Influencing factors of obesity in school-age children and adolescents - A systematic review of the literature in the context of obesity monitoring.

Around 15% of children and adolescents in Germany are overweight or obese. To support the planning, implementation and evaluation of preventive activities, the Robert Koch Institute (RKI) has developed a population-wide monitoring of influencing factors relevant to the development of obesity during childhood (AdiMon). AdiMon is a web-based indicator system providing population-wide meaningful and regularly updated data on factors that influence obesity in kindergarten-age girls and boys (0- to 6-years-old). Towards the end of 2020, the RKI will expand the indicator system to also cover the 7- to 17-year-old age group. To this end, a systematic review of the literature was conducted, a process which served to identify over 80 relevant factors that influence the development of obesity. These factors have been attributed to the categories behaviour, environment, biology, pre- and postnatal, psychosocial factors and context. Compared to a previous literature review for kindergarten-age children, around one tenth of the influencing factors now identified are new, including 'peer group influences' and 'bullying'. As the results highlight, an array of influencing factors must be considered when expanding the monitoring system, ranging from individual health behaviour to the social framework conditions and environmental factors.

Risky Alcohol Consumption and Heavy Episodic Drinking among Parents in Germany: Results of a Nationwide Cross-Sectional Study.

Introduction: Risky alcohol consumption (RAC) and heavy episodic drinking (HED) by parents can have negative effects on their children. At present, little is known about these forms of alcohol consumption among parents in Germany. The aim of this analysis is to estimate the percentage of parents living in Germany who practise RAC and HED and to study associations between these consumption patterns and sociodemographic factors. Material and Methods: The data basis comprises the data of the nationwide studies "Gesundheit in Deutschland aktuell" (GEDA) of 2009, 2010, and 2012. The data were collected by means of computer-assisted telephone interviews (CATI). Our analysis included all participants living in a household with at least one child of their own under 18 years of age (n = 16,224). Information on RAC and HED was collected using the AUDIT-C screening instrument. Logistic regression models were used to study the relationship between parental alcohol consumption and sociodemographic variables. Results: 18.4% of the mothers and 29.6% of the fathers exhibited RAC; 8.4% of the mothers and 21.0% of the fathers practised HED. After mutual adjustment, RAC showed a significant association with the level of education, income (only mothers), employment status (only mothers), migration background, relationship status (only mothers), and the age of the youngest child. HED showed a significant association with income (only mothers), the age of the youngest child (only mothers), and the level of education (only fathers). Conclusions: The presented analysis emphasizes the relevance of preventive measures to reduce parental alcohol consumption. In addition to universal interventions, risk group-specific measures (e.g., for parents with high income) are needed to reduce parental alcohol consumption and thus support a healthy development of children.

Time trends in healthy lifestyle among adults in Germany: Results from three national health interview and examination surveys between 1990 and 2011.

BACKGROUND: The combined impact of multiple healthy behaviors on health exceeds that of single behaviors. This study aimed to estimate trends in the prevalence of a healthy lifestyle among adults in Germany. METHODS: A data set of 18,058 adults aged 25-69 years from three population-based national health examination surveys 1990-92, 1997-99 and 2008-11 with complete information for five healthy behavior factors was used. A 'daily intake of both fruits and vegetables, 'sufficient physical exercise', 'no current smoking' and 'no current risk drinking' were assessed with self-reports and 'normal body weight' was calculated based on measured body weight and height. A dichotomous 'healthy lifestyle' indicator was defined as meeting at least four out of five healthy behaviors. Age-standardized prevalence was calculated stratified by sex, age groups (25-34, 35-44, 45-54 and 55-69 years) and education level (low, medium and high). Trends were expressed in relative change (RC) between 1990-92 and 2008-11. RESULTS: In Germany, the overall prevalence of healthy lifestyle increased from 9.3% in 1990-92 to 13.5% in 1997-99 and to 14.7% in 2008-11 (RC: +58.1%). The prevalence increased among men and women and in all age groups, with the exception of men aged 45-54 years. The RC of increasing healthy lifestyle prevalence between 1990-92 and 2008-11 was stronger albeit on a higher level among women compared to men. Therefore, the gender difference in healthy lifestyle has increased, but age-related differences have overall decreased in this period. Among high educated men the prevalence of a healthy lifestyle increased between 1990-92 and 2008-11 from 10.6% to 16.3% (p = 0.01) and among high educated women from 16.4% to 30.3% and also among medium educated women (10.9 to 16.6, p<0.01), but no significant increase in healthy lifestyle prevalence was observed among men with low and medium education and among women with low education level. CONCLUSIONS: The prevalence of a lifestyle with at least four out of five healthy behaviors markedly increased from 1990-92 to 2008-11. Nevertheless, additional health promotion interventions are needed to improve the number of combined healthy behavior factors and the awareness in the population that each additional healthy behavior factor leads to a further improvement in health, especially in men in the age-range 45 to 54 years, and among persons with low education level.

