Health indicators in Europe: availability and data needs.

BACKGROUND: The European Union (EU) lacks adequate capacity for public health monitoring. The creation of a stable European Health Information System would help Member States to carry out evidence-based health policy. Such a system would also benefit EU health priorities by providing European wide comparable information. This study is the first comprehensive assessment of the availability of general health data in Europe. METHODS: The main aim was to assess the availability of the European Community Health Indicators (ECHI) in each EU Member State. This was done by means of a review of international health databases, an online survey and face-to-face discussions with experts in 31 European countries. RESULTS: The European average availability score for all ECHI indicators was 74% ranging from 56% to 84%. In most countries, about half of the ECHI indicators can be derived from routinely collected health information. This is true for demographic information, mortality and hospital discharge-based morbidity. However, many important ECHI indicators are lacking in most European countries. These include population representative data for health determinants, the provision and use of health care services, injuries, the quality of health care and health promotion. CONCLUSION: Valid health information is essential for improving people's health across Europe. There is an urgent need to develop harmonized methods for gathering and disseminating representative health data. These methods should be developed jointly by DG Health and Consumers, Eurostat and EU Member States.

Public health indicators for the EU: the joint action for ECHIM (European Community Health Indicators & Monitoring).

BACKGROUND: Public health policies aim to improve and maintain the health of citizens. Relevant data and indicators are needed for a health policy that is based on factual information. After 14 years of work (1998-2012), the multi-phase action on European Community Health Indicators (ECHI) has created a health monitoring and reporting system. It has generated EU added value by defining the ECHI shortlist with 88 common and comparable key health indicators for Europe. METHODS: In the 2009-2012 Joint Action for ECHIM project the ECHI shortlist was updated through consultation with Member State representatives. Guidelines for implementation of the ECHI Indicators at national level were developed and a pilot data collection was carried out. RESULTS: 67 of the ECHI Indicators are already part of regular international data collections and thus available for a majority of Member States, 14 are close to ready and 13 still need development work. By mid-2012 half of the countries have incorporated ECHI indicators in their national health information systems and the process is ongoing in the majority of the countries. Twenty-five countries were able to provide data in a Pilot Data Collection for 20 ECHI Indicators that were not yet (fully) available in the international databases. CONCLUSIONS: The EU needs a permanent health monitoring and reporting system. The Joint Action for ECHIM has set an example for the implementation of a system that can develop and maintain the ECHI indicators,, and promote and encourage the use of ECHI in health reporting and health policy making. The aim for sustainable public health monitoring is also supported by a Eurostat regulation on public health statistics requiring that health statistics shall be provided according to the ECHI methodology. Further efforts at DG SANCO and Eurostat are needed towards a permanent health monitoring system.

European community health monitoring: the EUPHIX-model.

AIMS: On 20 June 2008, the EUPHIX website (www.euphix.org) was officially launched. EUPHIX aims to provide policy relevant health information, data and knowledge for policy makers, public health experts and educated lay people in the European Union (EU). The project was carried out by a partnership of European health reporting experts. METHODS: The conceptual structure of EUPHIX resembles the one used for the ECHI-indicator framework, but adds health policies. EUPHIX includes texts (EUphacts) next to indicator data, as well as links to organizations, data and literature. Other contributions, called EUphocus, address broader agenda issues, such as mental health and health inequalities. Some EUphocus contributions contain summarized outcomes of EU projects. In this sense, EUPHIX has a European platform function as well. Behind the surface of the EUPHIX website lies a complex internet application, including databases, i.e. for indicator data, for internal and external web links and for references and definitions. This back-office contains a Content Management System that guides an editorial process allowing the differentiation of the roles of authors, reviewers and content editors. User oriented functionalities include different ways to interactively manipulate data for personal presentation needs. Some EUphacts are linked to the Health-EU Portal. RESULTS: EUPHIX is drawing increasing numbers of visitors and has the potential to become the nucleus of a health monitoring system for the EU. However, current financing practice puts serious limits to its sustainability. CONCLUSIONS: The conclusion is that the EUPHIX model launched in June 2008 is integrating data, information and knowledge into a new type of Health Information System. The EUPHIX model is proposed to be the future model for EU health reporting.

The ECHI project: health indicators for the European Community.

BACKGROUND: Within the EU Health Monitoring Programme (HMP), the ECHI project has proposed a comprehensive list of 'European Community Health Indicators'. METHODS: In the design of the indicator set, a set of explicit criteria was applied. These included: i) be comprehensive and coherent, i.e. cover all domains of the public health field; ii) take account of earlier work, especially that by WHO-Europe, OECD and Eurostat; and iii) cover the priority areas that Member States and Community health policies currently pursue. Flexibility is an important characteristic of the present proposal. In ECHI, this has been emphasized by the definition of 'user-windows'. These are subsets from the overall indicator list, each of which should reflect a specific user's requirement or interest. RESULTS: The proposed indicators are, in most cases, defined as generic indicators, i.e. their actual operational definitions have not yet been attempted. This work has been, and is being carried out to a large part by other projects financed under the HMP, which cover specific areas of public health or areas of data collection. Apart from indicators covered by regularly available data, indicators (or issues) have been proposed for which data are currently difficult to collect but which from a policy point of view would be needed. CONCLUSION: All this points to the fact that establishing an indicator list which is actually used by Member States is a continuously developing process. This process is now continued by the first strand of the new EU Public Health Action Programme.