NETWORK OF COMPETENT AUTHORITIES DG SANCO - …ec.europa.eu/health/ph_information/implement/nca/...Eurostat D-6 Network of Competent Authorities DG SANCO - Meeting 19/01/2005 6 European

Eurostat D-6 Network of Competent AuthoritiesDG SANCO - Meeting 19/01/2005 1

NETWORK OF COMPETENT AUTHORITIESNETWORK OF COMPETENT AUTHORITIESDG SANCO DG SANCO -- Meeting 19/01/2005Meeting 19/01/2005

Eurostat D-6 “Health and food safety”

Point 10Progress in public health statistics


Eurostat Health statistics

Directorate D – Single Market, employment & social statistics; Mr. Michel Glaude (since 1rst May 2004)Unit D/6 « Public Health & food safety »; Ms. MarleenDe Smedt

Public Health and health & safety at work; Didier Dupré : Causes of deaths (COD), Morbidity: Sabine GagelHealth Surveys, Disability (HIS): Lucian AgafiteiHealth CARE, SHA: Gunter BrücknerHealth & Safety at Work (occupational accidents anddiseases, work-related health problems): Antti Karjalainen

Food safetyCrime (drugs, etc.)


Partnership for Public Health Statistics - StructureSecond year of contract 01/09/2004 - 31/08/2005

IrelandDenmark

Luxembourg

ONS-UK


Causes of Death statistics (COD)

According to a Europan short list of 65 causes, for a majority of countries also according to ICD 10 or 9By sex, age groups & NUTS 2, from 1994 onwardsDevelopments 2004-2005 :

training tool on certification of COD : manual, leaflet, web tool developed 2004 & on Eurostat web site soonautomated coding (ACME) implementation & e-deathcertificate in 2005 SANCO work programme data series from 1975 in 2005 (Eurostat from WHO)TFs : 2004 on quality controls & 2005 on ACME & ICD10 implementation


Health Interview Surveys (HIS)current EU data collections

Previous/current EU Health surveys statistical data collection :18 Health Interview Surevy (HIS) items 1999-2002-2004LFS on disability, including 2002 LFS ad hoc moduleECHP 1994-2001

18 HIS items 2004 :Covering 25 MS + BG, RO, CH, IS, NO, 1998-2003 surveys depending on countries (linked with HIS/HES database); results to be released & most comparable ones uploaded in Eurostat web site by the end of first quarter 2005Background variables : sex, age group, educational level ISCED 1997, economic activity (active - non active &, when available, detailed groups such as employee, self-employed, unemployed, student, domestic activity, retired, disable, etc.)


European Health Survey System - EHSS: 1) Synthesis

In addition, in collaboration with DG EMPL (Employment and social affairs), development of a European Disability Module - EDM -that may be considered later in the framework of the EHSS and other European surveys as well as national surveys.

EHSS

European Health Survey

ECHIS (EUROSTAT – ESS) European Core Health

Interview Survey

HIS / HES Database

Health Interview Survey / Health Examination Survey

Annual component from 2004 onwards 1 module with 7 variables:

• First 3 variables: MEHM (Minimum European Health Module) in EU-SILC survey (Statistics on Income and Living Conditions) perceived health, chronic illness and limitation HLY indicator (SI, SDI indicators).

• Other 4 variables unmet needs for medical / dental examination or treatment.

Every five years component from 2006/2007 onwards – 4 modules: • EHSM (European Health Status Module) (*) • EHCM (European Health Care Module) • EHDM (European Health Determinants Module) • EBM (European Background Module).

These surveys address specific policy demands for in-depth analysis on some health issues (e.g., nutrition, injuries, mental health, etc.). From 2004 onwards, they can be carried out only once or repeated some time to time.

This is a database of certified standard and recommended reference instruments. Current database developed by NIPH-Belgium and KTL-Finland with the support of DG SANCO and Eurostat.

Eurostat-SANCO steering

workshop

Could also be complemented in future by a European HES.

* Already developed, includes MEHM questions and also covers detailed chronic conditions, physical and sensory functional limitations, personal care activities, household care activities, other daily activities and mental health.