[Gender equality and the gender gap in life expectancy in Germany]. / Gleichstellung der Geschlechter und Geschlechterunterschiede in der Lebenserwartung in Deutschland.

BACKGROUND: The gender gap in life expectancy is documented worldwide with lower life expectancy in male new-borns. International studies have shown that the gender gap in life expectancy varies markedly with gender inequality. OBJECTIVES: The paper addresses the questions: (1) whether there are life-expectancy differences between the federal states and whether the extent of gender equality at federal level is associated with (2) gender differences in life expectancy and (3) the life expectancy of women and men. MATERIALS AND METHODS: The Gender Inequality Index (GII) developed by the United Nations Development Project was calculated using data from the federal states. Using linear regressions, GII was associated with the gender gap in life expectancy as well as with life expectancy in males and females. RESULTS: The GII varies between 0.065 (Bavaria) and 0.117 (Mecklenburg-Vorpommern) and the gender gap in life expectancy differs by almost two years within Germany. We found a correlation between the gender difference in life expectancy and GII (R2 linear = 0.848) as well as between GII and life expectancy of male (R2 linear = 0.700), but not female newborns (R2 linear = 0.102). The association remains if GDP is taken into account as an indicator of economic power. CONCLUSIONS: Gender equality seems to be positively related to the life expectancy of men. This can be explained by the reduced importance of male gender stereotypes and associated risk behaviors. The requirements for gender-differentiated interventions formulated in the Prevention Act (Präventionsgesetz) are highly significant.

Socioeconomic Inequalities in the Rise of Adult Obesity: A Time-Trend Analysis of National Examination Data from Germany, 1990-2011.

OBJECTIVE: Despite extensive study of the obesity epidemic, research on whether obesity has risen faster in lower or in higher socioeconomic groups is inconsistent. This study examined secular trends in obesity prevalence by socioeconomic position and the resulting obesity inequalities in the German adult population. METHODS: Data were drawn from three national examination surveys conducted in 1990-1992, 1997-1999 and 2008-2011 (n = 18,541; age range: 25-69 years). Obesity was defined by a body mass index ≥30 kg/m2 using standardised measurements of body height and weight. Education and equivalised household disposable income were used as indicators of socioeconomic position. Time trends in socioeconomic inequalities in obesity were examined using linear probability and log-binomial regression models. RESULTS: In each survey period, the highest socioeconomic groups had the lowest prevalence of obesity. The low and medium socioeconomic groups showed increases in obesity prevalence, whereas no such trend was observed in the high socioeconomic groups. Absolute inequalities in obesity by income increased by an average of 0.53 percentage points per year (95% confidence interval [CI] 0.01-1.05, p = 0.047) among men and 0.47 percentage points per year (95% CI 0.05-0.90, p = 0.029) among women. Absolute inequalities in obesity by education increased on average by 0.64 percentage points per year (95% CI 0.19-1.08, p = 0.005) among women but not among men (0.33 percentage points, 95% CI -0.27 to 0.92, p = 0.283). CONCLUSIONS: These findings suggest a widening obesity gap between the top and the bottom of the socioeconomic spectrum. This has the potential to have adverse consequences for population health and health inequalities in coming decades. Interventions that are effective in preventing and reducing obesity in socially disadvantaged groups are needed.

Road map towards a harmonized pan-European surveillance of obesity-related lifestyle behaviours and their determinants in children and adolescents.

