European Health
Information Initiative:
Recent developments and
relevance for Small
Countries
Dr Claudia Stein
MD, PhD, FFPH
Director
Division of Information, Evidence, Research and
Innovation
WHO Regional
Officetitle
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Europe
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Small Countries and health information
Small countries tend to have:
• Low levels of mortality and high life expectancy;
• Good health information systems with high quality data & high
coverage but despite Health 2020 monitoring requirements:
• 3 countries did not report to WHO on majority of H2020 indicators
last year;
• 5 countries reported data that for some indicators were 3-4 years old.
• Small numbers of deaths and cases → high fluctuations in rates
from one year to the next;
• Small health information departments/agencies dealing with
monitoring and high reporting burden by multiple organizations;
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Small Countries and health information
• Sometimes requests from international organizations not appropriate
for Small Countries;
• Sometimes survey requests from various organizations not
coordinated or tend to overwhelm;
• Small Countries national health plans have strong elements of
monitoring and evaluation → integration of health information is key.
WHO internal mapping of survey
requests and gatekeeper function to be
introduced to reduce number
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Health information in the European Region
Health information (HI) is the foundation of public
health and an integral part of health systems, and
many HI activities take place in the Region. Yet:
• Evidence and knowledge is dispersed, incomplete and
difficult to access;
• Health information activities are often not funded through
sustainable structures;
• International data collections are poorly harmonized;
• We are faced with persistent health information
inequalities.
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WHO/EU collaboration towards a single
integrated Health Information System
for Europe (53 Member States)
Moscow Declaration 2010
Vilnius Declaration 2015
OECD
a partner since
2012
Regional Committee 2015:
title the
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strengthening health information
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EHII - multi-partner network providing guidance for
health information activities in European Region
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EHII participants to date
Russian Federation:
1. New WHO Collaborating
Centre on health info;
2. Autumn School 2015
Lithuania:
Established PhD
programme in EVIPNet
Poland:
Hosted autumn school
Oct 2014
Kazakhstan &
Kyrgyzstan:
Staff & infrastructure for
regional health information
network in CARK countries
UK:
1. New WHO Collaborating
Centre on indicator
development
2. Wellcome Trust: Grant
funding & senior staff
secondment
Small
Countries (< 1
million, 8 MS)
PresentationTurkey:
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Hosted first autumn
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school Oct 2013
24-25 March 2015:
First meeting of the EHII
Steering Group
Third meeting 6 Nov 2015
• Terms of Reference and
scope agreed;
• Work plan and next steps
agreed
Extensive mapping exercise
of existing indicator sets in
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the region: quality, feasibility,
relevance
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Health Information Networks
• Launched in
European
Region in 2012;
• Uses multistakeholder
country teams
to translate
research
evidence in
policy-making;
• Now “live” in
16 countries.
•
Small countries
– formalized at
last Regional
Committee;
•
South East
European
Health Network
(SEEHN) is
discussing a
health
information
network.
Kazakhstan, Kyrgyzstan,
Tajikistan,
Turkmenistan,
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Uzbekistan
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CARINFONET –
what are the benefits?
•
Strong platform for exchange and mutual support of
countries with common systems, history and
epidemiology;
•
Ability to identify joint priorities in region;
•
Provides platform for joint reporting of health statistics
and research;
•
Joint capacity building in and improvement in health
statistics in terms of quality, timeliness and completeness;
•
Enables closer alignment with international standards and
better coordination with international partners (sharing of
experience with other countries);
•
Constitutes a larger force to bring sub-regional issues to
wider audience and form larger alliances.
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Small Countries Health Information Network
Meeting of Ministers of Small Countries
at Regional Committee September 2015:
• Chaired by Minister of Health, Malta;
• Countries agreed to establish health
information network;
• Terms of Reference and Scope and Purpose
for network agreed;
• Countries to nominate network focal points first meeting in early 2016.
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Thank you & please use our products
Factsheets
All products available
at:
http://www.euro.who.i
nt/en/data-andevidence/europeanhealth-report2015
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Thank you
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Extra slides
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Health information networks: possible models
(not ‘one size fits all’)
1. Basic:
• Formal/non-formal network as platform for exchange and mutual
support;
• Ability to identify joint priorities and issues and make joint requests to
international players;
• Membership in European Health Information Initiative;
2. Intermediate: Joint reporting and joint web-based platform;
3. Advanced:
• Joint capacity building for Small Countries’ specific
needs (specialized Autumn School);
• Joint strategy development, communication
and advocacy.
