in public health surveys, more specifically as embedded in the Public Health Monitor (PHM) conducted by the GGDs in the Netherlands. SE forms part of the WHO Social Determinants of Health framework, but the concept has been ill defined in health research, a generally accepted measure was lacking and the evidence base was not well developed. A systematic review on the relation between SE and health confirmed the hypotheses derived from theory and practice that SE is associated with poor mental and general health. A 15-item index, the Social Exclusion Index for Health Surveys (SEI-HS), was constructed with 2008 and 2012 PHM data. The SEI-HS was validated in the general population and in major non-Western migrant groups in Amsterdam, Rotterdam, The Hague and Utrecht. A possible application of the SEI-HS in public health was explored using 2016 PHM data. Relative risks and population attributable fractions showed a high-risk/high-need population segment in the four cites in which social problems, low agency and ill health coincide. These findings can be used to guide public health policy and resource allocation.

• Social exclusion
• Public health monitoring
• Social determinants of health
• Canonical correlation analysis
• Embedded measure

• All authors: Bergen, A.P.L. van
• Supervisor: Hemert, A..M. van; Wolf, J.R.L.M.
• Committee: Numans, M.E.; Verhoeff, A.P.; Hoff, S.J.M.; Mheen, H. van de
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2022-01-20
• ISBN (print): 9789464169584
• Sponsorship: Academic Collaborative Centre of Amsterdam, The Hague, Rotterdam and Utrecht G4-USER Municipality of Utrecht