Madhavi Bajekal, Chris White Office for National Statistics

1. Implementing the EU-SILC health questions in the GHS (now GSL)- UK ExperienceTF-Health Expectancy, Luxembourg 2nd June 2008 Madhavi Bajekal, Chris White Office for National Statistics

2. Context • EU-SILC regulation • Improve consistency between countries & standardise definitions, questions and analysis procedures • UK agreed to comply from 2005 • Eurostat’s health outputs from UK • EHIS derived from HSE (dedicated health survey) • MEHM (EU-SILC) derived from GHS(L) • Eurostat now aspires to harmonise SILC with EHIS

3. Circumstances • SILC harmonisation affects GHS(L) questions on: • General Health (PH010) • Chronic morbidity [Long-standing illness] (PH020) • Activity limitation [Limiting Long-standing illness] (PH030) • Differences in questions e.g. reference time periods, terminology, routing, response categories • Current UK position – questions asked 2005-2008 • ONS initiated further testing (2007/8) and consultation to assess impacts on long-running UK statistical series • Reconcile national statistical needs (eg DDA) with EU needs (disability harmonisation project)

4. Existing and Proposed EU-SILC questions on Chronic Morbidity • Existing: Do you have any long-standing illness, disability or infirmity? By long-standing I mean anything that has troubled you over a period of time or is likely to affect you over a period of time? Yes/No • Proposed: Do you have any longstanding illness or longstanding health problem? [By longstanding I mean illnesses or health problems which have lasted or are expected to last for six months or more] • Differences Disability and infirmity excluded Explicit time period of six months included (past and future)

5. UK modified chronic morbidity question • Modified question to be tested: • Do you have any long-standing illness, health condition or disability? By long-standing I mean illnesses, health conditions or disabilities which have lasted or are expected to last for six months or more • Differences: • Explicit time period 6 months to existing question • Health condition replaces health problem

6. Existing and Proposed EU-SILC questions on Activity Limitation • Existing: • Does this illness or disability/Do any of these illnesses or disabilities limit your activities in any way? • Would you say your activities are limited or strongly limited? • Proposed: • For at least the past six months, to what extent have you been limited because of a health problem in activities that people usually do? Would you say you have been...? • Severely limited Limited, but not severely Not limited at all • Purpose is to measure presence of long-standing activity limitation (not illnesses) vis-à-vis population ‘norm’?

7. Differences in proposed activity limitation question • Time period • specific six month time period (past) • relates to the duration of the activity limitation not the illness • Routing proposed question is asked of everyone (not only those with LLTI) • Severity of disability • terms ‘severely’ and ‘strongly’ may be interpreted differently (eg. substantially) • Terminology • limitations restricted to health-related problems only (disability/old age excluded)

8. Modified activity limitation question • Now thinking about all your health problems, not just those which are long-standing, for at least the past six months, to what extent have you been limited in your day to day activities because of a health problem or disability? Include health problem(s) or disability/ disabilities which are due to old age. Would you say you have been...? • Severely limited • Limited, but not severely • Not limited at all • Age-related disability included – consistency with census 2011 • re-inforce consideration of all health probs. not only long-standing

9. Test Design Three armed trial design Source: OMNIBUS SURVEY Dec. 07 and Apr May Jun 08

10. Test Components • Filter effects: • compare prevalence of activity limitation in filtered, non-filtered and pseudo filtered questions (approx 5 pp difference) • Time period effects: • compare prevalence of chronic morbidity/activity limitation with/without a specified time period • Terminology: • compare prevalence of chronic morbidity including/excluding the term disability • compare prevalence of activity limitation including/excluding age-related limitation

11. Initial Results (December 2007 wave) Prevalence and severity of Chronic morbidity by question with 95 per cent Confidence Intervals

12. Tentative indications • Existing and proposed chronic morbidity questions produce similar prevalence but higher in modified question • Prevalence of total activity limitation higher in the GALI than existing question • ‘Strongly’ and ‘severely’ limited prevalence largely similar using question variants

13. Issues with planned testing • Any differences found will indicate but not prove the size of the impact of adopting the proposed / modified questions • The change elements are too numerous to adequately test with four months data and further testing may be needed • Harmonisation with DDA and the UK census 2011 question defined disability needs testing, informed from a wider range of stakeholders

14. DDA definition - UK 1995 DDA definition of disability as a: ‘physical or mental impairmentwhich has a substantial and long-term adverse effect on (a person’s) ability to carry out normal day-to-day activities’. (without medication, past disability, progressive illnesses)

15. 2011 Census – prototype 1

16. Census 2011 – prototype 2

17. UK – unresolved issues • Conceptual clarity: do both q’s include impairments (‘disability’), infirmities? • Statistical impacts on national DFLE series • Cross-EU comparisons HLY – within country over time or across countries? • IHS core vs GSL vs new EHIS survey?