12.5. The European Public Health Programme

 

In 2002, the Council and Parliament adopted the first integrated public health programme as the key enabling mechanism for the Community’s public health policy under Article 152 of the Treaty (European Council, 2002). A description of the main activities and all reports from the programme can be found on the Internet at http://ec.europa.eu/health/index_en.htm and in several recent publications. In 2003, the Programme started to cover health information, health threats and health determinants, with a budget allocation of € 365 million from 2003 to 2008.

 

In May 2006 the Commission adopted a proposal for a European Parliament and Council Decision creating the Second Programme for Community Action in the field of Health. This proposal replaced the earlier proposal of April 2005 for a Community Programme for Health and Consumer Protection. This was done following the European Parliament’s first reading of the 2005 proposal and in the light of the final inter-institutional agreement on the general EU budgetary perspectives for 2008 to 2013. The Health Ministers Council adopted a “common position” in early 2007, and the Programme went through the European Parliament in second reading on 23 October 2007. The Programme sets the framework for the Commission's funding of projects relating to health until 2013, with a budget of € 321.5 million. The new Programme’s objectives are built on multiple lines (Table 12.9).

 

Table 12.9. Actions referred to in the Second Public Health Programme.

 

1. Improve citizens' health security.

1.1. Protect citizens against health threats.   1.1.1. Develop strategies and mechanisms for preventing, exchanging information on and responding to health threats from communicable and non-communicable diseases and health threats from physical, chemical or biological sources, including deliberate release acts; take action to ensure high-quality-diagnostic cooperation between Member States' laboratories; support the work of existing laboratories carrying out work with relevance to the Community; work on the setting up of a network of Community reference laboratories.   1.1.2. Support the development of prevention, vaccination and immunisation policies; improve partnerships, networks, tools and reporting systems for immunisation status and adverse events monitoring.   1.1.3. Develop risk management capacity and procedures; improve preparedness and planning for health emergencies, including preparing for coordinated EU and international responses to health emergencies; develop risk communication and consultation procedures on counter-measures.   1.1.4. Promote the cooperation and improvement of existing response capacity and assets, including protective equipment, isolation facilities and mobile laboratories to deploy rapidly in emergencies.   1.1.5. Develop strategies and procedures for drawing up, improving surge capacity of, conducting exercises and tests of, evaluating and revising general contingency and specific health emergency plans and their inter-operability between Member States.

1.2. Improve citizens' safety   1.2.1. Support and enhance scientific advice and risk assessment by promoting the early identification of risks; analyse their potential impact; exchange information on hazards and exposure; foster integrated and harmonised approaches.   1.2.2. Help to enhance the safety and quality of organs and substances of human origin, blood, and blood derivatives; promote their availability, traceability and accessibility for medical use while respecting Member States' responsibilities as set out in Article 152(5) of the Treaty.   1.2.3. Promote measures to improve patient safety through high-quality and safe healthcare, including in relation to antibiotic resistance and nosocomial infections.

2. Promote health

2.1. Foster healthier ways of life and the reduction of health inequalities   2.1.1. 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.   2.1.2. Support initiatives to identify the causes of, address and reduce health inequalities within and between Member States, including those related to gender differences, in order to contribute to prosperity and cohesion; promote investment in health in cooperation with other Community policies and funds; improve solidarity between national health systems by supporting cooperation on issues of cross-border care and patient and health professional mobility.

2.2. Promote healthier ways of life and reduce major diseases and injuries by tackling health determinants   2.2.1. Address health determinants to promote and improve physical and mental health, creating supportive environments for healthy lifestyles and preventing disease; take action on key factors such as nutrition and physical activity and sexual health, and on addiction-related determinants such as tobacco, alcohol, illegal drugs and pharmaceuticals used improperly, focusing on key settings such as education and the workplace, and across the life cycle.

3. Collect, analyse and disseminate health information

3.1. 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 screening1; collect data on health status and policies; develop, with the Community Statistical Programme, the statistical element of this system.   3.2. Develop mechanisms for analysis and dissemination, including Community health reports, the Health Portal and conferences; provide information to citizens, stakeholders and policy makers, develop consultation mechanisms and participatory processes; establish regular reports on health status in the European Union based on all data and indicators and including a qualitative and quantitative analysis.   3.3. Provide analysis and technical assistance in support of the development or implementation of policies or legislation related to the scope of the Programme.

 

 

The health information and knowledge strand provides the technical platform for the collection, analysis and dissemination of data and information related to health status, health determinants and health systems. Several working parties have been set up to take forward activities on indicators, data and diffusion in a number of priority areas (health indicators, health and environment, lifestyles, mortality and morbidity, injuries and accidents, mental health and health services). A Network of Competent Authorities provides the necessary link to the Member State authorities and to relevant international organisations (WHO, OECD) in cooperation with EUROSTAT. A European Health Portal (http://ec.europa.eu/health-eu/index_en.htm) has become the main entry point to search for health-related information, with a short list of European health indicators, including the “Healthy Life Years” structural indicator, submitted every year to the Spring European Council. The telematic implication of the system is the European Public Health Information Network (EUPHIN) (see also the EUPHIN newsletter). Among others, the European Commission aims at producing comparable information on health and health-related behaviour of the population, and on diseases and health systems, based on European-wide common agreed indicators with regard to their definition, their collection and use (see Annex 12.1).