ESHIS (SANCO)

European Special Health Interview Survey

www.iph.fgov.be/hishes


EHSS: 2) European Core Health Interview Survey ECHIS 2-1) Annual component in SILC - MEHM

EU-SILC implemented in 2003 (national) in BE, DK, EL, IE, LU, AT, NO, 2004 in ES, FR, IT, PT, FI, SE, 2005 in UK, NL, DE & all new MSMinimum European Health Module - MEHM :

General health : Very good / good / fair / bad /very badSuffer from any chronic (long-standing) illness or condition : Yes/noLimitation in activities people usually do because of health problems for at least the last 6 months : Strongly limited / limited / not limited

Still some translation problems in some countries ⇒to be solved 2005 with Eurostat SILC working group


EHSS: 2) European Core Health Interview Survey ECHIS2-2) 2004-2005(-2006) developments

European health status module (EHSM) : Eurostat2004 grants with 9 of EU-25 MS for translation according to the protocol and field testing, carried out in 2005 (link UNECE “health status measurement”)Second round of translation EHSM grants in 2005European health determinants (EHDM) & health care (EHCM) + background modules : Eurostat 2004 grant for development in 2005 & 1rst half 2006 (BE, DE, DK, FR, HU, UK) - similar translation protocol -European Disability Module (EDM) : call for proposals to be launched in 2005 (link WCG)To prepare and carry out implementation : Eurostatgrants on SANCO subdelegated budget from 2006


EHSS - ECHIS - Morbidity2-3) Other developments

Adoption of guidelines for development & adoption of instruments (TF 2004, for developments EHIS)2005 TF on guidelines / quality criteria for health survey design & methods, including for characteristics of surveys that will host the ECHIS modules Implementation SANCO-EUROSTAT EHSS steeringgroup (workshop 16/10/2004)EHIS Forum (Circa newsgroups)Morbidity : TF 2003 & Eurostat grant 2004 for development 2005 - 2006 : short list of diseases for morbidity statistics & pilot data collections from new sources in particular on chronic diseases (EE, DE, LT)


Health Care Statistics (CARE)Current EU data collection (national & NUTS2)

Health staff : practising doctors, dentists, specialists (21 specialities) & nursesTF 2004 : new classification of nurses adopted; 2005 : national mapping; 2006 : use (OECD : partially used 2005)by sex & age and according to the ICHA classification of health care providers (hospital -acute care, etc.-, medical practice, etc.)

Hospital beds (according to ICHA) :Hospital discharges by diagnosis & average lenght stay :

in-patient cases, 1-day cases, hopsital daysshort list diseases : 20 main groups & 39 sub-groups at 2 levels

Major surgical & selected procedures for treatment of hospital in-patients (20 groups of procedures & 19 sub-categories)


CARE : Improvement EU data collection from 2005Hospital minimum data set (2004 TF) - 1)

FrameworkResults of the Hospital Data Project 1 (project 2 for future)Comply with the framework conditions of the SHAStore in MS data in a way that allows them to deliver different variables combinations (link : unique hospital ID)Coordinate data provision to Eurostat, OECD and WHO, using the same data

Areas of informationPatient-related data for discharged inpatients and day casesHospital resourcesHigh-tech equipment in hospitalsHospital manpowerFinancial data on revenue/turnover and cost factorsGlobal information data


Submission at EU levelRaw aggregated data sets (epidemiological, patient mobility)Diagnoses & procedures: short lists to be harmonised with OECD & WHO : meetinfg 31/01/2005

To store and deliver in 2005:Patient-related dataCore output dataHigh-tech equipment data

To organize & evaluate via 2005 pilot data collectionManpower dataTechnical equipment data

For further exploration in 2005 (TF)Financial data & hospital resources other than high-tech

CARE : Improvement EU data collection from 2005Hospital minimum data set (2004 TF) - 2)


CARE : Implementation of the collection of SHA(System of Health Accounts)-compliant data

on health expendtiures from 2005 - 1)The SHA

Provides framework for a family of interrelated tables for standard reporting on expenditures of health & its financing3-dimensional system according to the International Classification for Health Accounts (ICHA) :

health care by function (ICHA-HC) - what kind of services are performed & goods are purchased ?health care by service providers industries (ICHA-HP) -where does the money go to ?sources of funding health care (ICHA-HF) - where does the money comes from ?

