Addi van Bergen

Chapter 7 152 IMPLICATIONS FOR FUTURE RESEARCH Based on this dissertation, some potential directions for future research on SE and health are outlined below. First, the large amount of SE data that are collected as part of PHM are currently underutilised. In 2020, the SEI-HS was administered for the third time in the G4 and a number of other GGD areas. Large amounts of data are thus available to help identify risk groups, assess relations with health outcomes, compare cities and rural areas, identify (syndemic) clusters and monitor developments over time. Until now, data analysis by GGDs has been limited to descriptive reports of the number and characteristics of socially excluded persons per municipality or neighbourhood [23]. It would be useful to develop a joint research agenda for in-depth analyses, for example, in the context of the Academic Collaborative Centre for Public Health G4 USER, and to share the outcomes. Second, a new round of qualitative interviews with PHM respondents with a high score on the SEI-HS and focus groups with professionals would be useful. The interviews and focus groups described here were conducted in 2014, just before the introduction of the social neighbourhood teams in January 2015. The interviews portrayed a diverse group of people, but despite their diversity, they all faced similar problems, such as an inability to solve certain problems on their own and inadequate care utilisation. A new round of interviews can shed light on the situation of socially excluded citizens in 2022 and on the role of the social neighbourhood teams in reaching these underserved groups. Third, it would be worthwhile to investigate whether the SEI-HS data can be made available as microdata by Statistics Netherlands, as part of the PHM dataset (GEMON) or via the CBS respondent number included in the GGD data files. This would offer opportunities to combine SE and PHM data with information from other databases, such as prescription reimbursement data, hospital admission and diagnosis data and mortality data [37], employment and social security data [38] and Dutch census data [39]. Data linkage allows one to follow developments over time and investigate, for example, the risk of a downward spiral of disadvantage into unemployment, poverty, family breakdown, deteriorating health, and homelessness, as described in the literature [40, 41]. An additional advantage is that SE data would become accessible to third parties, which could lead to wider use of the data. Last, regarding the application of the findings at an individual level, in clinical practice, for example, an SE index could be developed on the basis of the available registration data and possibly supplemented with a short questionnaire. A data infrastructure such as that of the ‘Healthy and Happy The Hague’ initiative may offer opportunities here [42].