DEVELOPMENTS ON THE DISSEMINATION OF THE
EUROPEAN COMUNITY HEALTH INDICATORS
Luxembourg, 7 December 2006
Antoni Montserrat
European Commission
DG SANCO Health Information Unit
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Key Line
An EU health information system, with indicators on health-related
behaviour, diseases and health systems
Being developed on the basis of Public Health Programme projects
and other EU actions
In cooperation with Eurostat, OECD and WHO
Based on common instruments and mechanisms
for health reporting (surveys, registers, hospital information, etc.)
Available through the DG SANCO web site and the internet-based EU
Health Portal, as well as through regular EU health reports
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How we define an Health indicator?
The ECHI (European Community Health Indicators) project was
carried out in the framework of the Health Monitoring Programme and
the Community Public Health Programme 2003-2008.
Objectives of ECHI:
1. Measure health status, its determinants and the trends therein
throughout the Community;
2. Facilitate the planning, monitoring and evaluation of Community
Programmes and actions;
3. Provide Member States with appropriate health information to
make comparisons and support their national health policies.
The result is a list of ‘indicators’ for the public health field arranged
according to a conceptual view on health and health determinants.
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Current legal basis for the developments of Health indicators in the EU
Public Health Policy
The Work Plans 2005, 2006 and 2007 contains explicit mention to
health indicators in item 2.1.1:
Putting into operation by means of a presentation tool of the European
Community Health Indicators (the “ECHI short list”)’ with collection of related
data; Implementing the ECHI system at national level as a public database
using a public web application.
Improving operational definitions of existing indicators in the “ECHI short
list”, when necessary.
Developing the technical scientific work on EU health indicators in the areas
not yet covered.
Projects focused on specific data sources aimed at improving the
methodological and technical bases for moving to routine data collection.
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Future legal basis for the developments of Health indicators in the EU
Public Health Policy
For the period 2007/2013 a new Health and Consumer Protection
Programme should replace the existing Public Health Programme (if
approved by the Council and the Parliament)
Draft Regulation from the Council and the Parliament (developed by
Eurostat) creating a statistical framework for data collection on health
and safety at work in some areas (health status, causes of death,
health care). It should be a ‘umbrella regulation’ to be developed via
Commission Regulations.
Via Commission Decision a Direct contract agreement with OECD for
developments in several areas e.g. Indicators on Health Quality, Data
collection on Primary Care, etc.
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Future legal basis for the developments of Health indicators in the EU
Public Health Policy
The new Research Programme (FP7) introduces a new common
approach between research activities and health information under
the pillar ‘Cooperation’
Emphasis will be put on translational research (translation of basic discoveries into clinical
applications), the development and validation of new therapies, methods for health promotion
and disease prevention, diagnostic tools and technologies, as well as sustainable and efficient
health care systems.
Some examples in ‘Translating research for human health’:
Health Examination Survey: to develop a pilot health examination survey at EU level including
biomonitoring approaches to provide data for European Community Health Indicators and based
on existing feasibility studies.
Brain diseases and ageing: to better understand the health impact of injury reduction
strategies directed at elderly persons with economic cost/benefit analysis.
Studies on how health professionals implement best clinical practice (eg. Continuing medical
education, role of professional organisations, registries of interventions and follow-up of
patients)
Creation of a representative sentinel network in each Member State to monitor patient safety
incidents
Mapping of clinical and out-patient care for psychiatric illnesses, and patient rights structures,
including compulsory admission and treatment of the mentally ill in the criminal justice system.
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Future legal basis for the developments of Health indicators in the EU
Public Health Policy
DG SANCO will elaborate during 2007/2008 a proposal for a
Commission Communication on the European Health Information and
Knowledge System:
Summarising the principles basing the EU health information and knowledge system,
The responsibilities of the different actors in this field, the role of DG SANCO,
The national and EU responsibilities on the mechanisms for collecting data (health
surveys, hospital information, etc.),
The interoperability of different systems of health indicators, the cooperation with
other actors (Eurostat, ECDC, OCDE),
The role of the consultative structures
A code of good practices on health information
Obligations that the European Commission should assume respect to the Member
States in the field of health information.
The proposal should be discussed in all the existing SANCO advisory structures
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Future legal basis for the developments of Health indicators in the EU
Public Health Policy
In 2007 the Commission plans to adopt a new Health Strategy. This will be an
ambitious project and one of DG SANCO's top priorities for the coming year. It
aims to:
Set a clear strategic framework which covers the broad range of work done within DG
SANCO, as well as in other parts of the Commission, and includes some new initiatives
Set broad objectives for a 10 year timeframe, with a 5 year mid-term review
Enable the closest possible cooperation with Member States to improve health in Europe in
the decade to come
Focus on key health issues, on mainstreaming health in all policies, and on global health
issues address key challenges such as pandemics and other threats, demographic change,
new technologies, health inequalities, chronic disease burden, globalisation, patient and
health professional mobility ….(etc)
How to input into the Strategy now:
A further discussion document including questions will be put on the SANCO website within
the coming days giving stakeholders the opportunity to input comments. There will be an 8
week period to respond to the questions, not including Christmas week.
Next steps:
During early 2007 the Impact Assessment and Strategy White Paper will be developed
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Adoption of the Strategy is expected mid-late 2007
Council will then discuss the Strategy
Future legal basis for the developments of Health indicators in the EU
Public Health Policy
During 2007 a Commission Communication on EU action on rare diseases and,
eventually, a Recommendation from the Council will be prepared
A Consultation regarding Community action on health services it’s in place
Before the Commission brings forward proposals for Community action on
health services, we are consulting all stakeholders involved in the health
services sector, on the basis of a specific consultation document. Responses to
this consultation, focused around the nine specific questions identified in the
text of the Communication, should be sent to the Commission by 31 January
2007.
In coming years (2008-2011): new Communications or public consultations or
legal initiatives affecting health information issues (European Health
Examination Survey, hospital information system, others ?)
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Sets of indicators in the EU Public Health Policy
National indicators:
ECHI (European Community Health Indicators)
Sub-national indicators:
ISARE (Indicateurs de Santé dans les Régions de l’Europe)
Urban indicators:
EURO-URHIS (European system of urban health indicators)
Structural indicators:
Healthy Life Years
Health Care Quality Indicators
OCDE Project
Environment & Health Indicators System
ENHIS System (with WHO and EEA)
Others:
Indicators on Social Protection
Sustainable Development Indicators
Key Indicator on Drug addiction
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To disseminate health indicators with the best qualitative approach in
terms of comparability needs mechanisms for health reporting with
common methodologies and systems of collection of data accepted by
all the Member States.
The Public Health Programme cooperates very closely with Eurostat
in the development of the European Health Survey System (health
interview and health examination surveys), with Eurostat and OECD to
develop the System of Health Accounts and a common system of
collection of information on hospital activities and, with WHO bodies
on the development of some disease registers (cancer, health and
environment, etc.).
The Public Health Programme develops also information instruments
for short term information needs as the health modules in the
Eurobarometer survey and other data collection projects.
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Improving mechanisms for health reporting with common
methodologies and systems of collection of data accepted by all the
Member States
Sustainable instruments
European Health Survey System (health interview and health
examination surveys)
Revision of the International Classifications
To develop the System of Health Accounts
A common system of collection of information on hospital activities
Development of some disease registers (cancer, health and
environment, etc.)
Collection of information on primary care
Sentinel networks
Short-term instruments
Instruments for short term information needs as the health modules
in the Eurobarometer survey and other Eurostat data collection
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projects (E4SM)
Improving mechanisms for health reporting with common
methodologies and systems of collection of data accepted by all
the Member States (Sustainable instruments)
European Health Survey System (health interview and health
examination surveys)
The database HIS/HES
The European Health Interview Survey implemented by the Statistical
Programme
The EHIS annual indicators would cover the prevalence of certain chronic diseases in past
twelve months; Body Mass Index (mainly overweight and obesity), hazardous alcohol consumption,
physical activity, smoking, consultations of doctors and dentists, medicine use,
preventative actions, selected physical and sensory functional
Limitations, pain and discomfort, SF-12 on mental health
The European Health Examination Survey implemented by the Public
Health Programme and the FP7
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Anthropometric measurements
Body weight and height
Waist and hip measurement
Demi-spam
Other, e.g. demi-span, sagittal diameter, bioimpedence
or skinfold
Blood lipids
Triglycerides
Total cholesterol
HDL cholesterol
LDL cholesterol
Apolipoproteins
Smoking indicators
Cotinine, blood
Cotinine, saliva
Cardiovascular function
Blood pressure
Electrocardiography (ECG)
Other (blood samples/blood clotting)
Respiratory function
Spirometry/PEF
Diabetes mellitus and other
metabolic functions
Blood glucose
Other blood samples for indicators used in diabetes
surveillance, e.g. insulin
Kidney, urinary tract and thyroid
function
Blood samples
Urine samples
Liver, gallbladder, stomach and
pancreas function
Blood samples, e.g. gamma GT
Haematological system function
and diseases
Blood samples, e.g. Hemoglobin, ferritin, leuc, eryt
Infections and inflammations
Blood samples, e.g. CRP
Allergy
Skin prick test
Blood samples, immunoglobulins
Musculoskeletal function
Bone density measurements
Sensory and physical function
Vision tests
Hearing tests
Functional capacity/physical function tests
Mental and cognitive function
Diagnostic measurement of mental health
Cognitive function tests (MMSE)
Other clinical examinations
Clinical dental examination
Clinical physical examination
Nutritional status
Blood samples, vitamins and/or minerals and trace
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Improving mechanisms for health reporting with common
methodologies and systems of collection of data accepted by all the
Member States
Sustainable instruments
To develop the System of Health Accounts
OECD/Eurostat/WHO Joint Collection
The PHP supports Eurostat and OECD in refinement of SHA procedures
First results available in 2007
A common system of collection of information on hospital activities
ISHT (International Short List Tablulation) from Eurostat/WHO/OECD on the basis of the
Hospital Data Project
First results available in 2006
Development of some disease registers
The EUNICE Project on cancer
The Health & Environment
Collection of information on primary care
Project with OECD
Sentinel networks
EISS (flu)
To be developed
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Improving mechanisms for health reporting with common
methodologies and systems of collection of data accepted by all the
Member States
Short-term instruments
Instruments for short term information needs as the health modules
in the Eurobarometer survey
5 modules in 2006 (mental well being, food, tobacco, medical errors, AIDS Prevention)
5 modules in 2007 (EMF, risk factors, tobacco, alcohol, organ donation)
Eurostat data collection projects
The SILC survey is used for Healthy Life Years and Unmet needs
New survey 'E4SM' (European System of Social Statistical Survey Modules) since 2009
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Improving mechanisms for health reporting with common
methodologies and systems of collection of data accepted by all the
Member States
Revision of international classifications
Revision of the International Classification of Diseases (ICD):
The WHO has launched the process of revision of the International Classification of Diseases
(ICD) -10 to prepare the new ICD-11 which should be ready around 2015. The EC is very
involved on the process from the side of the Rare Diseases.
Discussions on the revision and improvement of the ICD will be also launched for the mental
health disorders.
Revision of the International Standard Classification of Occupations (ISCO):
The ILO (International Labour Organisation) has launched the process of revision of the
Standard Classification of Occupations (ISCO 88) which should be replaced by a new ISCO 08
to be completed in 2008. The revision of the Chapter on Health Professions could have a
significant impact in all the surveys, registers and health accounts which uses ICO 88.
Eurostat responsibility.
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Improving mechanisms for health reporting with common
methodologies and systems of collection of data accepted by all the
Member States
Revision of the International Classification on Health Accounts (ICHA): The OECD, Eurostat
and WHO agrees on the start of the process of revision of the ICHA (International
Classification on Health Accounts) used for the creation of the SHA (System of Health
Accounts).
In the framework of the Work Plan 2006 for the implementation of the Public Health
Programme, DG SANCO is supporting some OECD activities in the area of refinements of the
SHA classification. Also some actions for the revision of SHA from the side of Eurostat will be
probably supported in 2007. The main objectives of these revisions are to refine the
conceptual framework for the treatment of health financing systems, to include a revised
structure (new dimension for financing sources and revised structure for the classification of
financing schemes), and revision of the current definitions, to put forward a set of accounts
(tables and T-accounts) in order to adequately present the transactions of health care
financing, to provide more detailed guidance on possible data sources and estimation
methods of private expenditure and to develop indicators that can provide adequate input
(together with other statistical resources) for the analysis of the sustainability of financing
macro-level efficiency and equity of utilisation of resources.
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Health Reports
The new Work Plan 2006 has given to the Health Reports a new impulse that was anticipated
by the action of SANCO.
The indicative calendar of production of health reports could be as follows:
HEALTH REPORTS BASED ON INDICATORS
- First Communicable Diseases Report
Third Quarter 2006
Produced by the ECDC with the cooperation of SANCO C-2 and ESTAT
- First Chronic Diseases Report
First Quarter 2007
Produced by TF MCD
- First Global Report on Health in the European Union
Early 2008
Produced by the EUGLOREH Project leaded by the Ministry of Health (Italy)
- Second report of the European Conference on Rare Diseases
2008
Produced by the RAPSODY Project leaded by EURORDIS
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HEALTH STATISTICAL REPORTS (Eurostat)
Health Pocketbook
(last release in 2006)
Atlas of Mortality
Key Data on Health
The Work Plan 2007 previews also the possibility of selecting for funding health reports in the
areas of:
gender specific health problems,
young people, the elderly, migrants, ethnic minorities, specific problems of social
groups with low living standards
sexual and reproductive health
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How we will to disseminate the indicators?
A part of the DG SANCO Web Site ‘Dissemination of Information and data’
(available in different phases since June 2005)
EU Health Portal
http://ec.europa.eu/health-eu/index_en.htm
(launched in May 2006)
All Member States languages will be available during 2007
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Other strategical Initiatives
Consensus instruments for treating and monitoring Alzheimer
and other dementias
The European Conference on Multiple Sclerosis 2007
Consensus instruments for treating and monitoring Autistic
Spectrum Disorders
The European Conference on Rare Diseases 2007
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DG SANCOs’ objective is
to develop a European Union System of
Information on Health and Knowledge fully
accessible to all the European experts and
public
becoming the reference instrument of
information to monitor the health of
Europeans
being the basis for any political action in
the field of public health
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