OBJECTIVES: To develop a road map towards a harmonized pan-European surveillance system for children and adolescents. METHODS: Representatives of five European surveillance systems and the German Health Interview and Examination Survey for Children and Adolescents contributed to the road map through a structured workshop in 2016. RESULTS: A conceptual framework for this road map was developed with seven action points (APs) guiding the successive cross-country harmonization. First, key indicators of health behaviour and their determinants in children and adolescents will be identified (AP1, 2); short screening instruments will be developed and implemented to assess and monitor key indicators (AP3, 4). In parallel, optional supplementary modules could be implemented to provide objective data (AP5). This would allow mutual calibration and improvement of existing instruments before their progressive replacement by more comparable measurement tools (AP6). The establishment of a competence platform is envisaged for guiding the harmonization process (AP7). CONCLUSIONS: This approach builds on existing systems, provides comparable key health indicators across European regions, helps to assess temporal trends and-once in place-will facilitate health reporting and monitoring of national and international health targets.

European Health Interview Survey (EHIS) 2 - Background and study methodology.

The scientific assessment of health issues, the design and further development of political guidelines as well as the targeted planning of measures in the European Union (EU) require data on population health. For this reason, all EU Member States regularly collect data on the health status, provision of healthcare, health determinants and socioeconomic situation of their respective populations in the European Health Interview Survey (EHIS). Participants are at least 15 years old and live in private households. The second wave of EHIS (EHIS 2) was conducted between 2013 and 2015. For EHIS 2, each EU Member State drew a nationally representative population sample from population registers, censuses, dwelling registers or other statistical or administrative sources. Data collection modes within individual EU Member States were used, according to nationally established methods, including the use of mixed-mode surveys. Across all EU Member States, data collection took an average of eight months to complete. Member States made considerable efforts to achieve the highest possible response rates. The harmonised EHIS data collected are highly comparable and constitute an important information base for European health policy and health reporting.

[Breastfeeding behaviour in Germany-News from KiGGS Wave 2]. / Stillverhalten in Deutschland ­ Neues aus KiGGS Welle 2.

Breast milk is the optimal nutrition for babies in their first six months of life and provides health benefits for both children and mothers. As part of the Robert Koch Institute's health monitoring, the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) regularly collects population-based data on the health situation of children and adolescents living in Germany, including information on breastfeeding. This article describes breastfeeding behaviour based on the results of KiGGS Wave 2 (2014-2017). The prevalence of breastfeeding and the duration of breastfeeding in the birth cohorts 2009-2016 as well as information on intention to breastfeed and reasons for weaning are described. The results from KiGGS Wave 2 show that breastfeeding proportions for any type of breastfeeding tended to increase between the birth cohorts 2009/2010 and 2013/2014, while the prevalence for full and exclusive breastfeeding show no change. The average duration of breastfeeding has remained constant. Almost 90% of mothers intended to breastfeed their baby after birth and 97% of these mothers actually started breastfeeding. Having insufficient breast milk has often been mentioned as a problem, both by mothers who intended to breastfeed but did not start breastfeeding and by mothers who have been breastfeeding their infants for less than six months. Despite some limitations, the KiGGS study is an important part of breastfeeding monitoring. Regular data collection and the largely consistent study design make it possible to map trends in time and to measure the impact of breastfeeding promotion on the population. KiGGS Wave 2 shows that breastfeeding promotion measures are still necessary.

Gender inequality and the gender gap in life expectancy in the European Union.

The gender gap in life expectancy (GGLE) varies substantially in EU 28 Member States. This paper addresses the question of whether gender inequality affects the GGLE as well as life expectancy (LE) in both genders. We conducted an ecological study and used the gender inequality index (GII) developed by the United Nations as well as the gender difference in LE in 2015. We found a correlation between GGLE and GII (r2=0.180) and between GII and LE of 0.418 (women) and 0.430 (men). Gender equality policies are still necessary and will have an effect on women's as well as men's health.

Health and health risk behaviour of adolescents-Differences according to family structure. Results of the German KiGGS cohort study.

