1. 1 DEVELOPMENTS ON THE DISSEMINATION OF THE EUROPEAN COMUNITY HEALTH INDICATORS Luxembourg, 2nd June 2008 Antoni Montserrat European Commission DG SANCO Health Information Unit

2. 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. 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. 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. 5 Current legal basis for the developments of Health indicators in the EU Health Strategy Actions Adoption of a Statement on fundamental health values (Commission, Member States) System of European Community Health Indicators with common mechanisms for collection of comparable health data at all levels, including a Communication on an exchange of health related information (Commission) Further work on how to reduce inequities in health (Commission) Development of a programme of analytical studies of the economic relationships between health status, health investment and economic growth and development (Commission, Member States)

6. 6 Current legal basis for the developments of Health indicators in the EU Health Strategy Actions In December 2007, the Council adopted conclusions on the content of the Strategy. These welcome the Strategy’s objectives and principles; focus on health in all policies, prevention, threats, and health and competitiveness; and call for an efficient implementation mechanism. On 10 June 2008, the Council will adopt conclusions setting up the cooperation mechanism needed to implement the Strategy. This follows from broad agreement reached at the informal meeting of Health Ministers in April and at COREPER on 20 May. Rather than creating a new group, the new Conclusions upgrade the mandate of an existing Council group, the 'Health Working Party at Senior Level', which will assume the role of Strategy cooperation mechanism. The Commission will play an active role by identifying issues for discussion and providing analysis and proposals for action. The first meeting is due to take place under the French Presidency.

7. 7 Current legal basis for the developments of Health indicators in the EU Health Strategy Actions The new Conclusions and the mechanism are important for the following reasons: This will be the first high-level group mandated to discuss strategic health issues and to help Ministers identify priorities and objectives for EU health action as well as ways to implement them. The group gives Member States and the Council greater involvement and ownership in shaping and implementing the EU health Strategy, working in closer cooperation with the Commission and amongst themselves. It provides an opportunity to raise the profile of EU health policy and to achieve concrete policy results. The Conclusions strengthen the Commissioner’s leadership in ensuring that health concerns are integrated into other policies by asking the Commission for well co-ordinated positions covering all health related issues. The Conclusions further remind the Commission of its commitment to streamline and rationalise existing structures. DG SANCO is examining how to make existing Committees more effective, to ensure that they work in a coherent manner, do not overlap and do match the objectives of the Strategy.

8. 8 Current legal basis for the developments of Health indicators in the Second Health Programme Increasing Healthy Life Years (HLY) by preventing disease and promoting policies that lead to a healthier way of life is important for the well-being of EU citizens and helps to meet the challenges of the Lisbon process as regards the knowledge society and the sustainability of public finances, which are under pressure from rising health care and social security costs. Promote initiatives to increase healthy life years and promote healthy ageing; support measures to promote and explore the impact of health on productivity and labour participation as a contribution to meeting the Lisbon goals; support measures to study the impact on health of other policies. (Promotion of health strand) Develop further a sustainable health monitoring system with mechanisms for collection of comparable data and information, with appropriate indicators; ensure appropriate coordination of and follow-up to Community initiatives regarding registries on cancer, based, inter alia, on the data collected when implementing the Council Recommendation of 2 December 2003 on cancer screening; collect data on health status and policies; develop, with the Community Statistical Programme, the statistical element of this system. (Generation of Knowledge strand)

9. 9 Future legal basis for the developments of Health indicators in the EU Health Policy The new Research Programme (FP7) introduces a new common approach between research activities and health information under the pillar ‘Cooperation’ Improving the health of European citizens and increasing the competitiveness of European health-related industries and businesses, while addressing global health issues including emerging epidemics. Emphasis will be put on translational research (translation of basic discoveries in clinical applications), the development and validation of new therapies, methods for health promotion and prevention, diagnostic tools and technologies, as well as sustainable and efficient healthcare systems. Optimising the delivery of health care to European citizens – Quality, efficiency and solidarity of health systems including transitional health systems. To translate effective interventions into management decisions, to ensure an adequate supply of human resources, to analyse factors influencing equity of access to high quality health care, including analyses of changes in population (e.g. ageing, mobility and migration, and the changing workplace).

