Addi van Bergen

Chapter 3 62 that the constructed indices will be closely interrelated with the SCP index, given the similarities in content and good agreement in measurement properties between the constructed indices and the SCP index. The main contribution of this paper is the development of a social exclusion index that can be measured reliably and validly with routine public health survey data. Until now, no generally accepted and validated instrument has been developed to measure social exclusion in health research [3,22-25], even though such an instrument is considered paramount to improve our understanding of how social exclusion influences health and health inequalities [2-4,22,26,27]. The index discussed in this article is not only relevant for the Netherlands, but may be applied in other public health surveillance systems as well, such as the Centers for Disease Control and Prevention National Health Interview Survey [28], the Health Survey for England [29] and the Italian risk factor surveillance system PASSI [30]. Once included in routine public health monitoring, large amounts of data will become available with which social exclusion can be quantified, risk groups identified and developments monitored over time. Relations with health outcomes and determinants can be assessed by combining social exclusion data with other health surveillance data. Such information is relevant from several perspectives. Social exclusion is considered an important determinant of health inequalities and offers a broader range of policy options than more simple concepts like low income and poverty [26,31,32]. Valid and reliable information can help policy makers to develop more effective policies to reduce health inequalities. Moreover, it can provide a baseline from which to monitor and assess the effects of policies and programmes [2,3,33]. Finally, the measurement of social exclusion can raise the profile and visibility of excluded groups and draw attention to the diverse causes and consequences of social exclusion [24]. This study set out to explore whether the multidimensional concept of social exclusion can be measured with the health questionnaires that are currently used in the public health surveys in the Netherlands. This question can be answered positively. We succeeded in constructing a brief measure for social exclusion with good measurement properties and high acceptability, which is suitable for use in routine public health surveys. The use of this measure in other countries and regions will enable the development of effective policies and programmes to tackle health inequalities. ACKNOWLEDGEMENTS The authors thank the Community Health Services of Amsterdam, Rotterdam and The Hague for making available the data used in this study.