Addi van Bergen

Chapter 1 14 Finally, the revised questionnaire was administered to a sample of the Dutch population (N=648). The questionnaire contained 45 items on social participation e.g. on sports, culture, leisure and other activities outside the house, voluntary work, informal care, membership of clubs and associations, frequency of contacts with family, friends and acquaintances, and feelings of loneliness; 26 items on material deprivation i.e. difficulty of making ends meet, debts and payment arrears, ownership of consumer durables, insurance against risks and insufficient means for basic necessities; 81 items on access to basic social rights e.g. on right to health care, housing, education, a safe and clean living environment, equal treatment and access to business and social services; and 38 items on normative integration e.g. on work ethic, abuse of social security, voting, and beliefs about ‘being a good citizen’. For each of the dimensions, a subscale containing three to four items was constructed using nonlinear canonical correlation analysis. The 15 items form a general index that measures the degree of social exclusion at the individual level, with a higher index score for persons simultaneously deprived in several dimensions [29, 59]. The SCP social exclusion index was validated in the same sample and replicated in a new sample two years later [60]. In short, the social exclusion index developed by Hoff and Vrooman [29, 59] is used as the gold standard for measuring the multidimensional concept of social exclusion. Local public health policy: the preventive care cycle and monitoring Preventive care cycle According to the Dutch Public Health Act (In Dutch: Wpg), municipalities in the Netherlands are tasked with protecting, monitoring and promoting the health of their inhabitants based on epidemiological analyses. The relationship between national and local governments is formalised in a four-year preventive care cycle. As shown in Figure 2, the national policy document on health – which sets out governmental health policy ambitions – is based on the Public Health Status and Forecasts Report (PHSF). This report is published every four years by the National Institute for Public Health and the Environment (RIVM) and gives an overview of the current state of public health in the Netherlands, including an estimation of what the situation will be in ten to twenty years based on the results of the most recent national and local monitoring efforts by Statistics Netherlands and the GGDs (community health services) [61]. The next step in the preventive care cycle occurs on a local level: municipalities and GGDs develop local health policies based on the main priorities and recommendations of the national health policy and epidemiological data provided by the GGD about the local health situation.