Addi van Bergen

Summary and general discussion 153 7 IMPLICATIONS FOR POLICYAND PRACTICE In Chapter 6, we have showed a serious accumulation of ill health, social problems and low agency in a relatively small urban population segment. Although more research can be done on this issue, these results emphasise the importance of paying attention to this group in health care practice, public health interventions and social care services. At the core of SE lies the inability of persons to participate fully in society and make full use of the benefits that society offers. SE reinforces feelings of powerlessness, alienation, demoralisation and a lack of self-esteem [43, 44]. Policymakers must take these factors into account when formulating policies, and professionals must do so when providing care and support. In Chapter 6, some examples were given of services in the G4 that take agency into account. We mention here stress-sensitive municipal services in Utrecht that are based on the principles of Mobility Mentoring® [45]; the Powerful Basic Care approach (Krachtige Basiszorg), which aims at a collaborative response by primary and social care givers to the health needs of patients in deprived areas in the G4, [46]; and Pathways to Empowerment (Krachtwerk), a programme for a wide range of people who, temporarily or more permanently, experience a loss of control in their lives and are confronted with an accumulation of risk factors for social exclusion [47]. Another example is the involvement of peer support workers to make care and assistance more accessible and foster people’s self-management [26]. We hope these examples will inspire others to pursue similar goals. FINALLY In this research, we took significant steps towards improving the knowledge base on the relation between SE and health. We largely confirmed the hypotheses derived from theory and practice that SE is associated with poor mental and general health. With the construction of the SEI-HS, there is now a reliable and valid instrument available to GGDs for measuring SE in the adult population, including the main non- Western migrant groups. As we hoped at the start of the study, the SEI-HS identifies a high-risk/high-need population segment in which social problems, low agency and ill health coincide. These findings can be used to guide public health policy and resource allocation. In particular, the high prevalence of low agency is an important factor to consider in choosing, designing and implementing interventions and services. To increase the utilisation of the SEI-HS data in local public health policymaking, we suggest combining quantitative data with qualitative data on the lived experience of socially excluded people, giving a human face to an abstract concept, and interpreting the results in a broader contextual perspective. SE is not just an individual problem. A lack of social cohesion as well as discrimination and stigma, deprived neighbourhoods, complex bureaucratic procedures, individualization, high demands on people’s self- reliance and lagging social benefits are all factors that affect SE and health. We further suggest that public health monitoring incorporate other methods in addition to the PHM to reach those who otherwise remain excluded from the picture. No one method is sufficient by itself. As one of the G4 policymakers put it: