New developments of the European Health Survey System: an update on Health Interview/Health Examination Surveys Paola Primatesta Honorary Consultant, UCL,

New developments of New developments of the European Health the European Health

Survey System: an Survey System: an update on Health update on Health Interview/Health Interview/Health

Examination SurveysExamination Surveys

Paola PrimatestaPaola PrimatestaHonorary Consultant, UCL, LondonHonorary Consultant, UCL, London

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The European Health Survey System The European Health Survey System (EHSS)(EHSS)

Eurostat and DG SANCO are developing, in parallel, the European Health Survey System (EHSS) to implement and develop health surveys and survey modules.

This an important instrument to collect the necessary data for the indicators defined in the Community Public Health Programme as the European Community Health Indicators (ECHI) list.

The EHSS is defined as a combination of existing international or national survey instruments with appropriately designed European common modules of questions. It is composed of:

a Core Health Interview Survey, managed by the Community Statistical Program (ECHIS);

a set of Special Health Interview Survey modules and additional interview surveys, managed by the Public Health Program (ESHIS).

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The European Health Survey System The European Health Survey System (EHSS): Developments in 2005(EHSS): Developments in 2005

Implementation of the Eurostat SILC (Statistics of Income and Living Conditions) Survey

Eurostat collected data from existing national HIS surveys on 18 topics

DG SANCO web information on the EHSS

DG SANCO Health modules (5) in the Eurobarometer survey

Launching of the EUHSID - European Union Health Surveys Information Database

DAFNE - European food availability databank based on household budget surveys

EMCDDA projects to develop European standard instruments and guidelines and to test the feasibility of conducting a common analysis on the basis of existing national surveys

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The European Health Survey System (EHSS): The European Health Survey System (EHSS): Developments in 2005Developments in 2005

Implementation of the Eurostat SILC (Statistics of Income and Living Conditions) SurveyImplementation of the Eurostat SILC (Statistics of Income and Living Conditions) Survey

EU-SILC implemented from 2003 (7 countries) 2004 (EU15) or 2005 onwards (new MSs), EU-SILC implemented from 2003 (7 countries) 2004 (EU15) or 2005 onwards (new MSs), Minimum European Health Module - MEHM :Minimum European Health Module - MEHM :

PH010 General health : PH010 General health : Very good / good / fair / bad /very badVery good / good / fair / bad /very bad PH020 PH020 Suffer from any chronic (long-standing) illness or condition : Yes/noSuffer from any chronic (long-standing) illness or condition : Yes/no PH030 PH030 Limitation in activities people usually do because of health problems for at least the last 6 Limitation in activities people usually do because of health problems for at least the last 6

months : Strongly limited / limited / not limitedmonths : Strongly limited / limited / not limited

Access to health care : Access to health care : PH040 – PH060 Unmet need for medical / dental examination or treatment during the last 12 months PH040 – PH060 Unmet need for medical / dental examination or treatment during the last 12 months

: At least one occasion / no occasion: At least one occasion / no occasion PH050 – PH070 Main reason for unmet need for medical / dental examination or treatment (see PH050 – PH070 Main reason for unmet need for medical / dental examination or treatment (see

below)below)

Results available at the end of 2006Results available at the end of 2006 Comparable data for EU-25 on Self perception of health and access to health careComparable data for EU-25 on Self perception of health and access to health care To be used in the calculation of the Healthy Life Years IndicatorTo be used in the calculation of the Healthy Life Years Indicator Analysis by income and living conditions: health inequalitiesAnalysis by income and living conditions: health inequalities See See http://europa.eu.int/comm/health/ph_information/dissemination/reporting/ehss_04_en.htmhttp://europa.eu.int/comm/health/ph_information/dissemination/reporting/ehss_04_en.htm

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The European Health Survey System The European Health Survey System (EHSS): Developments in 2005(EHSS): Developments in 2005

Eurostat collected data from existing national HIS surveys on 18 topics Eurostat collected data from existing national HIS surveys on 18 topics 

Health Interview Survey data are collected in different years depending on the Health Interview Survey data are collected in different years depending on the country, going from 1996 to 2003country, going from 1996 to 2003

There is no fixed periodicity in these kinds of health surveys. Very few countries have There is no fixed periodicity in these kinds of health surveys. Very few countries have a yearly survey on these topicsa yearly survey on these topics

The HIS data are available (varying degrees) for all EU Member States (except The HIS data are available (varying degrees) for all EU Member States (except Luxembourg) and for Bulgaria, Romania, Iceland, Norway and Switzerland. Luxembourg) and for Bulgaria, Romania, Iceland, Norway and Switzerland.

The coverage is very diverse depending on the indicator. The national surveys are The coverage is very diverse depending on the indicator. The national surveys are not all performed in the same period and results are not all available at the same not all performed in the same period and results are not all available at the same time.time.

Data available in the NewCronos databaseData available in the NewCronos database

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The European Health Survey System (EHSS): The European Health Survey System (EHSS): Developments in 2005Developments in 2005

web information on the EHSSweb information on the EHSS

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The European Health Survey System (EHSS): The European Health Survey System (EHSS): Developments in 2005Developments in 2005

Launching of the EUHSID - European Union Health Surveys Information Launching of the EUHSID - European Union Health Surveys Information DatabaseDatabase

Update of the Health Interview Survey databaseUpdate of the Health Interview Survey database: Inclusion of new surveys in : Inclusion of new surveys in the database (53 HIS performed during the period 2002-2004 are currently in the the database (53 HIS performed during the period 2002-2004 are currently in the Database) Database)

Update of the HES databaseUpdate of the HES database: The following HES have been added into the : The following HES have been added into the database: Croatia (HR04), Cyprus (CY02), Norway (NO03) and Poland (PL05)database: Croatia (HR04), Cyprus (CY02), Norway (NO03) and Poland (PL05)

Update with new recommended instruments for Interview SurveysUpdate with new recommended instruments for Interview Surveys

Update with new recommended examination protocols for examination Update with new recommended examination protocols for examination SurveysSurveys

Relationship with the ECHI listRelationship with the ECHI list

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How is an indicator (ECHI) defined?How is an indicator (ECHI) defined?

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.

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The European Health Survey System (EHSS): The European Health Survey System (EHSS): Developments in 2005Developments in 2005

EUHSID – www.iph.fgov.be/hishesEUHSID – www.iph.fgov.be/hishes

Number of questions per Number of questions per area in the HIS/HES area in the HIS/HES

database database (Phase II: 2001-2003)(Phase II: 2001-2003)

AreaAreaNumber Number

of of questionquestion

ss

PercentaPercentagege

1 Demographic and socio-economic 1 Demographic and socio-economic

factorsfactors

15521552 12.1%12.1%

2 Health status2 Health status 36723672 28.8%28.8%

3 Personal factors3 Personal factors 278278 2.1%2.1%

4 Life style factors4 Life style factors 27232723 21.4%21.4%

5 Living and working conditions5 Living and working conditions 10351035 8.1%8.1%

6 Prevention, health protection & 6 Prevention, health protection & promotionpromotion

420420 3.3%3.3%

7 Use of health and social services7 Use of health and social services 28592859 22.4%22.4%

8 Other factors: not classified8 Other factors: not classified 186186 1.4%1.4%

TotalTotal 1272512725 100%100%

Health areas covered in clinical examinations in Health areas covered in clinical examinations in HIS/HES in Europe (n=14) HIS/HES in Europe (n=14) (Phase II: 2001-2003)(Phase II: 2001-2003)

TopicTopic No. of No. of surveyssurveys

Risk factorsRisk factors 1414

Cardiovascular function and diseaseCardiovascular function and disease 1414

Respiratory function and diseaseRespiratory function and disease 77

Diabetes mellitus and other metabolic functionDiabetes mellitus and other metabolic function 66

Kidney, urinary tract and thyroid functionKidney, urinary tract and thyroid function 44

Liver, gallbladder, stomach and pancreas Liver, gallbladder, stomach and pancreas function and diseasefunction and disease

55

Haematological system function and diseaseHaematological system function and disease 77

Infections and inflammationInfections and inflammation 55

AllergyAllergy 55

Musculoskeletal function and diseaseMusculoskeletal function and disease 22

Sensory function, physical function and fitnessSensory function, physical function and fitness 44

Mental disorders, mental and cognitive functionMental disorders, mental and cognitive function 44

Nutritional statusNutritional status 66

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The European Health Survey System The European Health Survey System (EHSS): Developments in 2005(EHSS): Developments in 2005

DG SANCO Health modules (5) in the Eurobarometer surveyDG SANCO Health modules (5) in the Eurobarometer survey

The Eurobarometer survey has been implemented for the first time in The Eurobarometer survey has been implemented for the first time in the 25 Member States and Candidate Countries = 30 countriesthe 25 Member States and Candidate Countries = 30 countries

For:For: AIDS Prevention AIDS Prevention (Available. Presented in the Think Tank AIDS)(Available. Presented in the Think Tank AIDS)

Medical errors Medical errors (Available)(Available)

Tobacco consumption Tobacco consumption (Available)(Available)

Food behaviour Food behaviour (Available)(Available)

Mental well-being Mental well-being (Tables available)(Tables available)

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Eurobarometer: Main characteristicsEurobarometer: Main characteristics

Twice a year the European Commission conducts the Eurobarometer survey in order to gather information on the attitudes of the population towards EU and its policy.

Each year additional questions about specific subjects are appended to the questionnaire.

A two-stage sampling method is used. In the first stage a random selection of sampling points within each region is made in such a way that urban and rural areas are represented proportionally.

Because quota sampling dominated, non-response figures are not available.

People who are rarely at home are less represented in the sample but the interview sample can be considered as representative for the category of average citizens who are accessible at home and who agree to be interviewed.

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Eurobarometer - ConsiderationsEurobarometer - Considerations

Extremely valid for opinions and perceptions of the population on health issuesExtremely valid for opinions and perceptions of the population on health issues

Not valid for data on prevalence or incidence of diseasesNot valid for data on prevalence or incidence of diseases

Valid, in certain cases, for testing questions or modules to be implemented in Valid, in certain cases, for testing questions or modules to be implemented in the European Health Survey Systemthe European Health Survey System

Valid as auxiliary element for calculations on health indicators (e.g. Healthy Life Valid as auxiliary element for calculations on health indicators (e.g. Healthy Life Years)Years)

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The European Health Survey System The European Health Survey System (EHSS): Developments in 2006(EHSS): Developments in 2006

Synthesis results/national reports of translation + tests of the Synthesis results/national reports of translation + tests of the European Health Status ModuleEuropean Health Status Module

Eurostat preparation of the 2007 / 2008 wave of the European Eurostat preparation of the 2007 / 2008 wave of the European Health Interview SurveyHealth Interview Survey

Health modules (3/6) in the Eurobarometer surveyHealth modules (3/6) in the Eurobarometer survey

Launch of the Feasibility Study on the European Health Launch of the Feasibility Study on the European Health Examination SurveyExamination Survey

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Surveys in monitoringSurveys in monitoring

HIS and HES are elements of health monitoring in HIS and HES are elements of health monitoring in many countriesmany countries

HIS dominate the scene in EuropeHIS dominate the scene in Europe Measurements, scales, tests and observations Measurements, scales, tests and observations

typically used in HES can provide information typically used in HES can provide information additional to HISadditional to HIS

National HESs are carried out in several European National HESs are carried out in several European countries and the UScountries and the US

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HES methodsHES methods

+ Many of them are well standardized and based on Many of them are well standardized and based on clinical and laboratory methodsclinical and laboratory methods

+ Solid quality assurance can be establishedSolid quality assurance can be established+ Well-founded accepted recommendationsWell-founded accepted recommendations+ International comparability can be achievedInternational comparability can be achieved+ Comparability over time and between population Comparability over time and between population

groups can be achievedgroups can be achieved± Cover only part of the information needs, therefore Cover only part of the information needs, therefore

must be used in conjunction with HISmust be used in conjunction with HIS± May be rather expensive when extensiveMay be rather expensive when extensive

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National HESsNational HESs

Several European countries and the United Several European countries and the United States carry out HESs of various types. States carry out HESs of various types. Canada initiates its first national HES in Canada initiates its first national HES in 2007.2007.

