Addi van Bergen

General introduction 15 1 At the end of the cycle, the IGZ assesses the state of the public health system, and its findings are used as input for the next PHSF document. [62] Figure 2. Preventive care cycle in the Dutch health system. Public Health Monitor The Public HealthMonitor (PHM) is a large-scale survey conducted by theAssociation of Regional Public Health Services (GGD GHOR Nederland), the RIVM and Statistics Netherlands (in Dutch: CBS). It provides data to the PHSF and guidance for setting national and local public health policies. Once every four years, approximately half a million Dutch citizens age 19 or older are contacted to participate. The survey uses a ‘mixed-mode’ design, i.e., a combination of several survey modes (online, in writing, face-to-face or by telephone). In the four major cities, translated questionnaires and foreign language interviewers are available. [63]Astratified sample is used to allow for analyses at the neighbourhood level and with subpopulations. To account for the complex sampling design and selective non-response, sample weights are calculated by Statistics Netherlands based on a linear model with 9 sociodemographic variables and their interaction terms [64]. The questionnaire covers a broad spectrum of health outcomes and (social) determinants. In addition to a mandatory national set of questions on gender, age, education, chronic conditions, height, weight, loneliness, smoking habits, alcohol consumption and informal care, some extra topics can be included to address local policy priorities formulated by municipalities. By linking the dataset to other datasets from Statistics Netherlands, the PHM dataset is enriched with data on, for example, standardised household income (in quintiles) and migration background. [63] Its central place in the preventive care cycle, wide coverage and high-quality standards make the PHM a unique vehicle for measuring social exclusion in the health domain. The space in the PHM for extra local topics is, however, limited, and competition is fierce. Important considerations for GGDs when choosing the extra items are the