Only two studies used an existing instrument for SE/SI, that is, the Social Inclusion Questionnaire User Experience (SInQUE)32,53 and Social exclusion index.33,42 Three studies used existing scales to measure dimensions of SE/SI.44,46,51 In two studies an index of social exclusion was constructed and partly validated.49,50 The majority of studies did not use a composite measure for SE/SI, and those that did, mostly calculated simple sum scores.41,47,49,54,57–59 In 10 studies, the data were not originally designed to measure SE/SI (e.g. Due to the typically small samples, the total sample size is modest compared to the general population sample (figure 4; Supplementary file S5 tables S1a and S1b). Social exclusion is a matter of degree, rather than a dichotomy between ‘us’ and ‘them’. 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. These were: (i) positive, when a significant (P < 0.05) concordant relationship was found for all measured SE/SI dimensions (high-SE/low SI corresponds to low health outcome), (ii) negative, when an inverse association was found, (iii) no association, when the relationships between the SE/SI dimensions and health were not statistically significant and (iv) partly (+/0), when studies reported multiple associations. Main reasons for exclusion in this stage were subject (58%) and publication type (22%). The outcomes included some that are widely used in public health monitoring such as self-assessed health, presence of any chronic disease and limitations due to health problems. All studies had CASP scores of 6 or more, indicating acceptable quality. Summary of study specific limitations with a high risk of bias, Figure 4 shows evidence in favour of our hypothesis that high SE/low SI is associated with adverse health outcomes for MH in the general population. "All our systems, including social, psychological and biological, have developed around social groups and interaction with one another," Ivanov says. A third cohort study showed partial evidence.59 In women, long-term sickness absence adjusted for age and previous SE increased the risk of the combination of economic and social exclusion, but not of the combination of economic and cultural exclusion. This does not indicate less evidence per se. The methodological quality of each study is summarised in Supplementary file S5. Next, we excluded studies not using a multidimensional construct of SE/SI (minimum two of four dimensions), studies in which health formed part of the SE/SI measure and studies using an ecological measure of SE/SI. Impact of poverty in children includes, deprivation of education, lack of proper health and children below the age of five die each day due to causes that can be prevented. A retrospective cohort study showed an association between high psychological distress in elderly persons and later SE. In: Ottawa, Canada: Proceedings of the Washington City Group meeting. Consequently, the methods of community development have been relatively under-developed in community care practice. We set out to systematically summarise existing evidence on the association between SE/SI and health and evaluate the hypotheses that high SE/low SI is associated with adverse MH, PH and GH outcomes, in the general population and in groups at high risk of SE. In groups at high risk of SE, support was found for the association between high SE/low SI and adverse mental health but no conclusions could be drawn for physical and general health. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (. The option to answer ‘yes moderately’ (0.5 points) was added by the reviewers. The second study49 showed that SE increased the likelihood of compulsory admission among people assessed under the Mental Health Act, but, when other factors such as diagnosis, life-threatening self-neglect and physical aggression towards others, were taken into account, the association became non-significant. Twenty-two observational studies were included. Addi P L van Bergen, Judith R L M Wolf, Mariam Badou, Kimriek de Wilde-Schutten, Wilhelmina IJzelenberg, Hanneke Schreurs, Bouwine Carlier, Stella J M Hoff, Albert M van Hemert, The association between social exclusion or inclusion and health in EU and OECD countries: a systematic review, European Journal of Public Health, Volume 29, Issue 3, June 2019, Pages 575–582, One reason for the absence of association may be the much broader spectrum of PH outcomes included in this study, ranging from headache and obesity to severe obstetric complications. Evidence was found for the interconnectedness of social exclusion and inclusion and health. [Characteristics of endolymphatic hydrops in low frequency descent sudden hearing loss]. The WHO/SCP model used in this paper may serve here as a useful template.3,25,26. Searches were conducted in March 2015 and January 2018. that high SE/low SI is associated with: (i) adverse mental health, (ii) adverse physical health and (iii) adverse general health outcomes in (a) the general population and (b) populations at high risk of SE. Evans-Lacko S, Courtin E, Fiorillo A, et al. Content uploaded by Patrice Van Cleemput. The financial crisis and economic downturn have worsened poverty and social exclusion. case files, registration or monitoring data). 13 years experience Clinical Psychology. One in three studies lacked a theoretical underpinning of SE/SI. As these results were classified as GH, this category may have become somewhat ambiguous. The social exclusion which families experience is rooted in the stigmatising effect attitudes in society can have on people affected by someone else’s substance misuse. A reciprocal relation was found in two longitudinal studies.41,60 Further longitudinal studies may contribute to unravel the dynamic relation between SE/SI and health. As confounding may affect the results of our review through over-estimation, the evidence was also analysed without these seven studies and the inferences remained unchanged. Most studies used self-chosen indicators without testing the psychometric properties. We followed PRISMA guidelines for reporting this systematic review.22,23 The review protocol is registered on the PROSPERO database (registration number CRD42017052718) and is available at Social exclusion is generally regarded as an important social determinant of health, yet, its evidence base is still weak. Burchardt T, Le Grand J, Piachaud D. 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