Selection of health variables for the new 3-yearly SILC module Item of the agenda Pascal Wolff ESTAT-F December 2014 Working Group Public Health

Outline 1.Background: health data in SILC 2.Overall approach - Module development process - State of the discussion 3.Discussion December 2014 Working Group Public Health 2

Background: Health data in SILC Currently: 7 annual variables In the future: Likely 7 annual variables in the nucleus Every 3-year health module (20 variables) Potentially other health-related variables (modules on Access to services, Quality of life, Children and child care) December 2014Working Group Public Health3

Why strengthening health in SILC? Relevance Periodicity December 2014Working Group Public Health4

Module development process Wide consultation: SILC TF, Living Conditions WG, JAF Expert Group Looking for consensus … but need to reconcile users and producers expectations Provisional agreement on most variables in September 2014 Harmonisation with EHIS … but adaptations when considered as useful Variables and questions: need for input-harmonisation Need for testing (before initial inclusion in 2017 SILC module) December 2014 Working Group Public Health 5

User perspective: possible use of future SILC for JAF Health Health status: o [Well-being (Quality of life module)] o (Mental health - refused by SILC TF) Health care system access: o Out-of-pocket payments for health care o Care utilisation Non-health care determinants: o Regular daily smoking o Obesity o (Risky single occasion drinking – refused by SILC TF) o Fruit consumption o Vegetable consumption o Physical activity December 2014Working Group Public Health6

Producer perspective Reduction of number of topics  more focus on selected ones (health status and access to care) Removal of some topics perceived as sensitive (diseases including depression, alcohol consumption) Adaptation or simplification of some topics to be more suited for SILC (out-patient care, physical activity) Integration with other SILC modules (unmet needs, mental well-being and informal care) Harmonisation of variables (with EHIS) Testing envisaged December 2014 Working Group Public Health 7

State of the discussion Content: 20 variables o 17 agreed variables, 3 placeholders under discussion o Health state: 4 variables, strengthen health status part and complement disability domain o Formal care: 3 variables, strengthen JAF 'access' o Financial burden: 3 new variables to complement JAF 'access' o Health behaviour: 7 variables, strengthen JAF 'lifestyles' and provide more frequent data Issues: o Sensitivity in SILC (e.g. BMI, alcohol consumption) o Relevance for SILC (e.g. BMI, physical activity) o Complexity of some variables (e.g. alcohol, fruits/vegetables) December 2014Working Group Public Health8

Eurostat Health status: 4 variables December 2014 Working Group Public Health 9 VariableWhy 1. Difficulty in seeing, even when wearing glasses or contact lenses ECHI 36 Strengthen health status content of SILC (incl. disability and long-term care) Recommended by Budapest Initiative 2. Difficulty in hearing even when using a hearing aid 3. Difficulty in walking or climbing steps 4. Difficulty in remembering or concentrating

Eurostat Formal care: 3 variables December 2014 Working Group Public Health 10 VariableWhy 5. Number of visits to a dentist or orthodontist ECHI 72 Health inequalities, Link with PH60-70 and N° 9 6. Number of consultations of a GP ECHI 71 Health inequalities, Link with PH40-50 and N° 8 7. Number of consultations of a specialist ECHI 72 Health inequalities, Link with PH40-50 and N° 8

Eurostat Financial burden: 3 variables December 2014 Working Group Public Health 11 VariableWhy 8. Financial burden of medical care (incl. hospital, generalist and specialist care) JAF, equity of access to services 9. Financial burden of dental care 10. Financial burden of medicines

Eurostat Health behaviour: 7 variables December 2014 Working Group Public Health 12 VariableWhy 11. Body Mass Index ECHI 42, JAF, EHIS Predictor of chronic disease and disability 12. Frequency of eating fruit, excluding juice ECHI 49 Link with WHO recommendation 13. Frequency of eating vegetables or salad ECHI 50 Link with WHO recommendation 14. Type of physical activity when working Link with labour market and leisure- time physical activity 15. Time spent on physical activities (excluding working) JAF, ECHI 52 Monitoring the HEPA recommendation

Eurostat Health behaviour: Smoking December 2014 Working Group Public Health 13 VariableWhy 16. Type of smoking behaviourJAF, ECHI 44, OMC HC-S Average number of cigarettes a day JAF, ECHI 44, OMC HC- S11, Severity of smoking

Eurostat Other health variables under discussion December 2014 Working Group Public Health 14 VariableWhy Use of home care services for personal needs Health inequalities, Ageing policies Number of nights spent as a patient in a hospital Link with health status and determinants Issue: comparability Use of any medicines prescribed by a doctor Link to ECHI 74 Medicine consumption and access to medicines Frequency of consumption of an alcoholic drink JAF, ECHI 47 Link with risky alcohol consumption Issue: sensitivity

SILC health module - timetable WhenWhoWhat September 2014 SILC Task-Force Discussion on the final list of variables End 2015 Directors of Social Statistics SILC part of the Integrated European Social Statistics (IESS). Nucleus is adopted (2015 or) 2016 National Statistical Institutes Pre-testing of some variables 2017 National Statistical Institutes Some variables are included in the 2017 ad-hoc module 2018 or 2019 Directors of Social Statistics Final decision on contents of rolling modules (incl. 3-year health module) December 2014Working Group Public Health15

Thank you for your attention December 2014Working Group Public Health16