DEVELOPMENT OF A EUROPEAN HEALTH EXAMINATION SURVEY

1. DEVELOPMENT OF A EUROPEAN HEALTH EXAMINATION SURVEY Luxembourg, April 2008 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. Future legal basis for the developments of Health indicators in the EU Public Health Policy • On 23 October 2007 the European Commission adopted a new Health Strategy, 'Together for Health: A Strategic Approach for the EU 2008-2013'. Building on current work, this Strategy aims to provide, for the first time, an overarching strategic framework spanning core issues in health as well as health in all policies and global health issues. The Strategy aims to set clear objectives to guide future work on health at the European level, and to put in place an implementation mechanism to achieve those objectives, working in partnership with Member States. • For the period 2008-2013 a new Health Programme replaces the existing Public Health Programme (approved by the Council and the Parliament). • New strand ‘Health Information and Generation of knowledge’. • The annual work plans will be a key instrument to support the Strategy's objectives.

4. Future legal basis for the developments of Health indicators in the EU Public Health Policy • 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. • The FP7 Programme (2007-2013) • Via Commission Decision a Direct contract agreement with OECD for developments in several areas e.g. Indicators on Health Quality.

5. Future legal basis for the developments of Health indicators in the EU Public Health Policy • Work Plan 2008: Health surveys • Development of the European Health Interview survey [Financing mechanism: Subdelegation to Eurostat] • Development of the European Union Health Surveys Information Database [Financing mechanism: Subdelegation to Eurostat] • To implement a pilot European Health Examination Survey in some Member States in order to test the examination modules for this survey defined by the earlier projects, so to contribute to completing the health surveillance and the ECHI indicators in the EU. [Financing mechanism: Call for tender] • Analysis of health survey data for child and adolescent population (less than 15 years) not covered in the existing European Health Survey System. [Financing mechanism: Call for proposals] • To contribute to the World Mental Health Survey on the basis of existing EU mental health surveys. [Financing mechanism: Call for proposals] • European-Wide Horizontal Integration of European and National Household Budget Survey Data (HBS) on food availability integrating the information sources from recent and ongoing EU health actions and research into the DAFNE Data Base. [Financing mechanism: Call for proposals]

6. 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 • eHealth dimension • 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)

7. 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 Health Programme and the FP7

8. Health examination survey (HES) is a population based survey were the measurements go beyond the questionnaire based data (interview or self-administration), such as blood pressure, blood samples, test of functional capacity etc. • HES provides crucial information for the health care planning and health promotion that cannot be obtained by any other way. There are successful examples of HES in some European countries and North America. • The FEHES (Feasibility of a European Health Examination Survey) Project, leaded by KTL (Finland), has assessed the feasibility of standardized HESs in European countries and prepared a proposal for their implementation.

9. Feasibility of a European Health Examination Survey (FEHES) • National HES in past 10 years • 10 countries: Croatia, Czech Republic, Finland, France, Germany, Ireland, Netherlands, Poland, Romania and UK • Presently ongoing surveys • 3 countries: Denmark, Luxembourg, Spain • Major regional surveys covering several areas (no national HES) • 9 countries: Cyprus, Denmark, Iceland, Italy, Lithuania, Norway, Slovakia, Slovenia, Sweden

10. Feasibility of a European Health Examination Survey (FEHES) • Large questionnaire to collect information on previous and planned health examination surveys (HES) and some key aspects affecting the feasibility of conducting a HES in the European countries. • Mailed in January to contact persons in 32 countries • 32 questionnaires returned by the end of May • Situation in Member States • Active plans for a national HES in the adult population in 17 countries (next 5 years) • Bulgaria, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Italy, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, UK • 4 countries with plans for a specific HES in children and/or the elderly • Finland, Ireland, Luxembourg, Poland • No plans for a national HES in 6 countries • Austria, Estonia, Hungary, Iceland, Latvia, Macedonia

11. Feasibility of a European Health Examination Survey (FEHES) • Support a flexible model where elements or degrees of complexity can be added as requested (modular) • Stepwise approach • Topics to include specific HIS and HES components (measurements) • Criteria of selection of topics similar to ECHI list: • Comprehensive; • Meeting user needs – important public health domains; • Being innovative as well as based on previous knowledge; • Using Health Monitoring Programme and Public Health Programme results. • Guiding criteria to select and prioritise HES component: • Practicality/easy to administer; • Acceptability to the respondent; • Cost; • Availability of international standard; • Clear interpretation of the results.

14. Improving mechanisms for health reporting with common methodologies and systems of collection of data accepted by all the Member States • Sustainable instruments • Human Biomonitoring (HBM) has been defined in the preparation of the Action Plan Environment & Health as "monitoring activities in human beings, using biomarkers, that focus on environmental exposures, diseases and/or disorders and genetic susceptibility, and their potential relationships". • ESBIO Project • The ultimate aim is to support environmental policy as well as public health policy by better data comparability and accessibility within and between countries and more effective use of resources through shared development of scientific tools and appropriate strategies.

15. Workshop on Health Examination Surveys in the European Union • 9-10-11/04/2008 • Luxembourg • Call for Tender for a project on Preparation of the European Health Examination Survey • Pilot survey in 11 Member States Phase I: Planning and preparing for a national HES in 11 countries in 2009-2010 • With previous experience: CZ, DE, NL, N, PL, UK (tbc) • With less previous experience: EL, IT, MT, PT, SK(tbc) • Creation of the Task Force on Health Examination Surveys • November 2008 (tbc) • Luxembourg • A phase II: Full-scale HES • in the 27 Member States, Norway and others is scheduled for 2011-2012 • if funding from the FP7 Programme available.