HESs range from comprehensive (US, Health HESs range from comprehensive (US, Health 2000 Fin, German HES) through intermediate 2000 Fin, German HES) through intermediate and less comprehensive (risk factor surveys, and less comprehensive (risk factor surveys, Monica/FinRisk, Health Survey for England)Monica/FinRisk, Health Survey for England)

Many health problem specific surveys Many health problem specific surveys employ HES methodsemploy HES methods

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HES environmentHES environment

Varies between countriesVaries between countries In some countries not more than a few In some countries not more than a few

measurements and taking blood samples can be measurements and taking blood samples can be carried out. Clearly that must be done in carried out. Clearly that must be done in conjunction with a HIS. conjunction with a HIS.

In other countries the more extensive HESs also In other countries the more extensive HESs also contain HIS components and are independent contain HIS components and are independent health surveys. The HES may be carried out on health surveys. The HES may be carried out on the whole HIS sample or in a subsample.the whole HIS sample or in a subsample.

The most extensive HESs include complex tests The most extensive HESs include complex tests and clinical examinations.and clinical examinations.

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HES environmentHES environment

Some health indicators can only be derived from Some health indicators can only be derived from Health Examination Surveys (HES)Health Examination Surveys (HES)

Only few MS have extensive experience on Only few MS have extensive experience on National or Regional HESNational or Regional HES

Growing interest in many MSGrowing interest in many MS International collaboration is needed to develop International collaboration is needed to develop

methods and to assure comparabilitymethods and to assure comparability

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Objective of FEHESObjective of FEHES

To contribute to the development of the To contribute to the development of the European Health Survey System by examining European Health Survey System by examining and analysing the feasibility of carrying out a and analysing the feasibility of carrying out a European HES or repeated HESs in EU Member European HES or repeated HESs in EU Member StatesStates

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FEHES specific FEHES specific objectivesobjectives

1.1. To create a network of experts and institutes for To create a network of experts and institutes for implementing HES in all EU MSsimplementing HES in all EU MSs

2.2. To describe and analyse the feasibility of models of To describe and analyse the feasibility of models of HES with different intensity and costHES with different intensity and cost

3.3. To collect and assess in all EU-countries To collect and assess in all EU-countries information on factors affecting feasibility of information on factors affecting feasibility of HES HES

Legal, data confidentiality and ethical issuesLegal, data confidentiality and ethical issues Availability of sampling framesAvailability of sampling frames Previous HESs, experience and expertisePrevious HESs, experience and expertise Perceived importance and interest in HES on the Perceived importance and interest in HES on the

national/regional level in each of the MSnational/regional level in each of the MS Perceived interest in a European HES in each MSPerceived interest in a European HES in each MS

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Specific objectives (ctd)Specific objectives (ctd)

4.4. To make proposals and recommendations for the To make proposals and recommendations for the future of HES in EU and all MSsfuture of HES in EU and all MSs

European HES combined with current national HIS or European HES combined with current national HIS or HIS/HES or separate European HESHIS/HES or separate European HES

Models of HES of different comprehensiveness and Models of HES of different comprehensiveness and complexitycomplexity

Topics for HES core modules and their measurement Topics for HES core modules and their measurement methodologymethodology

Resource needsResource needs

5.5. To prepare To prepare a proposal for a European HES pilot to be a proposal for a European HES pilot to be carried out in MSscarried out in MSs

with previous national HES experience andwith previous national HES experience andwithout such national surveyswithout such national surveys

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Thank you Thank you Q & AQ & A