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

2. 2 The European Health Survey System (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).

3. 3 The European Health Survey System (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

4. 4 The European Health Survey System (EHSS): Developments in 2005 Implementation of the Eurostat SILC (Statistics of Income and Living Conditions) Survey Implementation 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 : Very good / good / fair / bad /very bad PH010 General health : Very good / good / fair / bad /very bad PH020 Suffer from any chronic (long-standing) illness or condition : Yes/no PH020 Suffer from any chronic (long-standing) illness or condition : Yes/no PH030 Limitation in activities people usually do because of health problems for at least the last 6 months : Strongly limited / limited / not limited PH030 Limitation in activities people usually do because of health problems for at least the last 6 months : 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 : At least one occasion / no occasion PH040 – PH060 Unmet need for medical / dental examination or treatment during the last 12 months : At least one occasion / no occasion PH050 – PH070 Main reason for unmet need for medical / dental examination or treatment (see below) PH050 – PH070 Main reason for unmet need for medical / dental examination or treatment (see below) Results available at the end of 2006 Results available at the end of 2006 Comparable data for EU-25 on Self perception of health and access to health care Comparable 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 Indicator To be used in the calculation of the Healthy Life Years Indicator Analysis by income and living conditions: health inequalities Analysis by income and living conditions: health inequalities See http://europa.eu.int/comm/health/ph_information/dissemination/reporting/ehss_04_en.htm See http://europa.eu.int/comm/health/ph_information/dissemination/reporting/ehss_04_en.htm

5. 5 The European Health Survey System (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 country, going from 1996 to 2003 Health Interview Survey data are collected in different years depending on the country, going from 1996 to 2003 There is no fixed periodicity in these kinds of health surveys. Very few countries have a yearly survey on these topics There is no fixed periodicity in these kinds of health surveys. Very few countries have a yearly survey on these topics The HIS data are available (varying degrees) for all EU Member States (except Luxembourg) and for Bulgaria, Romania, Iceland, Norway and Switzerland. The HIS data are available (varying degrees) for all EU Member States (except Luxembourg) and for Bulgaria, Romania, Iceland, Norway and Switzerland. 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 time. 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 time. Data available in the NewCronos database Data available in the NewCronos database

6. 6 The European Health Survey System (EHSS): Developments in 2005 web information on the EHSS

7. 7 The European Health Survey System (EHSS): Developments in 2005 Launching of the EUHSID - European Union Health Surveys Information Database Launching of the EUHSID - European Union Health Surveys Information Database Update of the Health Interview Survey database: Inclusion of new surveys in the database (53 HIS performed during the period 2002-2004 are currently in the Database) Update of the Health Interview Survey database: Inclusion of new surveys in the database (53 HIS performed during the period 2002-2004 are currently in the Database) Update of the HES database: The following HES have been added into the database: Croatia (HR04), Cyprus (CY02), Norway (NO03) and Poland (PL05) Update of the HES database: The following HES have been added into the database: Croatia (HR04), Cyprus (CY02), Norway (NO03) and Poland (PL05) Update with new recommended instruments for Interview Surveys Update with new recommended instruments for Interview Surveys Update with new recommended examination protocols for examination Surveys Update with new recommended examination protocols for examination Surveys Relationship with the ECHI list Relationship with the ECHI list

8. 8 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.

9. 9 The European Health Survey System (EHSS): Developments in 2005 EUHSID – www.iph.fgov.be/hishes

10. Number of questions per area in the HIS/HES database (Phase II: 2001-2003) Area Number of questions Percentage 1 Demographic and socio-economic factors 155212.1% 2 Health status 367228.8% 3 Personal factors 2782.1% 4 Life style factors 272321.4% 5 Living and working conditions 10358.1% 6 Prevention, health protection & promotion 4203.3% 7 Use of health and social services 285922.4% 8 Other factors: not classified 1861.4% Total12725100%

11. Health areas covered in clinical examinations in HIS/HES in Europe (n=14) (Phase II: 2001-2003) Topic No. of surveys Risk factors 14 Cardiovascular function and disease 14 Respiratory function and disease 7 Diabetes mellitus and other metabolic function 6 Kidney, urinary tract and thyroid function 4 Liver, gallbladder, stomach and pancreas function and disease 5 Haematological system function and disease 7 Infections and inflammation 5 Allergy5 Musculoskeletal function and disease 2 Sensory function, physical function and fitness 4 Mental disorders, mental and cognitive function 4 Nutritional status 6

12. 12 The European Health Survey System (EHSS): Developments in 2005 DG SANCO Health modules (5) in the Eurobarometer survey DG SANCO Health modules (5) in the Eurobarometer survey The Eurobarometer survey has been implemented for the first time in the 25 Member States and Candidate Countries = 30 countries The Eurobarometer survey has been implemented for the first time in the 25 Member States and Candidate Countries = 30 countries For: For: AIDS Prevention (Available. Presented in the Think Tank AIDS) AIDS Prevention (Available. Presented in the Think Tank AIDS) Medical errors (Available) Medical errors (Available) Tobacco consumption (Available) Tobacco consumption (Available) Food behaviour (Available) Food behaviour (Available) Mental well-being (Tables available) Mental well-being (Tables available)

13. 13 Eurobarometer: 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.

