A module on health of children Agenda item 3.3 Paul Camenzind ESTAT Unit F-4 6-7 July 2017 Task Force EHIS

Outline Background information → Needs, criteria for development, work done Discussion in TG HIS 02/2017 Content of the module: 2 versions A & B Conclusions and next steps 6-7 July 2017 Task Force EHIS

Why data on children in EHIS? Envisaged in the current framework regulation 1338/2008 (Annex I, Scope) Part of the modernisation of social statistics → DSS broad agreement to develop measures of disability prevalence, including children → EHIS identified as a possible appropriate source by GALI TF Commission Policy DGs consultation → Various needs Consultation of TG HIS → Broad support to consider for future EHIS 6-7 July 2017 Task Force EHIS

Selection of topics questions /variables Policy relevance/importance Appropriateness in survey: → Feasible to be collected via survey & provide reliable estimates → Suitable for proxy respondents & different data collection modes Take into account existing instruments and data sources → CSHCN, UNICEF/WG, HBSC, ESPAD, national surveys (Annex) Alignment with EHIS adults and harmonization with SILC children variables Reasonable size → Number of variables / questions 6-7 July 2017 Task Force EHIS

Work done Consultation of TG HIS on the list of issues regarding the EHIS (April 2016) Eurostat study: a proposal for a possible module on health of children Discussions with TF EHIS (May and October 2016) Consultation of TG HIS on health of children modules in national HIS (January 2017) & Discussion (February 2017) ESTAT analysis of some methodological aspects (sample size, proxy interviews; January 2017) ESTAT first draft: Module on health of children (June 2017) 6-7 July 2017 Task Force EHIS

Discussion in TG HIS (February 2017) Statistical methodology aspects → Statistical population: 0–14 years; different instruments for different ages depending on content of the module → Sample size & sampling method: minimum sample size for children; sample 1 or more children in HH? Sampling method? → Use of proxy respondents: Legal issues; exclude some topics? Who can be proxy to obtain reliable data? How feasible is to involve only appropriate proxies? → Modes of data collection; special weights for children Sample size → Sample size should be sufficient for all countries (Annex) Proxy respondents & relationship proxy – children → SILC 2014: Proxy would be on of parents: 91% (70% to 99%) → EHIS W2: Proxy would be on of parents: 59% (29% to 70%) 6-7 July 2017 Task Force EHIS

Discussion in TG HIS (February 2017) • Content – 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 6-7 July 2017 Task Force EHIS

Discussion in TG HIS (February 2017) • Content – available "material" from ESTAT study Topic Short Long Background information (age, sex, proxy) 3 Health status and functioning MEHM for children Perceived oral health Physical and sensory functional limit. Cognitive limitations Social and mental health difficulties Mobility and participation (15) 7 2 4 (20) Health determinants and potential Height and weight Physical activity Consumption of fruit and vegetables Sweetened beverages Breastfeeding (0) (11) 1 6-7 July 2017 Task Force EHIS

Health of children (ESTAT draft, Jun 2017) Sub-module in adult questionnaire (not stand-alone) → Legal (child protection / privacy) → Organisational (data collection process) → Methodological (sufficient sample in small countries) Answers only given by proxy respondents → Who could be the proxy respondents? Respondents burden & limitation of questions → Limit to 20 health-related questions (+5 background) Propose 2 versions of children module → Version A: Clear focus on disability & participation restrictions → Version B: Focus on disability & participation restriction and on some prevention issues 6-7 July 2017 Task Force EHIS

Health of children (ESTAT draft, Jun 2017) Dimension Number of questions: Version A Number of questions: Version B Height and weight 2 Minimum Europ. Health Module 3 Physical & sensory funct. limit. 6 Cognitive limitations Social & mental health difficult. Mobility & participations restr. 5 - Physical activity & excercise Consumption of fruit & veget. Consumption of soft-drinks 1 Total 20 (+5) 6-7 July 2017 Task Force EHIS

Health of children (ESTAT draft, Jun 2017) Dimension Number of questions: Version A Number of questions: Version B Height and weight 2 Minimum Europ. Health Module 3 Physical & sensory funct. limit. 6 Cognitive limitations Social & mental health difficult. Mobility & participations restr. 5 - Physical activity & excercise Consumption of fruit & veget. Consumption of soft-drinks 1 Total 20 (+5) 6-7 July 2017 Task Force EHIS

Health of children (ESTAT draft, Jun 2017) General information (2) → Presence of any children aged 0-14 in the HH → Names of the children Proxy respondent’s characteristics (1) → Respondent’s relationship with (each?) child Demographic data on each child (2) → Child’s sex → Child’s age 6-7 July 2017 Task Force EHIS

Health of children (ESTAT draft, Jun 2017) Weight and height (2) → Height of child without shoes → Weight of child without shoes or clothes Minimum European Health Module (3) → Respondent-perceived general health of child → Longstanding health problem of child → General activity limitation of child (routed version) 6-7 July 2017 Task Force EHIS

Health of children (ESTAT draft, Jun 2017) Physical and sensory functional limitations (6) → Child wearing glasses or contact lenses → Difficulty of child in seeing – even when wearing glasses or contact lenses → Child using hearing aids → Difficulty of child in hearing – even when using hearing aid → Child using equipment or receiving assistance for walking → Difficulty of child in walking without any aid or support 6-7 July 2017 Task Force EHIS

