156 CHAPTER 6 The first thousand days of our life, spanning from conception to our second birthday, lay the foundation for optimal future health and well-being (1-3). During those first thousand days, our development and opportunities are not only driven by medical factors, but strongly depend on the direct and indirect influences of social factors as well (4). Reducing health inequities and providing every child a good start in life therefore requires preventive and integrated initiatives across the social and medical sector. In 2018, the nationwide action program ‘Solid Start’ was launched by the Ministry of Health, Welfare and Sport (Dutch abbreviation: VWS), aiming for the best possible start for all children during the first thousand days of life (5). The action program Solid Start promotes cross-sectoral collaboration and focuses particularly on (future) parents and young children in vulnerable situations. Starting from 2019, the Ministry of Health, Welfare and Sport commissioned the National Institute for Public Health and the Environment (Dutch abbreviation: RIVM) to monitor the action program Solid Start. This thesis forms the scientific basis for the monitor. The main objective of this thesis was to provide insight into the adoption of the action program Solid Start, thereby focusing on monitoring and cross-sectoral collaboration. Using a wide range of quantitative and qualitative research methods, the studies included in this thesis offer insights into what and how to monitor, as well as the developments and experiences with the action program Solid Start. This final chapter begins with a summary of the main findings of the included studies in this thesis, followed by a reflection that outlines and contextualizes key lessons learned using the main findings and recent literature. Subsequently, this chapter highlights methodological considerations along with recommendations for research. This chapter closes with a future outlook, providing recommendations for policy, practice and education, and concluding remarks. MAIN FINDINGS What is vulnerability during pregnancy, and how to operationalize vulnerability for monitoring? We studied the concept of vulnerability and its operationalization for monitoring purposes in Chapter 2 and 3. Both studies included pre-pregnancy data on a wide range of social risk and protective factors, as derived from nationwide routinely collected data sources within DIAPER (acronym for Data-InfrAstructure for ParEnts and childRen) and self-reported data on health, wellbeing and lifestyle from the Public Health Monitor 2016 (PHM-2016). The study in Chapter 2 aimed to provide more insight into vulnerability by identifying classes (groups) of pregnant women with similar characteristics, and their relation with adverse outcomes to validate classes. A latent class analysis among pregnant women showed five different vulnerability-classes with varying combinations of risk and protective factors to vulnerability: multidimensional vulnerability, socioeconomic vulnerability, psychosocial vulnerability, high care utilization, and the healthy and socioeconomically
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