OBJECTIVE: This study's aim was to investigate the association between family structure and different health-related outcomes in adolescence (self-rated health, emotional and behavioural problems, health-related quality of life, regular smoking, and heavy episodic drinking). Furthermore, we analysed the extent to which socio-economic status, family cohesion and the pre-transition health status explain family structure-related health disparities. METHODS: We used longitudinal data from the first two waves of the German KiGGS cohort study carried out by the Robert Koch Institute (baseline: 2003-2006, follow-up: 2009-2012). The sample comprised 4,692 respondents aged 11 to 17 years. Using data from both waves, effects of family structure on health status at follow-up were calculated applying linear and logistic regression models. RESULTS: We found that adolescents continuously living with both birth parents were in good health. Adolescents whose parents separated after the baseline survey, reported poorer health and were more likely to smoke. The transition from stepfamily to single parent family was also associated with a higher risk of regular smoking. Lower health-related quality of life as well as higher scores for emotional and behavioural problems occurred in almost all non-nuclear family structures, although not all effects were statistically significant. No significant effects of family structure on heavy episodic drinking were found. While family cohesion mediated the effects of family structure on adolescents' health, the mediating effect of socio-economic status was small. After controlling for pre-transition health, the effects were even lower. CONCLUSIONS: Because the direct effects of family structure on adolescents' health were small and family cohesion was found to be an important mediator in the association between family structure and adolescents' health, prevention programmes and interventions should be directed towards the parent-adolescent relationship rather than just the family structure, in order to minimize the psychosocial stress of adolescents during the period of family transition.

Mixing modes in a population-based interview survey: comparison of a sequential and a concurrent mixed-mode design for public health research.

BACKGROUND: Population-based surveys currently face the problem of decreasing response rates. Mixed-mode designs are now being implemented more often to account for this, to improve sample composition and to reduce overall costs. This study examines whether a concurrent or sequential mixed-mode design achieves better results on a number of indicators of survey quality. METHODS: Data were obtained from a population-based health interview survey of adults in Germany that was conducted as a methodological pilot study as part of the German Health Update (GEDA). Participants were randomly allocated to one of two surveys; each of the surveys had a different design. In the concurrent mixed-mode design (n = 617) two types of self-administered questionnaires (SAQ-Web and SAQ-Paper) and computer-assisted telephone interviewing were offered simultaneously to the respondents along with the invitation to participate. In the sequential mixed-mode design (n = 561), SAQ-Web was initially provided, followed by SAQ-Paper, with an option for a telephone interview being sent out together with the reminders at a later date. Finally, this study compared the response rates, sample composition, health indicators, item non-response, the scope of fieldwork and the costs of both designs. RESULTS: No systematic differences were identified between the two mixed-mode designs in terms of response rates, the socio-demographic characteristics of the achieved samples, or the prevalence rates of the health indicators under study. The sequential design gained a higher rate of online respondents. Very few telephone interviews were conducted for either design. With regard to data quality, the sequential design (which had more online respondents) showed less item non-response. There were minor differences between the designs in terms of their costs. Postage and printing costs were lower in the concurrent design, but labour costs were lower in the sequential design. No differences in health indicators were found between the two designs. Modelling these results for higher response rates and larger net sample sizes indicated that the sequential design was more cost and time-effective. CONCLUSIONS: This study contributes to the research available on implementing mixed-mode designs as part of public health surveys. Our findings show that SAQ-Paper and SAQ-Web questionnaires can be combined effectively. Sequential mixed-mode designs with higher rates of online respondents may be of greater benefit to studies with larger net sample sizes than concurrent mixed-mode designs.

Trends in Absolute and Relative Educational Inequalities in Adult Smoking Since the Early 2000s: The Case of Germany.

Introduction: Since the early 2000s, several tobacco control policies have been implemented in Germany. Current research is inconsistent about how strengthening tobacco control can affect social inequalities in smoking. This study examines whether educational inequalities in adult smoking have widened in Germany since 2003. Methods: Data were used from four cross-sectional national health surveys conducted between 2003 and 2012 (n = 54,197; age = 25-69 years). Participants who smoked daily or occasionally were classified as smokers. The regression-based Slope Index of Inequality and Relative Index of Inequality (RII) were calculated to estimate the extent of absolute and relative educational inequalities in smoking, respectively. Results: In each survey year, smoking was associated with lower education. Overall, crude and age-standardized smoking rates declined over time. Stratified by education, trends of declining smoking rates were observed only in the high and medium education groups, whereas no statistically significant trend was found in the low education group. Relative educational inequalities in smoking increased significantly in men (2003: RII=1.74, 95% confidence interval 1.46 to 2.07; 2012: RII = 2.25, 95% confidence interval 1.90 to 2.67; p-trend = .019). Absolute educational inequalities in smoking were not found to have changed significantly during the study period. Conclusions: In the course of declining smoking rates, educational inequalities in smoking persisted in both absolute and relative terms. In men, relative inequalities in smoking may even have widened within only 9 years. Tobacco control policies should not only be targeted at the entire population but also attempt to reduce social inequalities in smoking by focusing more on socially disadvantaged groups. Implications: Smoking is associated with lower education in most European countries and contributes to social inequalities in health. Since the beginning of the 2000s, Germany has implemented a variety of tobacco control policies to reduce smoking in the population. This study reveals that despite a general decline in adult smoking, educational inequalities in smoking have persisted and even widened in Germany since 2003. The findings emphasize that more targeted efforts are needed to tackle smoking-induced inequalities in health.