Comprehensiveness (whole field of health), hign comparability between countries (using same rules & classifications), compatibility with the System of National Accounts (SNA) OECD (2000) & WHO manuals, ONS-UK guidelines for EU


CARE : Implementation of the collection of SHA(System of Health Accounts)-compliant data

on health expendtiures from 2005 - 2)Implementation of the SHA

Full scale implementation in 2005 : OECD data collection 02/2005 (12/2004), common data collection Eurostat-OECD 12/2005 (EU-MS & CCs, OECD non-EU countries), on about 4 of the SHA standard tablesPreparation at EU level

Eurostat grant 2004 for 3 seminars on SHA 2005-2006 (LU, ES, PT); 2005 call for tender : data collection tool2005 Eurostat implementation grants on SANCO subdelegated budget

From 2006 onwards in EU : annual data collection (later Minimum Data Set), TF to monitor the process, thematic workshops (with international participation), reinforced coordination with OECD & WHO


PHARE - transition facilities multicountry projects

Launched in 2004 (« 2002 » Phare) : SHALaunched beginning 2005 (« 2003 » Phare) : Health Labour Accounts (HLA) and HIS (1 - first steps for preparation)Expected to be launched half 2005 (« 2004 » Phare for BG and RO; transition facilities for 10 new MS; HR & TR special programs) : COD quality improvement & HIS (2 - more preparation and pilot ECHIS); Perhaps last round in 2006 (« 2005 » Phare & transition facilities, topics to be defined)


Structural indicator HLY-DFLE : Background for the inclusion of HLY-DFLE as first

health indicatorCommission Communication COM(2003) 585 final of 08/10/2003on SI (Synthesis Report to the Spring Council 2004) included inpart “indicators under development” the « healthy life years ».According to the EU Sustainable Development Strategy & the 6th Environmental Action Plan, and as requested by the Council conclusions of 8 December 2003, indicators on biodiversity & health need to be included in the SI databaseSupported by DG SANCO Network of Competent Authorities .Commission COM (2004) 0029 of 21/01/2004 - report from the Commission to the Spring European Council delivering Lisbon reforms for the enlarged Union : priority to examine possibilities for integrating Public Health into the Lisbon strategy by 2005, as a contribution to growth & sustainable development.


HLY-DFLE : Definition & methodology for development in 2004 - 1)

HLY measures the number of years that a person at birth is still expected to live in a healthy condition; breakdown by gender.HLY is a health expectancy indicator; health expectancies are calculated using the Sullivan method which combines information on mortality & morbidity :

information on mortality is taken from life tables (age-specific mortality information from Eurostat demographic statistics)information on morbidity is based on prevalence measures of the age specific proportion of the population in healthy and unhealthy conditions.

For HLY, a healthy condition is defined by the absence of limitations in functioning / disability; consequently, the indicator is also called disability-free life expectancy (DFLE).



Source of data on limitations in functioning / disability :Minimum European Health Module (MEHM) in the Statistics on Income and Living Conditions survey SILC carriedout from 2004 - respectively 2005 - onwards in the EU15 -respectively EU25 (i.e. new) - MS; 5 MS + NO : pilot 2003For 1995-2001, use of the similar variable in the European Community Households Panel (ECHP) for EU15 (excl. LU), with validated corrections for some countriesEstimation on 2002 and 2003 on the basis of the ECHP trend 1995-2001 (high inertia in limitations / disability levels); pilot SILC data 2003 to be used later for relevant countries (possibly)For new MS & EFTA national sources used when comparable -only 6 countries : CZ, HU, CY, MT, PL, NO.


1995- 2001 EU15 (excl. LU): ECHP variable « Are you hampered in your daily activities by any physical or mental health problem, illness or disability ? Severely / to some extend / not limited » - corrections for few countries (in particular DE & UK due to use of another source than ECHP to provide « ECHP » health data).2002-2003 EU15 (excl. LU): extrapolation (or SILC 2003)5 new MS + NO, 2002 or 2003 only, different sources :

18 HIS items (CZ, HU, CY, MT, PL 1996 )others : PL 2002 census, NO 2003 pilot SILCData from EE & LV not used (not sufficiently comparable)

Break in series between 2003 & 2004/2005 (SILC)2004/2005 onwards - SILC variable « Limitation in activities people usually do because of health problems for at least the last 6 months : Strongly limited / limited / not limited »



