Addi van Bergen

Summary and general discussion 149 7 as the presence of dirt floors, overcrowding and illiteracy may be more pertinent for SE [22]. In high-income countries, a single adjustment of the items and a re-scaling of weights and factor loadings may be required. The method used in chapter 4 can accomplish this. IMPLICATIONS FOR PUBLIC HEALTH MONITORING Now that there is a reliable and valid SE measure available for use in the local PHM conducted every four years, the next challenge will be to increase the utilisation of the SE data in local public health policy. A recent study among GGD epidemiologists and local policymakers identified three main barriers to the utilisation of SEI-HS data in local public health policy: 1) the abstractness of the concept of SE, 2) difficulty in translating the SEI-HS results into policy actions and 3) the limited reach of the SEI- HS [23]. Barrier 1: Abstractness of the concept of SE: a storytelling approach The first barrier to the research application mentioned by GGD epidemiologists and local policymakers is the abstractness of the SE concept. Local policymakers indicate that they find the SE concept vague, broad and difficult to interpret. Epidemiologists find it difficult to make the results tangible for policymakers. ‘It is an abstract concept. Municipalities in our region, if they read something like that, they think: “What is that, what can we do with it?’ [GGD policy advisor] [23] The current research focused primarily on the delineation of the concept of SE, its reliable and valid measurement and the systematic mapping of the scientific evidence base. As a consequence, the language we used in this research was abstract, the findings were interpreted cautiously, and particular emphasis was placed on limitations and possible pitfalls. We think the time has come to shift the focus from methodological and conceptual discussions to the people affected by social exclusion using a storytelling approach. Behind the abstract figures on SE lies the often-harsh reality of people experiencing social exclusion and its consequences in everyday life. As Taket et al. [24] state, ‘the concept of social exclusion attempts to help us make sense out of the lived experience arising from multiple deprivations and inequities experienced by people’, and the concept should certainly not obscure this reality. According to the WHO Social Exclusion Knowledge Network, the complexity of the nature and impact of exclusionary processes can only be adequately ‘represented’by using both quantitative and qualitative data – through indicators and stories [5]. Cairney et al. state that successful engagement in ‘evidence-based policymaking’ requires pragmatism, the combination of scientific evidence and governance principles, and persuasion to