Physical activity among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends.

Self-reported data from wave 2 of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) provides the basis for assessing whether the levels of physical activity of children and adolescents in Germany meet the levels recommended by the World Health Organization (WHO). Merely 22.4% of girls and 29.4% of boys in the 3-17 age group are physically active for at least 60 minutes per day and therefore meet the WHO recommendations. Prevalence of recommended levels of physical activity decreases continuously with age, both for girls and boys. In KiGGS Wave 2, girls in the 3-10 age group met the levels of physical activity recommended by the World Health Organization significantly less often than in KiGGS Wave 1. Low levels of physical activity were highest amongst adolescent age girls, as well as among boys and girls of low socioeconomic status. The results indicate a great potential to promote physical activity.

Sports and dietary behaviour among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends.

This article focuses on selected indicators related to sports and dietary behaviour - two important factors that influence the development of obesity. The analyses are based on data collected for the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), which was conducted between 2014 and 2017. These data were collected, using a questionnaire, from 6,810 girls and 6,758 boys aged between 3 and 17. The analyses also compare the data collected for wave 2 with those from the KiGGS baseline study (2003-2006). More than 70% of 3- to 17-year-olds state that they participated in sports. However, boys do so significantly more often than girls, and 11- to 17-year-olds do so more frequently than 3- to 10-year-olds. In addition, there is a correlation between children's and adolescents' sports participation and those of their parents, and with an activity-friendly living environment. Younger children and girls have healthier diets than older children and boys. However, although the consumption of confectionery and sugary drinks by 3- to 17-year-olds has declined significantly since the KiGGS baseline study was conducted, 11- to 17-year-olds, in particular, eat significantly smaller amounts of vegetables than they did about ten years ago. Significantly more 3- to 10-year-olds currently eat at least five servings of fruit and vegetables per day than ten years ago, although the proportion of the children who reach this recommendation continues to remain very low at 14% overall. It is important to set an example by following a healthy lifestyle within families and other settings in early life. Furthermore, the living environments also need to be made more health-oriented to support children and adolescents in reaching the national recommendations on physical activity and healthy eating.

Tobacco and alcohol use among 11- to 17-year-olds in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends.

Tobacco and alcohol use are among the leading preventable risk factors associated with premature mortality and a variety of diseases that have long-term effects. Although tobacco and alcohol use among adults is widespread in Germany, there is a trend towards lower levels of consumption. The foundations for health-related behaviour in adulthood are set at an early age: young people who use alcohol and tobacco also tend to do so regularly when they reach adulthood. With this in mind, health policies should focus on preventing young people from smoking, and encouraging them to adopt a responsible, low-risk approach to alcohol. This article analyses patterns of tobacco and alcohol use among children and adolescents (aged between 11 and 17 years). It describes the prevalences of tobacco and alcohol use, as well as trends and correlates. The data used in this article was sourced from the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2). The survey's results show that 7.2% of 11- to 17-year-old children and adolescents smoke at least occasionally, with 3.7% doing so daily. The survey also demonstrates that a good half (51.0%) of 11- to 17-year-olds have ever drunk alcohol; at-risk drinking was prevalent among 12.1%, and heavy episodic drinking among 7.0%. The consumption of tobacco and alcohol increases considerably with age. Patterns of at-risk drinking and heavy episodic drinking show gender-associated differences: While more girls than boys practice at-risk drinking, more boys than girls practice heavy episodic drinking. Nevertheless, the KiGGS survey waves demonstrate a highly significant trend towards a decline in tobacco use (KiGGS baseline study 21.4%, KiGGS Wave 1 12.4%). The proportion of 11- to 17-year-olds who have ever drunk alcohol is also declining (KiGGS baseline study 63.9%, KiGGS Wave 1 55.6%). The proportions of at-risk drinking (KiGGS Wave 1 16.5%) and heavy episodic drinking (KiGGS Wave 1 12.0%) decreased as well. The results presented here are in line with findings from other studies that have surveyed adolescent tobacco and alcohol use in Germany, and they underscore the success of preventive measures.

