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DEVELOPMENT OF A EUROPEAN HEALTH EXAMINATION SURVEY

Luxembourg, April 2008

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 mechanismsfor 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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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.

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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.

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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]

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Improving mechanisms for health reporting with common methodologies and systems of collection of data accepted by all the

Member StatesSustainable 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)

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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)

• 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 pasttwelve 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

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• 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.

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Feasibility of a European Health Examination Survey (FEHES)

National HES in past 10 years10 countries: Croatia, Czech Republic, Finland, France, Germany, Ireland,

Netherlands, Poland, Romania and UK

Presently ongoing surveys3 countries: Denmark, Luxembourg, Spain

Major regional surveys covering several areas (no national HES)9 countries: Cyprus, Denmark, Iceland, Italy, Lithuania, Norway, Slovakia,

Slovenia, Sweden

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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 elderlyFinland, Ireland, Luxembourg, Poland

• No plans for a national HES in 6 countriesAustria, Estonia, Hungary, Iceland, Latvia, Macedonia

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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.

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Level of recommendation

HES component HIS component

Minimum data collection

Height Weight Waist circumference Blood pressure Blood sample (non-fasting,

eg. For total-, HDL-cholesterol…)

Age Sex Education [Occupation/Income] General health/ general

health status CVD Hypertension Hyper/dyslipidemia Diabetes Smoking Drinking Use of health services

(general)/ medication Minimum + 1 The above plus

Fasting blood sample (e.g. for glucose)

Ankle/ brachial index Physical fitness test Lung function test Physical performance/

functional test (e.g. walking speed test, vision test, hand grip test)

Cognitive function test

The above plus Physical activity Diet: fruit & veg

consumption Psychological distress Respiratory disease (e.g.

COPD, asthma) Use of health services (for

specific conditions) Use of medications (for

specific conditions)

Minimum + 2 The above plus ECG Urine sample (glucose,

cotinine) Saliva sample (alt. for

cotinine) Bone density

The above plus Mental health Oral health Social support

Minimum + 3 The above plus Other items pertaining to

research question

The above plus Other items pertaining to

research question

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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

• 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.

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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 StatesPhase 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 SurveysNovember 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.