Any combination of the above
is possible
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RD’s article
in EJPH
Why Europe needs the European Health Information Initiative:
• To broaden international cooperation and to support the
development of the single European health information
system;
• To improve health information and research in countries in
the European Region;
• To call for other Member States and institutions to join and
support this important effort.
Thank you
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Спасибо
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What could be the next steps?
•
Discussion on relevance/need of any form of network at this meeting;
•
Further discussion at capacity building workshop at EUPHA, Milan;
•
WHO Europe convenes a further brainstorming workshop with Small Countries
to:
• Discuss models and options in more detail;
• Support the decision for the model requested;
• Support the formalization of the network, if desired.
•
Small Countries to indicate in this meeting:
• Their level of interest in a health information network;
• Whether exploratory workshop is desired;
• In due course, nominate attendees of workshop.
•
No matter what is decided – please consider active membership of the
European Health Information Initiative!
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What would any model require?
• Setting up of Steering Group (formal/informal):
• Each country to nominate a focal point (attendance at meetings
and calls) – informal;
• Supports the Secretariat and Chair - formal;
• Agreed Terms of Reference - formal.
• Setting up of a Secretariat:
• Provided by country which is Chair (could be rotational);
• Ability to hold web-ex meetings or conference calls;
• Small budget.
• WHO Europe would always support the network technically and
strategically.
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eHealth standards for health data
exchange and interoperability
The outcome of
this process that
began in 2013 as a
result of the WHA
resolution on
eHealth will be a
WHO Guideline on
Standards and
Interoperability,
due for release in
summer 2015.
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Revitalizing Highlights on Health
and Wellbeing
New concept:
• Focus on Health 2020
• Piloted with Moldova
• Slovenia next
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Target 6. Setting national targets
Policy addressing health inequity or social determinants of health exists
National or subnational target setting process exists
All answers (n=31 and 36 for 2010 and 2013, respectively)
All answers (n=31 and 36 for 2010 and 2013, respectively)
Targets defined
Yes, stand alone
Indicators defined
OnOn-line survey
Yes, included elsewhere
2013
2010
No, but planned for the future
No
No, and not planned for the future
Internet Explorer.lnk
0%
10%
20%
30%
40%
50%
60%
70%
0%
10%
20%
30%
40%
50%
National health policy is aligned with H2020
There is a health policy accountability mechanism in place
All answers (n=31 and 36 for 2010 and 2013, respectively)
All answers (n=31 and 36 for 2010 and 2013, respectively)
60%
Yes, comprehensive health policy
Yes, adopted
Yes, another strategy
2013
Yes, in process
2010
No, but planned for the future
No, and not planned for the future
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No and not planned for the future
0%
10%
20%
30%
40%
50%
60%
70%
0%
10%
20%
Source: WHO. Qualitative indicators for Health 2020 policy targets monitoring, 2014
30%
40%
50%
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60%
Guidelines development:
Electronic Health Records (EHR)
• As a reflection of the priority being given globally to the
development of national Electronic Health Records
(EHRs), WHO commenced guidelines development of
best practices in EHR implementation;
• This process includes global thought leaders on EHR
development to formulate best practices based upon a
systematic review of existing EHR literature;
• The first global meeting was hosted by WHO Europe
last month;
• Preliminary results are expected at the end of 2015.
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AREA
TARGET
QUANTIFICATION
CORE INDICATORS
Burden
of
disease
and risk
factors
1.
Reduce
prematur
e
mortality
in Europe
by 2020
1,5% relative annual
reduction in overall
premature mortality from
CVD, cancer, DM and
chronic respiratory
disease
Premature overall premature
mortality rate for CVD, cancer,
DM and chronic respiratory
disease
Prevalence of current tobacco
use
Total per capita alcohol
consumption
Prevalence of overweight and
obesity
Elimination of selected
vaccine-preventable
diseases
% of children vaccinated
against measles, polio, and
rubella
Reduction of mortality
from external causes
Mortality rates from all
external causes and injuries
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AREA
TARGET
QUANTIFICATION
CORE INDICATORS
Healthy
people,
wellbeing
and
determinants
2.
