European Union initiatives in child immunization-the need for child centricity, e-health and holistic delivery.

BACKGROUND: Low childhood immunization rates in Europe are causing concern and have triggered several EU initiatives. However, these are counter-factual as they make immunization a stand-alone issue and cut across best practice in integrated child health services. They also focus unduly on 'anti-vax' pressures, generalize 'vaccine hesitancy' and overlook practical difficulties and uncertainties encountered by parents in real world situations about presenting children for immunization. Meanwhile European expertize in child health electronic record systems and relevant standards are ignored despite their being a potentially sound foundation ripe for enhancement. METHODS: Situation and literature reviews, and cohesion of two European research projects, led to shared investigation. As a result, two cross-sectoral expert workshops were held to consider digital health standards for harmonizing integrated preventive child health including immunization, and the work of other stakeholders such as the World Health Organisation and the European Centre for Disease Control. RESULTS: Progress in child health information models and digital health standards was assessed, areas needing further standards development identified and desirable steps towards innovation in service delivery and record keeping agreed. CONCLUSION: The European Commission, member states and child health stakeholders should take an integrated approach to child health with immunization as a component. Service delivery should be sensitive to parental concerns and challenges, and the way child- and family-centric data are recorded and used should be enhanced. Services should be enabled by the International Patient Summary and related electronic health record standards and linkages, and evaluated to assess most effective systems and practice.

Child health indicators for Europe: a priority for a caring society.

BACKGROUND: Measurement of children's health is important for two reasons: first, because young people are citizens in their own right, yet largely unable to act as self-advocates, particularly at the population level; and second, because their health determines the health of the future population. Indicators based on measurements of child health are important for identifying progress, problems and priorities, changes over time, and newly emergent issues. The European Community Health Monitoring Programme (HMP) is a comprehensive programme to develop and implement a set of national-level indicators. The Child Health Indicators of Life and Development (CHILD) project is the only population group-specific project, seeking to determine a holistic set of measures. METHODS: The project endeavoured to address all aspects of child health and its determinants, balancing positive and negative aspects. It undertook a structured search of published evidence to seek to identify, and validate, indicators of health and illness, health determinants and challenges to health, quality of healthcare support and health-promoting national policies. A systematic approach was used in identifying valid indicators, and in assembling a balanced composite list. All ages from infancy to adolescence were covered. RESULTS: The project's final report identifies 38 core desirable national indicators, citing purpose and evidence for each. Of equal importance, it also identifies 17 key child health topics on which further research work is needed in order to identify and validate indicators appropriate across different national settings.