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IntroductionSocial exclusion is considered a major factor in the causation and maintenance of health inequalities, but its measurement in health research is still in its infancy. In the Netherlands the Institute for Social Research (SCP) developed an instrument to measure the multidimensional concept of social exclusion in social and economic policy research. Here, we present a method to construct a similar measure of social exclusion using available data from public health surveys.MethodsAnalyses were performed on data from the health questionnaires that were completed by 20,877 adults in the four largest cities in the Netherlands. From each of the four questionnaires we selected the items that corresponded to those of the SCP-instrument. These were entered into a nonlinear canonical correlation analysis. The measurement properties of the resulting indices and dimension scales were assessed and compared to the SCP-instrument.ResultsThe internal consistency of the indices and most of the dimension scales were adequate and the internal structure of the indices was as expected. Both generalisabiliy and construct validity were good: in all datasets strong associations were found between the index and a number of known risk factors of social exclusion. A limitation of content validity was that the dimension “lack of normative integration” could not be measured, because no relevant items were available.ConclusionsOur findings indicate that a measure for social exclusion can be constructed with available health questionnaires. This provides opportunities for application in public health surveillance systems in the Netherlands and elsewhere in the world.

BackgroundSocial exclusion (SE) refers to the inability of certain groups or individuals to fully participate in society. SE is associated with socioeconomic inequalities in health, and its measurement in routine public health monitoring is considered key to designing effective health policies. In an earlier retrospective analysis we demonstrated that in all four major Dutch cities, SE could largely be measured with existing local public health monitoring data. The current prospective study is aimed at constructing and validating an extended national measure for SE that optimally employs available items.MethodsIn 2012, a stratified general population sample of 258,928 Dutch adults completed a version of the Netherlands Public Health Monitor (PHM) questionnaire in which 9 items were added covering aspects of SE that were found to be missing in our previous research. Items were derived from the SCP social exclusion index, a well-constructed 15-item instrument developed by the Netherlands Institute for Social Research (SCP). The dataset was randomly divided into a development sample (N =129,464) and a validation sample (N = 129,464). Canonical correlation analysis was conducted in the development sample. The psychometric properties were studied and compared with those of the original SCP index. All analyses were then replicated in the validation sample.ResultsThe analysis yielded a four dimensional index, the Social Exclusion Index for Health Surveys (SEI-HS), containing 8 SCP items and 9 PHM items. The four dimensions: “lack of social participation”, “material deprivation”, “lack of normative integration” and “inadequate access to basic social rights”, were each measured with 3 to 6 items. The SEI-HS showed adequate internal consistency for both the general index and for two of four dimension scales. The internal structure and construct validity of the SEI-HS were satisfactory and similar to the original SCP index. Replication of the SEI-HS in the validation sample confirmed its generalisability.ConclusionThis study demonstrates that the SEI-HS offers epidemiologists and public health researchers a uniform, reliable, valid and efficient means of assessing social exclusion and its underlying dimensions. The study also provides valuable insights in how to develop embedded measures for public health surveillance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4175-1) contains supplementary material, which is available to authorized users.

This review found evidence for the association between high SE/low SI and adverse health outcomes, particularly mental health outcomes. The evidence is mainly based on cross-sectional studies using simple and often ad hoc indicators of SE/SI. The development and use of validated measures of SE/SI and more longitudinal research is needed to further substantiate the evidence base and gain better understanding of the causal pathways.

The social exclusion of children is problematic for two reasons. Young people typically inherit their marginal position from their family, and therefore cannot be held responsible for their hardship themselves; and social exclusion in childhood may affect their wellbeing and subsequent development, possibly leading to a "scarring effect" in later life. In this contribution we develop an instrument for measuring social exclusion among children. Social exclusion is regarded as a theoretical construct with four sub-dimensions: material deprivation, limited social participation, inadequate access to social rights, and a lack of normative integration. First we analyse data from a survey of 2,200 Dutch children, which contains a large set of social exclusion items. We applied nonlinear principal components analysis in order to construct a multidimensional scale. Measured in this way, the prevalence of social exclusion among children is 4.5%. Boys and children living in large families are more likely to experience social exclusion than girls and children with few siblings. The parental level of education and dependency on social security benefits are also important driving factors of childhood social exclusion. Subsequently we investigate the scarring effect. Longitudinal administrative income and household data covering 25 years were combined with a new survey of just under 1,000 Dutch adults, a third of whom were poor as a child. The survey assessed their past and current degree of social exclusion, and their health and psychosocial development, educational career, past family circumstances, etc. In an absolute sense scarring turns out to have been limited during this period: a very large majority of those who were poor or excluded as a child are above the threshold values in adult life. However, the "descendants of hardship" are still more likely to be socially excluded as adults than people who grew up in more favourable conditions. A causal analysis suggests that low educational achievements are the main mediator of scarring risks.