1 DEVELOPMENT OF THE EUROPEAN HEALTH EXAMINATION SURVEY Luxembourg, 20th January 2010 Antoni Montserrat European Commission DG SANCO Health Information Unit

2 Future legal basis for the developments of Health examination surveys in the EU Public Health Policy On 23 October 2007 the European Commission adopted a new Health Strategy, 'Together for Health: A Strategic Approach for the EU '. Building on current work, this Strategy aims to provide, for the first time, an overarching strategic framework spanning core issues in health as well as health in all policies and global health issues. System of European Community Health Indicators with common mechanisms for collection of comparable health data at all levels. The European Health Examination Survey is mentioned in the Staff Working Document For the period a new Health Programme replaces the existing Public Health Programme (approved by the Council and the Parliament). New strand ‘Health Information and Generation of knowledge’. Develop further a sustainable health monitoring system with mechanisms for collection of comparable data and information, with appropriate indicators. In the Work Plan 2009 for the implementation of such Programme: To implement a pilot European Health Examination Survey in some Member States in order to test the examination modules for this survey defined by the earlier projects, so to contribute to completing the health surveillance and the ECHI indicators in the EU. On 16 December 2008 the European Parliament and the Council adopt (under the initiative of Eurostat) the Regulation 1338/2008 creating a statistical framework for data collection on health and safety at work in some areas (health status, causes of death, health care). It should be a ‘umbrella regulation’ to be developed via Commission Regulations. In Annex I: The implementation of Health Examination Surveys shall be optional in the framework of this Regulation

3 Improving mechanisms for health reporting with common methodologies and systems of collection of data accepted by all the Member States (Sustainable instruments) European Health Survey System The database HIS/HES The European Health Interview Survey implemented by the Statistical Programme The EHIS annual indicators would cover the prevalence of certain chronic diseases in past twelve months; Body Mass Index (mainly overweight and obesity), hazardous alcohol consumption, physical activity, smoking, consultations of doctors and dentists, medicine use, preventative actions, selected physical and sensory functional limitations, pain and discomfort, SF-12 on mental health Special health modules developed by the Health Programme (e.g. AIDS prevention, musculoskeletal pain, etc.) to be implemented in the EPSS (European Programme of Social Surveys) The the Mini European Health Module implemented in the (annual) EU-SILC (Statistics on Income and Living Conditions) under the Community Statistical Programme. This is actually used to calculate the Healthy Life Years structural indicator. The European Health Examination Survey implemented by the Health Programme and the FP7

4 Health examination survey (HES) is a population based survey were the measurements go beyond the questionnaire based data (interview or self-administration), such as blood pressure, blood samples, test of functional capacity etc. HES provides crucial information for the health care planning and health promotion that cannot be obtained by any other way. There are successful examples of HES in some European countries and North America. 1968: G Rose. Cardiovascular Survey Methods : WHO MONICA Project : European Health Risk Monitoring (EHRM) Project : Feasibility of a European Health Examination Survey (FEHES) Project leaded by KTL (Finland), has assessed the feasibility of standardized HESs in European countries and prepared a proposal for their implementation. European Health Examination Survey (EHES) Pilot

5 Conclusions of the Feasibility of a European Health Examination Survey (FEHES) Project Finland Sweden Norway Netherlands West Germany Germany UK - England UK - Scotland Ireland Poland Denmark Romania Spain Croatia France Czech Republic Italy

6 Conclusions of the Feasibility of a European Health Examination Survey (FEHES) Project National HES in past 10 years 10 countries: Croatia, Czech Republic, Finland, France, Germany, Ireland, Netherlands, Poland, Romania, United Kingdom Presently ongoing surveys 3 countries: Denmark, Luxembourg, Spain Major regional surveys covering several areas (no national HES) 9 countries: Cyprus, Denmark, Iceland, Italy, Lithuania, Norway, Slovakia, Slovenia, Sweden General acceptance, as answer in the FEHES Survey to MS, in all Member States and EEA countries about the creation of a European Health Examination Survey

7 Roadmap for the European Health Examination Survey The FEHES (Feasibility of a European Health Examination Survey) Project, leaded by KTL (Finland), has assessed the feasibility of standardized HESs in European countries and prepared a proposal for their implementation. Project selected in 2006 and concluded in The Work Plan 2009 (February 2009) for the implementation of the Second Health Programme calls for: To implement a pilot European Health Examination Survey in some Member States in order to test the examination modules for this survey defined by the earlier projects, so to contribute to completing the health surveillance and the ECHI indicators in the EU. [Financing mechanism: Call for tender] The International Workshop on Health Examination Surveys (Luxembourg, April 2008) endorses FEHES Recommendations and open the process for the EHES.