Changing educational inequalities in sporting inactivity among adults in Germany: a trend study from 2003 to 2012.

BACKGROUND: Social inequalities in health can be explained in part by the social patterning of leisure-time physical activity, such as non-participation in sports. This study is the first to explore whether absolute and relative educational inequalities in sporting inactivity among adults have changed in Germany since the early 2000s. METHODS: Data from four cross-sectional national health surveys conducted in 2003 (n = 6890), 2009 (n = 16,418), 2010 (n = 17,145) and 2012 (n = 13,744) were analysed. The study population was aged 25-69 years in each survey. Sporting inactivity was defined as no sports participation during the preceding 3 months. The regression-based Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were calculated to estimate the extent of absolute and relative educational inequalities in sporting inactivity, respectively. RESULTS: Sporting inactivity was consistently more prevalent in less-educated groups. The overall prevalence of sporting inactivity declined significantly over time. However, the decline was observed only in the high and medium education groups, while no change was observed in the low education group. Both absolute and relative educational inequalities in sporting inactivity were found to have widened significantly between 2003 (SII = 0.30, 95% CI = 0.25-0.35; RII = 2.08, 95% CI = 1.83-2.38) and 2012 (SII = 0.41, 95% CI = 0.37-0.45; RII = 3.44, 95% CI = 3.03-3.91). Interaction analysis showed that these increases in inequalities were larger in the younger population under the age of 50 than among the elderly. CONCLUSIONS: The findings suggest that the gap in sports participation between adults with high and low educational attainment has widened in both absolute and relative terms because of an increase in sports participation among the better educated. Health-enhancing physical activity interventions specifically targeted to less-educated younger adults are needed to prevent future increases in social inequalities in health.

German Health Update: New data for Germany and Europe: The background to and methodology applied in GEDA 2014/2015-EHIS.

GEDA 2014/2015-EHIS is an up-to-date health survey of the adult population undertaken within the framework of the Robert Koch Institute's (RKI) health monitoring system. It uses the EHIS (European Health Interview Survey) Wave 2 questionnaire and includes four modules covering health status, health care, health determinants, and socio-economic variables. Data on nationally relevant issues is also collected. The study employs a mixed-mode design, using both online and paper-based questionnaires to gather data from 24,016 people aged 18 and above: the response rate was 26.9%. The Statistical Office of the European Union (Eurostat) provides prepared data from 28 European Union (EU) member states (plus Norway and Iceland) on the Eurostat website. National analyses for Germany are published as Fact sheets on health reporting in the Journal of Health Monitoring.

Corrigendum: Health monitoring and health indicators in Europe.

[This corrects the article on p. 3-21 in vol. 2.].

Health monitoring and health indicators in Europe.

Demographic change, new health threats and inequalities in health and healthcare provision in and between European Union (EU) member states pose a great challenge to European health care systems. Not only for these reasons does it make sense to collect comparable European health data. Such information provides insights on the distribution of risk and protection factors, the prevalence of chronic diseases and the levels of care provided in the member states and supports the planning and implementation of (health) policy measures. Since 2013, in the context of the European Health Interview Survey (EHIS), all EU member states are obliged to collect data on the health status, the provision of healthcare, health determinants and socio-economic conditions of their populations. In Germany, the EHIS is integrated into health monitoring at the Robert Koch Institute (RKI). The RKI is thus Germany's interface to the European health monitoring presented here. European health monitoring relies on different indicator systems such as the European Core Health Indicators (ECHI), EU social indicators and the health indicators of the European Sustainable Development Strategy. These are based on administrative and survey data, which stem for example from the EHIS or the European Union Statistics on Income and Living Conditions (EU-SILC) survey. Comparative data analyses must take into account the differences between health care systems, socioeconomic conditions and the age structures of societies. Variances in the prevalence of allergies for example are also due to differences in the available diagnostic tools. Significant differences in the prevalence of hypertension in Europe (with a range of 20% for women and 17% for men) are also related to different levels of awareness of hypertension. Comparative analyses can support the planning of and provide information for policy measures, and enhance the sharing of experiences between EU member states. A forthcoming EU regulation aims to harmonise the content of and intervals between health and social statistical data collection. Moreover, plans exist to establish a European Research Infrastructure Consortium (ERIC), which is set to develop and institutionalise European health monitoring.