DEVELOPMENTS ON THE DISSEMINATION OF THE EUROPEAN COMUNITY HEALTH INDICATORS

1. DEVELOPMENTS ON THE DISSEMINATION OF THE EUROPEAN COMUNITY HEALTH INDICATORS Luxembourg, 7 December 2006 Antoni Montserrat European Commission DG SANCO Health Information Unit

2. 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

3. 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.

4. 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.

5. 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.

6. 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.

7. 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

8. 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 daysgiving 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 • Adoption of the Strategy is expected mid-late 2007 • Council will then discuss the Strategy • Stakeholders and experts are encouraged to take the opportunity to input into the development of the Strategy.

9. 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 ?)

10. 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

11. 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.

12. 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 projects (E4SM)

13. 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

15. 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

16. 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

17. 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.

18. 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.

19. 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

20. 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

21. 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

22. 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

23. 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