Transcript Document

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 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
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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 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
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projects (E4SM)
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
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 years
10 countries: Croatia, Czech Republic, Finland, France, Germany, Ireland,
Netherlands, Poland, Romania and UK
Presently ongoing surveys
3 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 elderly
Finland, Ireland, Luxembourg, Poland
No plans for a national HES in 6 countries
Austria, 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
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Minimum + 1
The above plus
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Fasting blood sample (e.g.
for glucose)
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Ankle/ brachial index
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Physical fitness test
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Lung function test
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Physical performance/
functional test (e.g. walking
speed test, vision test, hand
grip test)
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Cognitive function test
Minimum + 2
The above plus
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ECG
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Urine sample (glucose,
cotinine)
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Saliva sample (alt. for
cotinine)
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Bone density
The above plus
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Other items pertaining to
research question
Minimum + 3
Height
Weight
Waist circumference
Blood pressure
Blood sample (non-fasting,
eg. For total-, HDLcholesterol…)
Age
Sex
Education
[Occupation/Income]
General health/ general
health status
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CVD
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Hypertension
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Hyper/dyslipidemia
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Diabetes
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Smoking
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Drinking
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Use of health services
(general)/ medication
The above plus
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Physical activity
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Diet: fruit & veg
consumption
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Psychological distress
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Respiratory disease (e.g.
COPD, asthma)
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Use of health services (for
specific conditions)
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Use of medications (for
specific conditions)
The above plus
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Mental health
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Oral health
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Social support
The above plus
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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 States
Phase 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 Surveys
November 2008 (tbc)
Luxembourg
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A phase II: Full-scale HES
in the 27 Member States, Norway and others is scheduled for 2011-2012
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if funding from the FP7 Programme available.
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