Potential new modules for future EHIS Module on health of children Agenda point 4.3 Jakub Hrkal ESTAT Unit F-4 13-14 October 2016 2nd meeting of EHIS Task Force

2nd meeting of EHIS Task Force Outline Need for statistics on health of children General issues and particularities of a sub-module on health of children Preselected topics and variables Remarks 13-14 October 2016 2nd meeting of EHIS Task Force

Why data on children in EHIS? Envisaged in the current framework regulation 1338/2008 (Annex I, Scope) Proposals as part of the modernisation of social statistics → DSS broad agreement to develop measures of disability prevalence, including children → EHIS identified as an appropriate source by GALI TF Policy DGs consultation → various needs Consultation of TG HIS → broad support to consider for future EHIS (+ proposals for topics & list of issues) 1338/2008, Annex I, Scope: Persons living in institutions as well as children aged 0-14 years shall be included, when appropriate and at the relevant ad hoc intervals, subject to successful prior pilot studies. 13-14 October 2016 2nd meeting of EHIS Task Force

2nd meeting of EHIS Task Force Criteria for selection of topics and construction of questions/variables Policy relevance/importance Appropriateness in survey: Feasible to be collected via survey Providing reliable estimates Suitable for proxy respondents Suitable for different data collection modes Take into account existing sources (CSHCN, UNICEF/WG, HBSC, ESPAD, national surveys) Alignment with EHIS adults and harmonization with SILC children variables, youth statistics Reasonable size (→ short and long version) 13-14 October 2016 2nd meeting of EHIS Task Force

Statistical methodology aspects Target population: 0 – 14 years Sample size and sampling method SILC: % of HHs with at least 1 child aged 0-15 is 24-43% EHIS 2: % HHs with at least 1 child aged: 0-4: 10% (5-14), 5-13: 17% (13-23) EHIS 2: Children (max. 2 children counted) to adults ratio: 0-4: 12% (6-17), 5-13: 23% (15-32) Sample 1 or more children? Sampling method? Use of proxy respondents Only proxy respondents → exclude some topics Define who can be proxy or at least collect info on the relation of proxy respondent to child Modes of data collection → pre-testing 13-14 October 2016 2nd meeting of EHIS Task Force

Identified needs for data EU needs/policies National interest Eurostat study Disability of children Health outcomes, incl. mental health Weight and height Eating behaviours: fruit, vegetables, sugar- sweetened beverages Physical activity and sedentary activities Tobacco use, Alcohol use, Cannabis use, Sexual behaviour Fighting, Being bullied and bullying others MEHM, diseases, injuries Phys. health: headache, stomach problems Mental health Disability Lifestyles: physical activity, obesity, eating habits, breastfeeding Violence (bullism) and psychological aspects Behaviour (anger, hyperactivity, isolation) Use of health services & medicines General health Oral health Diseases and chronic conditions Health potential and mental wellbeing Special health care needs incl. funct. limit. Physical activity/exercise Consumption of fruits and vegetables Curative services Preventive services 13-14 October 2016 2nd meeting of EHIS Task Force

Overview of preselected topics and number of variables by version Short Long Background information 3 Health status and functioning MEHM for children Perceived oral health Physical and sensory functional limit. Cognitive limitations Mobility and participation 13 (15) 7 (9) 2 4 18 (20) Health determinants and potential Weight and height Physical activity Consumption of fruit and vegetables Sweetened beverages Breastfeeding 11 1 13-14 October 2016 2nd meeting of EHIS Task Force

2nd meeting of EHIS Task Force Age: 0-1y 2-4 y 5-14 years Background variables MEHM Oral health Functional limitations Mobility and participation Weight and height Physical activity Fruit and vegetables Sweetened beverages Breastfeeding 13-14 October 2016 2nd meeting of EHIS Task Force

Background information General information Presence of any children aged 0-14 in the HH Names of the children Proxy respondent’s characteristics Respondent’s relationship with (each?) child Demographic data on each child Child’s sex Child’s age 13-14 October 2016 2nd meeting of EHIS Task Force