Health of children (ESTAT draft, Jun 2017) Cognitive limitations of children (2) → Difficulty of child in learning new things → Difficulty of child in remembering things Social and mental health difficulties of children (2) → Behavioural difficulty of child → Mental health difficulty of child 6-7 July 2017 Task Force EHIS

Health of children (ESTAT draft, Jun 2017) Mobility and participation restrictions of children in major life domains (3) → Difficulty of child in leaving his/her home* → Difficulty of child in accessing buildings* → Difficulty of child in moving about in buildings* Participation of children in compulsory education (1) → Difficulty of child in participating in compulsory education* Participation of children in leisure activities (1) → Difficulty of child in pursuing leisure activities* * (he/she wants to use) because of a longstanding health problem 6-7 July 2017 Task Force EHIS

Health of children (ESTAT draft, Jun 2017) Mobility and participation restrictions of children in major life domains (3) → Difficulty of child in leaving his/her home* → Difficulty of child in accessing buildings* → Difficulty of child in moving about in buildings* Participation of children in compulsory education (1) → Difficulty of child in participating in compulsory education* Participation of children in leisure activities → Difficulty of child in pursuing leisure activities* (1) * (he/she wants to use) because of a longstanding health problem Version A 6-7 July 2017 Task Force EHIS

Health of children (ESTAT draft, Jun 2017) Physical activity / exercise of children (2) → Number of days carrying out sports, fitness, or recreational physical activities that cause child to get out of breath or sweat → Time spent on carrying out sports, fitness, or recreational physical activities that cause child to get out of breath or sweat Child consumption of fruit and vegetables (2) → Frequency of child eating fruit, excluding juices a week → Frequency of child eating vegetables and salad a week, excluding potatoes and juices Child consumption of sugar-sweetend beverages (1) → Frequency of child drinking sugar-sweetened soft-drinks a week 6-7 July 2017 Task Force EHIS

Health of children (ESTAT draft, Jun 2017) Physical activity / exercise of children (2) → Number of days carrying out sports, fitness, or recreational physical activities that cause child to get out of breath or sweat → Time spent on carrying out sports, fitness, or recreational physical activities that cause child to get out of breath or sweat Child consumption of fruit and vegetables (2) → Frequency of child eating fruit, excluding juices a week → Frequency of child eating vegetables and salad a week, excluding potatoes and juices Child consumption of sugar-sweetend beverages (1) → Frequency of child drinking sugar-sweetened soft-drinks a week Version B 6-7 July 2017 Task Force EHIS

How to continue? Data on health of children important, currently missing; EHIS could complement other sources of data ESTAT believes in feasibility to include a module on health of children in EHIS (see experience in countries) Is concrete ESTAT proposal (Versions A & B) including questionnaire & methodology useful for further steps? Favoured version? Other proposals: adding & removing variables; changing variables, answer categories, guidelines? Informing TG HIS / WG PHS about developments and possible consultation on a draft module (Autumn 2017) Pretesting and pilot testing within EHIS -> Grants 2017 Further discussion about introducing a module on children in future EHIS 6-7 July 2017 Task Force EHIS

Annex: Other international sources of children data Name Health Behavior in School-Aged Children (HBSC) European School Survey Project on Alcohol and Other Drugs (ESPAD) Countries EU 27 + NO + IS + other countries EU 23 + NO + IS + other countries Periodicity Every four years Target population 11-, 13-, and 16-year old students 16-year old students Collection method Self-administered questionnaire to students Sample size Approximately 1,500 students, per age group, per country Net sample of at least 2,400 students, per country Topics health outcomes (self-rated health, injuries, obesity) health behaviours (dieting, physical activity) risk behaviours (smoking, alcohol cannabis, sexual behaviour, bullying) use of psychoactive substances (smoking, alcohol, illegal drugs) use of the internet for various activities in the lifetime 6-7 July 2017 Task Force EHIS

Annex: Estimation of sample sizes of children (data EHIS wave 2) Variable avg min max Number of HHs with children 0-13 1,915 505 5,445 % of HHs with children 0-13 23% 15% 28% Number of children 0-13 2,968 738 8,084 Number of children 0-4 1,380 247 3,591 Number of children 5-13 2,428 653 6,545 No. ch. 0-13 (max 1 child per HH) No. ch. 0-13 (max 2 children per HH) 2,382 645 7,159 No. ch. 4-13 (max 2 children per HH) 2,330 634 6,417 6-7 July 2017 Task Force EHIS

Annex: Alignment with SILC children variables Financial burden (3): all ages → Financial burden of medical examinations/treatments last 12 mths → Financial burden of dental examinations/treatments last 12 mths → Financial burden of medicines (pre-& non-prescribed) last 12 mths General health and limitation in activities (2): 0-15 yrs. → Respondent-perceived general health of child(ren) → Limitation (>6 months) in activities because of health problem (routed version) 6-7 July 2017 Task Force EHIS

Annex: Alignment with SILC children variables Unmet needs (4): 0-15 years → Unmet need for medical examination or treatment last 12 months → Main reason for unmet need for medical examination or treatment last 12 months → Unmet need for dental examinations or treatments last 12 months → Main reason for unmet need for dental examination or treatment last 12 months 6-7 July 2017 Task Force EHIS