10. 10 Future legal basis for the developments of Health indicators in the EU Public Health Policy DG SANCO will elaborate during 2009 a proposal for a Commission Communication on the European Health Information, Knowledge and eHealth 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 Defining the content of the Electronic Health Card and the type of information to be shared by Member States 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

11. 11 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) Indicators on Social Protection ISG System (developed by DG EMPL) Sustainable Development Indicators SDS Indicators (developed by Eurostat)

12. 12 Future legal basis for the developments of Health indicators in the EU Public Health Policy Work Plan 2008 All projects should Contribution to improving the health of European citizens, as measured where possible by appropriate indictors, including the Healthy Life Years indicator; Reducing health inequalities in and between EU Member States and regions; Building capacity for development and implementation of effective public health policies particularly in areas of high need;

13. 13 Future legal basis for the developments of Health indicators in the EU Public Health Policy Work Plan 2008: Health indicators Development of a sustainable health monitoring system with mechanisms for collection of comparable data and information, with appropriate indicators Actions already supported at European level have concentrated on developing a number of comparable indicators, resulting in a first set of European Community Health Indicators (ECHI), which are widely disseminated. Improvements in these indicators by refinement and disaggregation and improvements in sources have been identified as priority areas. Health indicators Disaggregation of the Healthy Life Year indicator by diseases. [Financing mechanism:Call for proposals or joint action] To link mortality to census data on socioeconomic status or by analysing self-reported health by socioeconomic position. To improve knowledge on socioeconomic inequalities in such determinants as health-related behaviours, housing and working conditions, psychosocial factors and health care utilization taking into account political priorities expressed in point 4.3.2. [Financing mechanism: Call for proposals or joint action] Further development of the ECHI system to cover a broad range of health indicators from all Member States (creation of fact sheets definitions, implementation of ECHI in each member State and at EU level, design of further steps, design on a EU level plan for the health information system and test the data flow between Member States and a central EU capacity for health monitoring.). Activities to develop the ECHI shortlist related to the development of health promotion, prevention, and public policy indicators, including tobacco control. [Financing mechanism: Call for tender or joint action]

14. 14 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]

15. 15 Work Plan 2008: New Financial Instruments Joint actions Specific actions may be financed by the Community and one or more participating countries. May be offered to a public body or non-government organisation Community contributions may be up to 50% (or 70% if there are at least 10 MS involved or 3 MS where the lead partner is from a post-2004 accession country. Participating countries will be invited to present proposals for joint actions. Operating grants These will be offered to a non-government organisation or specialised network to cover core functioning costs. Organisations must be independent of industry and conflicting interests. Member organisations must be presented in at least half the Member States with a balanced geographical coverage. Community contributions may be up to 60%. Conferences in public health Presidency conferences (Maximum one per Presidency) Up to 50% of the budget awarded as a lump sum Other conferences Up to 50% of the budget awarded as a lump sum Offered as call for proposals on a competitive basis Aims should be in line with overall Programme objectives Conferences must have a European-wide dimension and be organised by a public or non-profit making body

16. 16 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)

17. 17 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

18. 18 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. 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).

19. 19 Health Reports The new Health Programme 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 Second report of the European Conference on Rare Diseases May 2008 Produced by the RAPSODY Project leaded by EURORDIS First Chronic Diseases Report June 2008 Produced by TF Major and Chronic Diseases Healthy Life Years in the European Union October 2008 Produced by TF Health Expectancies First Global Report on Health in the European Union End 2008/First Quarter 2009 Produced by the EUGLOREH Project leaded by the Ministry of Health (Italy) By 2010 Health profiles of the EU regions Perinatal health in the European Union Reproductive health in the European Union Women’s and child’s health in the European Union Atlas of Cancer