1. 1 DEVELOPMENTS ON EUROPEAN HEALTH INDICATORS Luxembourg, 3 December 2007 Antoni Montserrat European Commission DG SANCO Health Information Unit

2. 2 Future legal basis for the developments of Health indicators 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 2008-2013'. 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. The Strategy aims to set clear objectives to guide future work on health at the European level, and to put in place an implementation mechanism to achieve those objectives, working in partnership with Member States. For the period 2008-2013 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’. The annual work plans will be a key instrument to support the Strategy's objectives.

3. 3 Future legal basis for the developments of Health indicators in the EU Public Health Policy Regulation from the Council and the Parliament (developed by Eurostat) 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. The FP7 Programme (2007-2013) Via Commission Decision a Direct contract agreement with OECD for developments in several areas e.g. Indicators on Health Quality.

4. 4 Current legal basis for the developments of Health indicators in the EU Health Strategy Actions Adoption of a Statement on fundamental health values (Commission, Member States) System of European Community Health Indicators with common mechanisms for collection of comparable health data at all levels, including a Communication on an exchange of health related information (Commission) Further work on how to reduce inequities in health (Commission) Development of a programme of analytical studies of the economic relationships between health status, health investment and economic growth and development (Commission, Member States)

5. 5 Current legal basis for the developments of Health indicators in the Second Health Programme Increasing Healthy Life Years (HLY) by preventing disease and promoting policies that lead to a healthier way of life is important for the well-being of EU citizens and helps to meet the challenges of the Lisbon process as regards the knowledge society and the sustainability of public finances, which are under pressure from rising health care and social security costs. Promote initiatives to increase healthy life years and promote healthy ageing; support measures to promote and explore the impact of health on productivity and labour participation as a contribution to meeting the Lisbon goals; support measures to study the impact on health of other policies. (Promotion of health strand) Develop further a sustainable health monitoring system with mechanisms for collection of comparable data and information, with appropriate indicators; ensure appropriate coordination of and follow-up to Community initiatives regarding registries on cancer, based, inter alia, on the data collected when implementing the Council Recommendation of 2 December 2003 on cancer screening; collect data on health status and policies; develop, with the Community Statistical Programme, the statistical element of this system. (Generation of Knowledge strand)

6. 6 Future legal basis for the developments of Health indicators in the EU Health Policy The new Research Programme (FP7) introduces a new common approach between research activities and health information under the pillar ‘Cooperation’ Improving the health of European citizens and increasing the competitiveness of European health-related industries and businesses, while addressing global health issues including emerging epidemics. Emphasis will be put on translational research (translation of basic discoveries in clinical applications), the development and validation of new therapies, methods for health promotion and prevention, diagnostic tools and technologies, as well as sustainable and efficient healthcare systems. Optimising the delivery of health care to European citizens – Quality, efficiency and solidarity of health systems including transitional health systems. To translate effective interventions into management decisions, to ensure an adequate supply of human resources, to analyse factors influencing equity of access to high quality health care, including analyses of changes in population (e.g. ageing, mobility and migration, and the changing workplace).

7. 7 Future legal basis for the developments of Health indicators in the EU Public Health Policy DG SANCO will elaborate during 2009 a proposal for a Commission Communication on the European Health Information, Knowledge and eHealth System: Summarising the principles basing the EU health information and knowledge system, The responsibilities of the different actors in this field, the role of DG SANCO, The national and EU responsibilities on the mechanisms for collecting data (health surveys, hospital information, etc.), The interoperability of different systems of health indicators, the cooperation with other actors (Eurostat, ECDC, OCDE), The role of the consultative structures A code of good practices on health information Defining the content of the Electronic Health Card and the type of information to be shared by Member States Obligations that the European Commission should assume respect to the Member States in the field of health information. The proposal should be discussed in all the existing SANCO advisory structures

