Implementing the EU-SILC health questions in the GHS (now GSL)- UK Experience TF-Health Expectancy, Luxembourg 2 nd June 2008 Madhavi Bajekal, Chris White Office for National Statistics

Context  EU-SILC regulation Improve consistency between countries & standardise definitions, questions and analysis procedures UK agreed to comply from 2005  Eurostat’s health outputs from UK EHIS derived from HSE (dedicated health survey) MEHM (EU-SILC) derived from GHS(L)  Eurostat now aspires to harmonise SILC with EHIS

Circumstances  SILC harmonisation affects GHS(L) questions on:  General Health (PH010)  Chronic morbidity [Long-standing illness] (PH020)  Activity limitation [Limiting Long-standing illness] (PH030)  Differences in questions e.g. reference time periods, terminology, routing, response categories  Current UK position – questions asked  ONS initiated further testing (2007/8) and consultation to assess impacts on long-running UK statistical series  Reconcile national statistical needs (eg DDA) with EU needs (disability harmonisation project)

Existing and Proposed EU-SILC questions on Chronic Morbidity  Existing: Do you have any long-standing illness, disability or infirmity ? By long-standing I mean anything that has troubled you over a period of time or is likely to affect you over a period of time? Yes/No  Proposed: Do you have any longstanding illness or longstanding health problem ? [By longstanding I mean illnesses or health problems which have lasted or are expected to last for six months or more ]  Differences Disability and infirmity excluded Explicit time period of six months included (past and future)

 Modified question to be tested:  Do you have any long-standing illness, health condition or disability? By long-standing I mean illnesses, health conditions or disabilities which have lasted or are expected to last for six months or more  Differences:  Explicit time period 6 months to existing question  Health condition replaces health problem UK modified chronic morbidity question

 Existing: Does this illness or disability/Do any of these illnesses or disabilities limit your activities in any way? Would you say your activities are limited or strongly limited?  Proposed: For at least the past six months, to what extent have you been limited because of a health problem in activities that people usually do ? Would you say you have been...? Severely limited Limited, but not severely Not limited at all  Purpose is to measure presence of long-standing activity limitation (not illnesses) vis-à-vis population ‘norm’? Existing and Proposed EU-SILC questions on Activity Limitation

 Time period  specific six month time period (past)  relates to the duration of the activity limitation not the illness  Routing proposed question is asked of everyone (not only those with LLTI)  Severity of disability  terms ‘severely’ and ‘strongly’ may be interpreted differently (eg. substantially)  Terminology  limitations restricted to health-related problems only (disability/old age excluded) Differences in proposed activity limitation question

 Now thinking about all your health problems, not just those which are long-standing, for at least the past six months, to what extent have you been limited in your day to day activities because of a health problem or disability ? Include health problem(s) or disability/ disabilities which are due to old age. Would you say you have been...? a.Severely limited b.Limited, but not severely c.Not limited at all  Age-related disability included – consistency with census 2011  re-inforce consideration of all health probs. not only long-standing Modified activity limitation question

Test Design Source: OMNIBUS SURVEY Dec. 07 and Apr May Jun 08 SAMPLE 1  1,600SAMPLE 2  1,600SAMPLE 3  1,600 Current GHS(L) routed question on Long-standing illness and limitation Proposed SILC harmonised questions on chronic illness and activity limitation (GALI) Modified questions on chronic illness and activity limitation Three armed trial design

Test Components Filter effects: compare prevalence of activity limitation in filtered, non-filtered and pseudo filtered questions (approx 5 pp difference) Time period effects: compare prevalence of chronic morbidity/activity limitation with/without a specified time period Terminology: compare prevalence of chronic morbidity including/excluding the term disability compare prevalence of activity limitation including/excluding age-related limitation

Initial Results (December 2007 wave) Prevalence and severity of Chronic morbidity by question with 95 per cent Confidence Intervals

Tentative indications  Existing and proposed chronic morbidity questions produce similar prevalence but higher in modified question  Prevalence of total activity limitation higher in the GALI than existing question  ‘Strongly’ and ‘severely’ limited prevalence largely similar using question variants

 Any differences found will indicate but not prove the size of the impact of adopting the proposed / modified questions  The change elements are too numerous to adequately test with four months data and further testing may be needed  Harmonisation with DDA and the UK census 2011 question defined disability needs testing, informed from a wider range of stakeholders Issues with planned testing

DDA definition - UK 1995 DDA definition of disability as a: ‘physical or mental impairment which has a substantial and long-term adverse effect on (a person’s) ability to carry out normal day- to-day activities’. (without medication, past disability, progressive illnesses)

2011 Census – prototype 1

Census 2011 – prototype 2

UK – unresolved issues  Conceptual clarity: do both q’s include impairments (‘disability’), infirmities?  Statistical impacts on national DFLE series  Cross-EU comparisons HLY – within country over time or across countries?  IHS core vs GSL vs new EHIS survey?