1. Measurement and Health Information WHO Health Surveys Calverton, Maryland, 10-11 July 2007 Somnath Chatterji Measurement and Health Information Systems World Health Organization Geneva

2. Measurement and Health Information WHO Surveys WHS WHS+ in GCC countries SAGE STEPS GATS School based surveys – GSHS, GYTS

3. Measurement and Health Information WHO - World Health Surveys WHS 2002/03 70 SURVEYS in 70 countries Household - long : 53 Household - short: 13 CATI : 4 The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2002. All rights reserved

4. Measurement and Health Information WHS Objectives Low cost means of providing data Measures that are valid, relevant, reliable and comparable Measure outcomes, functions & inputs to health systems Supplement the information provided by HIS

5. Measurement and Health Information WHS Objectives build the evidence base necessary for policy- makers to routinely monitor if health systems are achieving the desired goals and in some countries, to assess if the increase in health resources is having the desired effect

6. Measurement and Health Information WHS Household Questionnaire Roster Insurance Indicator of permanent income (assets) Health Expenditure Health Occupations

7. Measurement and Health Information WHS Individual Questionnaire Socio Demographics Health State Description Health State Valuation Risk Factors Mortality Coverage Health System Responsiveness Health System Goals and Social Capital

8. Measurement and Health Information WHS + Being implemented in GCC countries – Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, UAE and Yemen Building on WHS modules Incorporates health examinations and biomarkers

9. Measurement and Health Information SAGE - WHO Study on Global Ageing and Adult Health The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2005. All rights reserved Mexico South Africa Ghana China India Russia Kenya Tanzania Bangladesh Viet Nam Indonesia

10. Measurement and Health Information SAGE Objectives To obtain reliable, valid and comparable data on levels of health on a range of key domains for older adult populations To examine patterns and dynamics of age-related changes in health using a longitudinal design To supplement and cross-validate self-reported measures of health and the anchoring vignette approach to improving comparability of self-reported measures, through measured performance tests for selected health domains To collect data on health examinations and biomarkers to improve reliability of data on morbidity, risk factors and monitor effect of interventions

11. Measurement and Health Information SAGE Objectives Follow-up to study intermediate outcomes, monitor trends, examine transitions and life events, and address relationships between determinants and health and health-related outcomes; To develop a mechanism to link survey data to data from demographic surveillance sites - INDEPTH To build linkages with other national and cross-national ageing studies – SHARE, ELSA, KLoSA, MHAS, Chile, Argentina To provide a public-access information base for an evidence based policy debate amongst all stakeholders

12. Measurement and Health Information SAGE Household Questionnaire Coversheet – contact record – sampling – GPS – recontact information Roster Housing Household and family support/transfers Assets and household income Health Expenditure

13. Measurement and Health Information SAGE Individual Questionnaire Socio Demographics Work History and Benefits Health State Descriptions Anthropometrics, Biomarkers, Performance Tests Risk Factors and Preventive Health Behaviours Chronic Conditions and Health Services Coverage Health Care Utilization Social Capital Subjective Well-Being and Quality of Life Optional – Impact of HIV/AIDS

14. Measurement and Health Information STEPS - Objectives Prevent chronic disease epidemics before they occur Collect consistent data across and within countries Develop standardized tools to enable comparisons over time and across countries/sites Help health services plan priority programmes and interventions Predict future caseloads of chronic diseases Monitor and evaluate population-wide interventions

15. Measurement and Health Information Demographics & Health Behaviours Basic Sociodemographic Tobacco Use Alcohol Consumption Fruit & Veg Consumption Physical Inactivity WHO STEPS – Step 1 Core 1

16. Measurement and Health Information Physical measures Height Weight Waist circumference Blood Pressure WHO STEPS – Step 2 Core 1 2

17. Measurement and Health Information WHO STEPS – Step 3 Core Biochemical measures Fasting blood sugar Fasting total cholesterol 3

18. Measurement and Health Information WHO STEPS – Step 1 expanded Demographic and Health Behaviours Smokeless tobacco use Tobacco use cessation Binge drinking Oil or Fat consumption History of high blood pressure History of diabetes

19. Measurement and Health Information WHO STEPS – Step 2 expanded Physical Measures Hip circumference Heart rate

20. Measurement and Health Information WHO STEPS – Step 3 Expanded Biochemical Measures Triglycerides HDL Cholesterol

21. Measurement and Health Information STEPS Optional Modules Mental health, Intentional and unintentional injury Oral health

22. Measurement and Health Information STEPS Methodology Targets a scientific sample of adults aged 25 – 64 Household surveys conducted using trained interviewers for Steps 1 (questionnaire) and Step 2 (physical measures) Clinic based for Step 3 biochemical measures

23. Measurement and Health Information Completed STEPS Surveys Regions AFR EMR SEAR WPR N° Countries 19 8 19

24. Measurement and Health Information GSHS – Global School Health Survey Objectives Help countries develop priorities, establish programmes, and advocate for resources for school health and youth health programmes and policies Allow comparisons across countries regarding the prevalence of health behaviours and protective factors Establish trends in the prevalence of health behaviours and protective factors by country for use in evaluation of school health and youth health promotion.

25. Measurement and Health Information GSHS Modules Alcohol Drugs Tobacco Physical Activity Diet – fruits and vegetables Hygiene Violence Mental health Sexual Behaviour

26. Measurement and Health Information GYTS - Global Youth Tobacco Survey Knowledge and attitudes of young people towards cigarette smoking Prevalence of cigarette smoking and other tobacco use among young people Role of the media and advertising in young peoples use of cigarettes Access to cigarettes Tobacco-related school curriculum Environmental tobacco smoke (ETS) Cessation of cigarette smoking Core questions + country specific questions

27. Measurement and Health Information GATS – Global Adult Tobacco Survey Objectives Develop a rigorous system to monitor the status of global tobacco use 15 high burden countries where >2/3rds of the worlds smokers live

28. Measurement and Health Information GATS

29. Measurement and Health Information GATS Content Smoking – current and past daily smoking Smokeless tobacco Cessation Costs Second hand smoke Knowledge and attitude Media

30. Measurement and Health Information Lessons Multiple, often uncoordinated efforts Varying coverage, items Often focussed on special topics Limited efforts at capacity building Limited coordination with international efforts Limited dissemination of microdata and metadata