8 Roadmap for the European Health Examination Survey

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10 Roadmap for the European Health Examination Survey

11 Roadmap for the European Health Examination Survey

12 Roadmap for the European Health Examination Survey Call for Tender 2008/S from the European Commission (July 2008): The development and planning of a pilot European Health Examination Survey in European Union and EFTA Member States in preparation to test examination modules and field procedures for this survey Creation of the European Health Examination Survey Reference Centre (EHES RC) The development of national surveys in accordance with the recommendations adopted by the First Workshop on Health Examination Surveys in the European Union (Luxembourg, 9– ), and in cooperation with the national authorities in the participating countries: (i)To establish a sampling procedure; (ii) To plan an examination procedure; (iii) To develop a quality control and assessment procedure; (iv) To plan and establish the data handling systems and sample storage protocols; (v) To address legal, ethical, and data confidentiality issues; (vi) To perform a risk assessment and prepare mitigation measures; (vii) To translate the Manual into the official languages of the European Union; (viii) To establish a European Reference Centre for the pilot EHES — develop a programme to train the survey staff from the Member States, — collection, compilation, storage, analysis, and transmission of the data, — compile and disseminate the interim and final reports, and to organise a final conference, workshop, or seminar. The recommendations on Health Examination Surveys in the European Union are available: Contract with the THL (National Institute for Health and Welfare) from Finland signed.

13 Roadmap for the European Health Examination Survey Call for Tender 2008/S from the European Commission (July 2008): The development and planning of a pilot European Health Examination Survey in European Union and EFTA Member States in preparation to test examination modules and field procedures for this survey Creation of the European Health Examination Survey Reference Centre (EHES RC) Two year project Receives funding from the EC (DG Sanco) EHES Reference Centre: Overall coordination Preparation and maintenance of the standards Training seminars Support to the countries organizing a national HES External quality control Data management and reporting system

14 Roadmap for the European Health Examination Survey Joint Action for the implementation of the pilot European Health Examination Survey This Joint Action will support the national activities needed to build the capacity for organizing Health Examination Surveys (HES) in 14 countries. The Partners will work in collaboration with the European Health Examination Survey Reference Centre (EHES RC) funded by the Call for Tender 2008/S The aim is to plan and prepare for a full-scale HES in the 14 countries, and to pilot the fieldwork, data collection, assessment and reporting. The full-size HESs will provide comparable information on major chronic disease risk factors and disease prevalence. This Joint Action will cover the Partners' national activities, which will be supported with the coordination, training and expert consultation provided by the EHES RC. Together the Joint Action and the EHES RC will use common tools, such as the EHES website for sharing information between Partners to prepare national survey plans and sampling descriptions. The Partners will plan and prepare a full-size HES, select a random sample, targeting for 200 participants in each country, conduct a field work pilot and transfer their pilot data to the EHES RC. The Partners will provide information for the basic external quality assessment and evaluate the quality assessment reports prepared by the EHES RC. The Partners will also produce local dissemination plans and prepare reports of the pilot results. This Joint Action will also cover the necessary EHES RC activities during the last 6 months of the Joint Action, after the EHES RC funding by the Tender is ceased. Participating countries or regions: FIN, CZ, DE, EL, HU, IT, MT,NL, NO, PT, PL, SK, ES, UK (ENG) Contract with the THL (National Institute for Health and Welfare) from Finland in process of signature. Start on January 2010.

15 Joint Action for the implementation of the pilot European Health Examination Survey

16 Joint Action for the implementation of the pilot European Health Examination Survey  Planning and preparation of the national HES  Preparation of the national HES manual  National language(s)  English  National training programme  A pilot HES of 200 persons/country

17 Joint Action for the implementation of the pilot European Health Examination Survey  After the two-year pilot phase  Pilot countries are ready to start their full-size national HESs  Other European countries plan, prepare and conduct of their national HESs  The HESs provide comparable and reliable health information  Sustainable EHES system

18 Roadmap for the European Health Examination Survey Kick-Off Meeting of the Joint Action for the implementation of the pilot European Health Examination Survey and First meeting of the Subgroup of the Health Information Committee on Health Examination Surveys (Luxembourg, January 2010) as governance bodies for the process. The launching of the Call for Proposals in the FP7 Programme for the phase II: Full-scale HES in the 27 Member States, Norway and others is scheduled for 2011 (negotiations with FP7 ongoing).

19 Conclusions of the Feasibility of a European Health Examination Survey (FEHES) Project on the incorporation of Biomonitoring activities to the future EHES Human Biomonitoring (HBM) has been defined in the preparation of the EU Action Plan Environment & Health as "monitoring activities in human beings, using biomarkers, that focus on environmental exposures, diseases and/or disorders and genetic susceptibility, and their potential relationships". ESBIO Project: The ESBIO project aimed to prepare the European Pilot Project to develop a coherent approach to Human Biomonitoring in Europe in close cooperation with the Member States in Several of the ESBIO pilot aims are also relevant for the future EHES as it aims to gain practical knowledge of access to study populations, recruitment procedures and response rates, to test the developed guidelines, protocols and technical procedures for field work, questionnaires, chemical analyses, data handling and processing, to test ethical guidelines and gain experience on ethical rules. The study population for the proposed biomonitoring pilot study will be children (aged 6- 11years) and their mothers. Scenario 1 (biomarkers: lead, cadmium, methyl-mercury and cotinine) forms the obligatory element, and Scenario 2 (a number of organic pollutants) the optional part of the project. Questionnaires will be used to assess exposure of the individual pollutants, and blood, urine and hair specimens will be collected.

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21 Pilot EHES Project web site at Hanna Tolonen, Project Manager European Commission EHES web site rting/report_en.htm?sancorep=4#rep_4 Antoni Montserrat, DG SANCO Policy Officer