Addi van Bergen

Chapter 3 48 forms of structural-economic exclusion i.e. “material deprivation” and “inadequate access to basic social rights”. A person is socially excluded to some extent if there is accumulation of deficiencies on one or more of these four dimensions. The greater the number of deficiencies and the larger these deficiencies are, the higher the degree of social exclusion. See Table 1 for the operationalisation of the dimensions. To construct an instrument to measure the four dimensions, the SCP administered a questionnaire to a sample of the Dutch population. The initial questionnaire consisted of 232 items derived from previous SCP research, literature, focus groups and cognitive tests. For each of the dimensions, a subscale containing three to four items was constructed by using nonlinear canonical correlation analysis. Together, these 15 items make a general index that reflects the underlying construct of social exclusion. The general index measures the degree of social exclusion at the individual level, with a higher index score for persons deprived simultaneously on several dimensions. [9,10]. Table 1. Operationalisation of the four dimensions of social exclusion. [9,10]. Dimension of social exclusion Operationalisation Lack of normative integration Non-compliance with core values of society. In the Dutch context, this relates to issues like “having no respect for other people”, “not saying ‘thank you’ when receiving change” or “putting out your garbage on a Tuesday when it’s only allowed on a Wednesday….. “*. Limited social participation Social isolation, limited participation in social networks and inadequate social involvement. Material deprivation Deficits that people experience as shown by debts and the absence of certain basic goods and services, such as a washing machine or a daily hot meal. Inadequate access to basic social rights Inability to exercise the rights people normally have. This dimension is operationalised as having access to adequate health care, sufficient education and a proper living environment. * The quotations are from participants in the focus groups organised by the SCP [10]. Although the SCP measurement instrument for social exclusion has been adapted and validated for the Dutch context, its suitability for routine public health surveys is limited. The Community Health Services consider the measure, with 15 items, too long to include in their health questionnaires. The total number of items that can be included in the questionnaires is limited and there is fierce competition between topics. Moreover, there is substantial overlap of the SCP-questionnaire of Social Exclusion with current topics of the health surveys, such as loneliness, social capital, financial situation and housing. This last observation prompted us to explore whether the multidimensional concept of social exclusion can validly be approximated with items from the health questionnaires that are already used in the public health surveys in the