Addi van Bergen

Chapter 4 72 (regarding social isolation and limited participation in social networks) and (lack of) Normative Integration (referring to non-compliance with core values of society); and two dimensions that concur with the Anglo-Saxon line i.e. Material Deprivation (deficits that people experience as shown by debts and the absence of certain basic goods and services) and (inadequate access to basic) Social Rights (referring to the people’s inability to exercise their citizens’ rights). The SCP Index, however, proved ill-suited for use in routine public health monitoring due to a substantial overlap with current topics, such as loneliness, social capital, financial situation and housing, and lack of space for 15 additional items. Our previous study [32] showed that in all four cities, the above described multidimensional concept of SE could be validly approximated with existing data from public health questionnaires. From each questionnaire we had selected the items that corresponded to those of the SCP-instrument and entered these into a nonlinear canonical correlation analysis. The internal consistency of the resulting indices was adequate to good, and so were the internal structure, generalisability and construct validity. The content validity however, was only moderate. The dimension scales for Material Deprivation and Social Rights did not cover the full width of the theoretical constructs. The Material Deprivation scales missed items on lack of basic goods and services such as club membership and heating one’s home. The Social Rights scales missed an item on the actual lack of access to healthcare. Such items were not available in the health questionnaires of the four cities. One of the SE dimensions, i.e. the dimension Normative Integration, could not be measured at all due to lack of appropriate items in the survey questionnaires. Another limitation of our study was that replication of the indices was confined to urban areas only. In the current prospective study we addressed these limitations by 1) extending the study to the national level and harmonizing with the Netherlands Public Health Monitor and 2) adding extra items to enhance content validity. Our ultimate goal is to develop a nationally validated and standardised measure to monitor SE in routine public health surveys among adults, that optimally employs available survey items. In the Netherlands, routine public health monitoring is carried out by 28 Community Health Services, in cooperation with Statistics Netherlands (CBS) and the Netherlands National Institute for Public Health and the Environment. Every four years, health questionnaires are distributed to a large sample of the Dutch adult population. The monitoring forms part of the health status assessment stage of the Dutch four year preventive care cycle, on the basis of which specific objectives for and the implementation of national and local health policies are defined, implemented and adjusted [40, 41]. Besides mandatory nationwide questions, the health questionnaires also contain optional questions that address local health policy priorities. Community Health Services are obliged to use standard questions developed within the framework of the Netherlands Public Health Monitor (PHM). Only when PHM standard questions are unavailable about a particular subject, can Community Health Services employ