HLY-DFLE : 2004 adoption as SI, implementation & state of play on data provision

HLY adopted by COM to the Commission on 14/10/2004 ⇒ in SI database for report to 2005 Spring EU CouncilQuality report approved by MS end 20041995-2003 calculations & metadata documents (SDDS) finalised & already available in Eurostat web-site in the SI & public health sectionsEasy to understand / explain, i.e. life expectancy (LE), divided into a good health - HLY/DFLE - & a bad health condition (limitations : DLE) life expectancy Strong methodological basis : Sullivan method recognised internationally (used since 70 ’s, also by WHO-Eur-HLA) & SILCis a survey with high standards characteristics & harmonisationSocial Inclusion indicators: HLY by socio-economic status?


Sustainable Development Indicators - SDIIndicators on Public Health

Level I : Disability Free Life Expectancy = HLY - DFLELevel II (also a level III) :

II-1 Human health protection and lifestyles : 1) body mass index, by age group (source = ECHP and 18 HIS items; 2) resistance to antibiotics (S.Pneumoniae - source = DG SANCO, EARSS - European Antimicrobial Resistance Surveillance System - project)Other groups : II-2 Food safety and quality, II-3 Chemicals management, II-4 Health risks due to environmental conditions

Ongoing implementation, data & graphs already in Circa SDI site; release at time 2005 Spring Council -> Eurostat web site


3) Health care and long-term care

New Open Method of Coordination (OMC) on Health care & long-term care.Decision by the Social Protection Committee on developing indicators to support OMC in this area :

importance for the OMC of developing common indicatorsstart by taking stock of data already available from WHO, OECD, ESTAT (& link ECHI), as well as first data EU SILC and health & long-term care indicators in the context of the social inclusion process; preliminary statements at time of 2005 Spring Council

Related new indicator sub-group (secretariat ; DG EMPL), first meeting 13/12/2004, next April 2005; strong link SHA; workshops efficiency/effectiveness February 2005 (also ECFIN)= New political demands to take into account (CARE)


Dissemination - links with ECHI & WP indicators

From 01/10/2004, Newcronos reference database ofEurostat available free of charge on Eurostat web site (including metadata in « SDDS » format)Publication in 2005 : Pocket book on health in EuropeFrom 2005 onwards : prepartion of statistical annex for SANCO health reports« ECHI short list » : when decision taken, definitions provided, portal or other support available, direct link for extraction of data from Eurostat web site (modalities to be agreed with SANCO)


Development of a EU Parliament & CouncilRegulation for Public Health statistics

« Umbrella » regulation (EU Parliament & Council)support on the principle by Eurostat 2004 Public HealthStatistics Working Group 24-25/11/2004preparation & discussion in 2005 : MS (Partnership Health, WG), DGs, Directors of Social Statistics 09/2005, StatisticalProgramme Committee (SPC) 11/2005then co-decision Council and EU Parliament2 years procedure (adopted en published +/- end 2006)

« Implementing » regulations (Commission & SPC only) for the different domains (COD, HIS, CARE), about 1 year procedure each

Eurostat Health statisticsPartnership for Public Health Statistics - StructureSecond year of contract 01/09/2004 - 31/08/2005Causes of Death statistics (COD)Health Interview Surveys (HIS)current EU data collectionsEuropean Health Survey System - EHSS: 1) SynthesisEHSS: 2) European Core Health Interview Survey ECHIS 2-2) 2004-2005(-2006) developmentsEHSS - ECHIS - Morbidity 2-3) Other developmentsStructural indicator HLY-DFLE : Background for the inclusion of HLY-DFLE as first health indicatorHLY-DFLE : Definition & methodology for development in 2004 - 1)HLY-DFLE : Definition & methodology for development in 2004 - 2)HLY-DFLE : 2004 adoption as SI, implementation & state of play on data provisionSustainable Development Indicators - SDIIndicators on Public Health3) Health care and long-term careDissemination - links with ECHI & WP indicators

Documents

NETWORK OF COMPETENT AUTHORITIES DG SANCO - …ec.europa.eu/health/ph_information/implement/nca/...Eurostat D-6 Network of Competent Authorities DG SANCO - Meeting 19/01/2005 6 European