8. 8 Future legal basis for the developments of Health indicators in the EU Public Health Policy A Community action on health services followed by a Directive on Health Services with the aims: common principles in all EU health systems, setting out which Member State shall be responsible for ensuring the common principles for healthcare and what those responsibilities include, in order to ensure that there is clarity and confidence with regard to which authorities are setting and monitoring healthcare standards throughout the EU; a specific framework for cross-border healthcare: the directive will make clear the entitlements of patients to have healthcare in another Member State, including the limits that Member States can place on such healthcare abroad, and the level of financial coverage that is provided for cross-border healthcare, based on the principle that patients are entitled to obtain reimbursement up to the amount that would have been paid had they obtained that treatment at home; European cooperation on health services: the directive establishes a framework for European cooperation in areas such as cooperation in border regions, recognition of prescriptions issued in other countries, European networks of centres of reference, health technology assessment, data collection and quality and safety, in order to enable the potential contribution of such cooperation to be realised effectively and on a sustained basis.

9. 9 Sets of indicators in the EU Public Health Policy National indicators: ECHI (European Community Health Indicators) Indicators on Social Protection ISG System (developed by DG EMPL) Sustainable Development Indicators SDS Indicators (developed by Eurostat) Sub-national indicators: ISARE (Indicateurs de Santé dans les Régions de l’Europe) Urban indicators: EURO-URHIS (European system of urban health indicators) Structural indicators: Healthy Life Years Health Care Quality Indicators OCDE Project Environment & Health Indicators System ENHIS System (with WHO and EEA)

10. 10 Future legal basis for the developments of Health indicators in the EU Public Health Policy Work Plan 2008 All projects should Contribution to improving the health of European citizens, as measured where possible by appropriate indictors, including the Healthy Life Years indicator; Reducing health inequalities in and between EU Member States and regions; Building capacity for development and implementation of effective public health policies particularly in areas of high need;

11. 11 Future legal basis for the developments of Health indicators in the EU Public Health Policy Work Plan 2008 Development of a sustainable health monitoring system with mechanisms for collection of comparable data and information, with appropriate indicators Actions already supported at European level have concentrated on developing a number of comparable indicators, resulting in a first set of European Community Health Indicators (ECHI), which are widely disseminated. Improvements in these indicators by refinement and disaggregation and improvements in sources have been identified as priority areas. Health indicators Disaggregation of the Healthy Life Year indicator by diseases. [Financing mechanism: Call for proposals or joint action] To link mortality to census data on socioeconomic status or by analysing self-reported health by socioeconomic position. To improve knowledge on socioeconomic inequalities in such determinants as health-related behaviours, housing and working conditions, psychosocial factors and health care utilization taking into account political priorities expressed in point 4.3.2. [Financing mechanism: Call for proposals or joint action] Further development of the ECHI system to cover a broad range of health indicators from all Member States (creation of fact sheets definitions, implementation of ECHI in each member State and at EU level, design of further steps, design on a EU level plan for the health information system and test the data flow between Member States and a central EU capacity for health monitoring.). Activities to develop the ECHI shortlist related to the development of health promotion, prevention, and public policy indicators, including tobacco control. [Financing mechanism: Call for tender or joint action]

12. 12 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 (health interview and health examination surveys) Revision of the International Classifications To develop the System of Health Accounts A common system of collection of information on hospital activities eHealth dimension Development of some disease registers (cancer, health and environment, etc.) Collection of information on primary care Sentinel networks Short-term instruments Instruments for short term information needs as the health modules in the Eurobarometer survey and other Eurostat data collection projects (E4SM)

13. 13 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 (health interview and health examination surveys) 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 The European Health Examination Survey implemented by the Public Health Programme and the FP7

14. 14 Health Reports The new Health Programme has given to the Health Reports a new impulse that was anticipated by the action of SANCO. HEALTH REPORTS BASED ON INDICATORS - First Communicable Diseases Report First Semester 2007 Produced by the ECDC with the cooperation of DG SANCO and ESTAT - First Major and Chronic Diseases Report First Quarter 2008 Produced by TF MCD and DG SANCO - Healthy Life Years in Europe Report Second Quarter 2008 Produced by the TF HE with the cooperation of DG SANCO and ESTAT - First Global Report on Health in the European Union End 2008 Produced by the EUGLOREH Project leaded by the Ministry of Health (Italy) and DG SANCO - Health Indicators in the European Regions End 2009