14. 14 Eurobarometer - Considerations Extremely valid for opinions and perceptions of the population on health issues Extremely valid for opinions and perceptions of the population on health issues Not valid for data on prevalence or incidence of diseases Not valid for data on prevalence or incidence of diseases Valid, in certain cases, for testing questions or modules to be implemented in the European Health Survey System Valid, in certain cases, for testing questions or modules to be implemented in the European Health Survey System Valid as auxiliary element for calculations on health indicators (e.g. Healthy Life Years) Valid as auxiliary element for calculations on health indicators (e.g. Healthy Life Years)

15. 15 The European Health Survey System (EHSS): Developments in 2006 Synthesis results/national reports of translation + tests of the European Health Status Module Synthesis results/national reports of translation + tests of the European Health Status Module Eurostat preparation of the 2007 / 2008 wave of the European Health Interview Survey Eurostat preparation of the 2007 / 2008 wave of the European Health Interview Survey Health modules (3/6) in the Eurobarometer survey Health modules (3/6) in the Eurobarometer survey Launch of the Feasibility Study on the European Health Examination Survey Launch of the Feasibility Study on the European Health Examination Survey

16. 16 Surveys in monitoring HIS and HES are elements of health monitoring in many countries HIS and HES are elements of health monitoring in many countries HIS dominate the scene in Europe HIS dominate the scene in Europe Measurements, scales, tests and observations typically used in HES can provide information additional to HIS Measurements, scales, tests and observations typically used in HES can provide information additional to HIS National HESs are carried out in several European countries and the US National HESs are carried out in several European countries and the US

17. 17 HES methods + Many of them are well standardized and based on clinical and laboratory methods + Solid quality assurance can be established + Well-founded accepted recommendations + International comparability can be achieved + Comparability over time and between population groups can be achieved ± Cover only part of the information needs, therefore must be used in conjunction with HIS ± May be rather expensive when extensive

18. 18 National HESs Several European countries and the United States carry out HESs of various types. Canada initiates its first national HES in 2007. Several European countries and the United States carry out HESs of various types. Canada initiates its first national HES in 2007. HESs range from comprehensive (US, Health 2000 Fin, German HES) through intermediate and less comprehensive (risk factor surveys, Monica/FinRisk, Health Survey for England) HESs range from comprehensive (US, Health 2000 Fin, German HES) through intermediate and less comprehensive (risk factor surveys, Monica/FinRisk, Health Survey for England) Many health problem specific surveys employ HES methods Many health problem specific surveys employ HES methods

19. 19 HES environment Varies between countries Varies between countries In some countries not more than a few measurements and taking blood samples can be carried out. Clearly that must be done in conjunction with a HIS. In some countries not more than a few measurements and taking blood samples can be carried out. Clearly that must be done in conjunction with a HIS. In other countries the more extensive HESs also contain HIS components and are independent health surveys. The HES may be carried out on the whole HIS sample or in a subsample. In other countries the more extensive HESs also contain HIS components and are independent health surveys. The HES may be carried out on the whole HIS sample or in a subsample. The most extensive HESs include complex tests and clinical examinations. The most extensive HESs include complex tests and clinical examinations.

20. 20 HES environment Some health indicators can only be derived from Health Examination Surveys (HES) Some health indicators can only be derived from Health Examination Surveys (HES) Only few MS have extensive experience on National or Regional HES Only few MS have extensive experience on National or Regional HES Growing interest in many MS Growing interest in many MS International collaboration is needed to develop methods and to assure comparability International collaboration is needed to develop methods and to assure comparability

21. 21 Objective of FEHES To contribute to the development of the European Health Survey System by examining and analysing the feasibility of carrying out a European HES or repeated HESs in EU Member States To contribute to the development of the European Health Survey System by examining and analysing the feasibility of carrying out a European HES or repeated HESs in EU Member States

22. 22 FEHES specific objectives 1. To create a network of experts and institutes for implementing HES in all EU MSs 2. To describe and analyse the feasibility of models of HES with different intensity and cost 3. To collect and assess in all EU-countries information on factors affecting feasibility of HES Legal, data confidentiality and ethical issues Legal, data confidentiality and ethical issues Availability of sampling frames Availability of sampling frames Previous HESs, experience and expertise Previous HESs, experience and expertise Perceived importance and interest in HES on the national/regional level in each of the MS Perceived importance and interest in HES on the national/regional level in each of the MS Perceived interest in a European HES in each MS Perceived interest in a European HES in each MS

23. 23 Specific objectives (ctd) 4. To make proposals and recommendations for the future of HES in EU and all MSs European HES combined with current national HIS or HIS/HES or separate European HES European HES combined with current national HIS or HIS/HES or separate European HES Models of HES of different comprehensiveness and complexity Models of HES of different comprehensiveness and complexity Topics for HES core modules and their measurement methodology Topics for HES core modules and their measurement methodology Resource needs Resource needs 5. To prepare a proposal for a European HES pilot to be carried out in MSs with previous national HES experience and without such national surveys

24. 24 Thank you Thank you Q & A Q & A