Health status and functioning (1) Minimum European Health Module (MEHM) for children CHS1: Perceived general health of child CHS2: Child long-standing health problem CHS3: Child general activity limitation Perceived oral health of child (COH) COH1: Perceived condition of child's teeth: how the respondent perceives the child's oral health in general COH2: Child occurrence of toothache, decayed teeth, and/ or unfilled cavities in the past 12 months 13-14 October 2016 2nd meeting of EHIS Task Force

Health status and functioning (2) Physical and sensory functional limitations of children (CPL) CPL1: Child wearing glasses or contact lenses CPL2: Child have difficulty seeing even when wearing glasses CPL3: Child using hearing aid CPL4: Child have difficulty hearing even when using hearing aid CPL5: Child using equipment or receiving assistance for walking CPL6: Child have difficulty walking even when using equipment or receiving assistance CPL7: Child have difficulty walking without any aid or support CPL8: Child have difficulty walking 500 meters even when using equipment or receiving assistance CPL9: Child have difficulty walking 500 meters without any aid or support 13-14 October 2016 2nd meeting of EHIS Task Force

Health status and functioning (3) Cognitive limitations of children (CCL) CCL1: Child have difficulty in learning new things CCL2: Child have difficulty in remembering things Mobility and participation of children in major life domains CMR1: Difficulty of child in [aspect of mobility] because of a longstanding health problem (Aspects: Leaving home, Accessing buildings, Moving about in buildings) CMR2: Lack of [type of support] contributing to the level of difficulty experienced by child in [aspect of mobility] (Type of support: Special aids or equipment, Personal help or assistance) CPR1: Difficulty of child participating in [major life domain] because of a longstanding health problem (Domains: Attending primary or secondary school at the moment, Pursuing hobbies or interests, or playing with other children, Attending cultural events) CPR2: Lack of [type of support] contributing to the level of difficulty experienced by child in [major life domain] 13-14 October 2016 2nd meeting of EHIS Task Force

Health determinants and potential (1) Weight and height of children (CBM) CBM1: Height of child without shoes CBM2: Weight of child without shoes or clothes Physical activity/ exercise of children (CPE) CPE1: Number of days in a typical week carrying out sports, fitness, or recreational (leisure) physical activities that cause child to get out of breath or sweat CPE2: Time spent on doing sports, fitness, or recreational (leisure) physical activities that cause child to get out of breath or sweat 13-14 October 2016 2nd meeting of EHIS Task Force

Health determinants and potential (2) Child consumption of fruit and vegetables (CFV) CFV1: Frequency of child eating fruit, excluding non-fresh juice CFV2: Number of portions of fruit a day consumed by child, excluding non-fresh juice CFV3: Frequency of child eating vegetables or salad, excluding potatoes and non-fresh juice CFV4: Number of portions of vegetables or salad a day consumed by child, excluding potatoes and non-fresh juice Sugar and artificial sweetener intake of children (CSI) CSI1: Frequency of child drinking sugar-sweetened and artificially-sweetened beverages CSI2: Amount of sugar-sweetened and artificially-sweetened beverages consumed by child, each time Breastfeeding (CBF) CBF1: Infant breastfed, at least partially, at three and six months of age 13-14 October 2016 2nd meeting of EHIS Task Force

2nd meeting of EHIS Task Force Remarks Possible new topics: Mental health, Psychological aspects, Behaviour (anger, hyperactivity, isolation) Simplification/aggregation: Aspects of mobility, Lack of support, Sugar and artificial sweetener intake Reconsider priorities: + MEHM - Oral health - Using equipment or receiving assistance for walking - Difficulty walking even when using equipment or receiving assistance - Number of portions of fruit/vegetables a day consumed Further discuss and harmonise minimum age: MEHM: age 0 for all vars or only for CHS1 and CHS2 and age 2 for CHS3? dietary habits (6 months or 2 years?) 13-14 October 2016 2nd meeting of EHIS Task Force

TF EHIS are kindly invited to: Comment on the content (selected and missing topics; priorities) Comment on the proposed questions (sources, modifications) Discuss methodological elements which need to be tackled and how they could be tackled Discuss next steps of development of the sub-module: Format of the development (continue with short/long version?) Need and maturity of the current proposal for pre-testing 13-14 October 2016 2nd meeting of EHIS Task Force