Increase
life
expectanc
y in
Europe
Continued increase in
life expectancy at
current rate + reduction
of differences in the
Region
Life expectancy at birth
3. Reduce
inequities
in Europe
Reductions in the gaps
in health status
associated with social
determinants within the
European population
Infant mortality per 1000 live
births
Life expectancy at birth
Proportion of children of
primary school age not
enrolled
Unemployment rate
(Sub)national policy
addressing reduction of health
inequities established and
documented
title (income
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coefficient
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distribution)
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AREA
TARGET
QUANTIFICATION CORE INDICATORS
Processes,
governanc
e and
health
systems
5. Universal Moving towards
coverage
universal coverage
and “right to by 2020
health”
Private household out-ofpocket expenditure as a
proportion of total health
expenditure
% of children vaccinated
against measles, polio, and
rubella
Total gross expenditure on
health (as % of GDP)
6. National
targets/goal
s set by
Member
States
Establishment of
processes for the
purpose of setting
national targets (if
not already in
place)
Establishment of process for
target-setting documented
Evidence documenting: a)
establishment of national
policies aligned with Health
2020, b) implementation plan,
c) accountability mechanism
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European Health 2020 policy:
A closer look at ‘objective’ well-being indicators
Domain
Indicator
Core
Social
•
connections/
relationships
Social support available
(Gallup World Poll)
Economic
security/
income
Natural and
built
environment
Education
•
Indicator already adopted in Health 2020
Additional
Core
•
% of persons aged
65 and over living
alone (28 countries)
•
Total household
consumption (48
countries)
•
•
GINI coefficient
Unemployment rate
by age and sex
•
Educational
attainment: at least
completed
secondary
education (32
countries)
•
Primary school age
not enrolled
Additional
% population with
improved sanitation
facilities (51 countries)
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Cultural determinants of health and
well-being
• Well-being is an innovative element in the
Health 2020 framework;
• Culture influences health and well-being;
• Understand how culture influences
subjective well-being measurements,
especially in a region as culturally diverse
as Europe;
• Not increase reporting burden on MS.
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Understanding cultural determinants
• Existing innovative work (E.g. Gallup, ISTAT);
• Need to assess evidence from a multidisciplinary angle and use innovative data and
evidence sources;
• Role of expert meeting to take stock of current
insights and existing evidence, and advise on
priorities for future work.
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EURO expert group meeting on culture
and health - objectives
• agreeing on a working definition of culture;
• rethinking data and evidence needs for wellbeing;
• suggesting ways to report more effectively on
well-being;
• identifying research gaps in relation to culture
and well-being.
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Expert group meeting recommendations
• Formally establish an
interdisciplinary expert
group on CCH;
• Adopt UNESCO 2001
definition of culture;
• Explore culture-centred,
participatory approaches.
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Expert group meeting recommendations
Encourage more research into:
• cross-cultural comparability of
subjective well-being data
(esp. within Europe);
• the use of new types of
evidence, particularly
qualitative and narrative
research.
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Examples of finalized and on-going EHII activities
A focus on
the
development
of practical
tools
Underlying values
Maintain compatibility
with existing
monitoring
frameworks,
including global ones
Apply the life
course
perspective
Guiding principles
1. Development of
information for
health and wellbeing with a focus
on indicators
6.
Communications
and advocacy
A focus on the
use of innovative
approaches and
the stimulation of
R&D work
2. Improved
access to
and
disseminatio
n of health
information
EHII
key
areas
EHII
key
areas
Aim to reduce
inequalities
Enhance
Interagency
collaboration
Enhance
Intersectoral
collaboration
5. Support for
health
information
strategy
development
3.
Capacity
building
4. Strengthening
of health
information
networks
1. Development of information for health and well
being with a focus on indicators
• Development of the Health 2020 monitoring
framework
• Developmental work on well-being
measurements with a focus on the cultural
contexts of well-being
2. Improved access to and dissemination of
health information
• Development of the WHO health information
and evidence portal
• Production of evidence syntheses in different
formats under the umbrella of WHO’s Health
Evidence Network (HEN)
• Support for the new WHO Regional Office for
Europe bi-lingual journal Public Health
Panorama (in English and Russian)
3. Capacity building
• Organization of the annual, one week Autumn
School on Health Information and Evidence for
Policy-making
4. Strengthening of health information networks
• Re-launch of CARINFONET, the Central Asian
Republics Information Network
• Launch of the Evidence-informed Policy
Network in the European Region (EVIPNet
Europe)
5. Support for health information strategy
development
• Development of a support tool for Member
States to develop national health information
strategies and enhance national health
information systems
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6. Communications and advocacy
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•
Development of a communications and
advocacy strategy
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Subjective well-being
AREA
TARGET
QUANTIFICATION
CORE INDICATORS
Healthy
people,
wellbeing
and
determinants
4.
Enhance
the wellbeing of
the
European
population
To be set as a result of
the base-line of the core
well-being indicators
Life satisfaction
Availability of social support
Still work in
progress,
also still
working on
additional
indicators on
subjective
well-being
% of population with improved
sanitation facilities
GINI coefficient (income
distribution)
Unemployment rate
Proportion of children of
primary school age not
enrolled
Objective well-being
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