 

 

Annex 12.1. System of European Community Health Indicators

 

Several EU co-funded projects have investigated the information needs in important areas of public health and health care and have proposed specific instruments for their determination. Via a system of consultative groups, set-up under the Community Public Health Programme, a System of European Community Health Indicators (ECHI) was defined, which consist of a brief shortlist and a comprehensive long list. Both lists are designed to cover all aspects of public health issues and current efforts are focusing on the development of common instruments and measures to implement these indicators in the EU-member states.

In the following a brief description of the ECHI-System is given. To obtain comprehensive information on the ECHI-list and its implementation process we recommend visiting the internet site of the ECHIM-project (http://www.echim.org).

The ECHI lists are organised in a structural framework that covers all relevant sectors of public health, health care and health policy. Due to its fundamental approach the structural framework creates the possibility to classify the large number of indicators that have been developed in the scope of the projects in the Community Public Health Programme. This provides the user with the possibility to retrieve specific information for a large scope of themes out of a simple conceptual structure.

 

The structural framework for the European Community Health Indicators (ECHI-Hierarchy) is as follows:

 

Demography and socio-economic situation

Population

Socio-economic factors

Health status

Mortality

Mortality Cause-specific

Morbidity Disease-specific

Perceived and functional health

Composite measures of health status

Determinants of health

Personal and biological factors

Health behaviours

Living and working conditions

Health systems

Prevention, health protection and promotion

Health care resources

Health care utilisation

Health expenditure and financing

Health care quality/performance

 

A comprehensive overview of the ECHI indicators and other health indicators presented by the different international organisations is available at the website of the International Compendium of Health Indicators (ICHI, www.healthindicators.org). The ongoing developments concerning the ECHI-Indicators are available at the internet site of the ECHIM-project http://www.echim.org.

 

In spite of the development of a rational and EU-wide system of indicators, the production and utilisation of data from all sectors of public health and the health care sector has to be seen before the background of the national context.

In this context a fragmentation of the public health and the health care sector lead to the situation, that information systems for specific sectors were usually set up, before comprehensive and integrative systems have been developed.

Important issues in this respect have been the surveillance of infectious diseases which has been one of the basic elements of national public health surveillance for a long time.

 

Typically national Health Information Systems are provided with data from several data sources. Such data sources, normally based on national data gathering routines, are

-          Population statistics (Mortality and Birth Statistics, Population data)

-          Disease registers (e. g. cancer, myocardial infarction, stroke)

-          Sentinel Networks (e. g. diseases not under mandatory surveillance)

-          Active Surveillance Measures(e. g. Notifiable Infectious diseases)

-          Administrative data (e. g. health insurance data, data on health care staff)

-          Process data (e. g. data on health care supply in hospitals and medical practice)

-          Data from Epidemiological studies

-          Data from Surveys (e. g. population representative health surveys, health surveys in special population subgroups)

 

 

Feasibility study for the adoption of the Healthy Life Years (HLY) as European Structural Indicator  

 

Prior to acceptance as EU Structural Indicator, HLY underwent a rigorous process of evaluation coordinated by Eurostat and carried out by EHEMU, conforming to a set of criteria concerning historical and future data methodology and accuracy and harmonization both within the EU and wider. Specifically Structural Indicators should cover all the EU Member States plus Iceland, Norway, the United States of America and Japan and data sets should cover a 10-year period, beginning in the 1990s, up to the year for which the most recent data is available.

The feasibility study for HLY used the European Community Household Panel survey (ECHP), the then current data source for disability-free life expectancy (DFLE) calculation (Robine, Jagger and Cambois, 2002 ; Robine, Jagger and Romieu, 2001). This survey, conducted from 1994 to 2001 on the 15 first Member States, allowed EHEMU to demonstrate both the wide range of variability in DFLE across EU Member States and the differing trends over time (Jagger and EHEMU 2005).

 

There is no obvious single trend of compression or morbidity between all countries for men and women. If we consider a gain of 5% between 1995 and 2001 to signify compression and a loss of 5% to signify expansion then for men Austria, Belgium, Finland, Germany and Italy appeared to experience a compression of disability, and Denmark, the Netherlands, Sweden and the United Kingdom an expansion. For women at age 65 Belgium, Italy and Sweden appeared to experience a compression of disability whilst Germany, Ireland, the Netherlands and Portugal experienced an expansion. Although there is some consistency between the genders with Italy and Belgium showing compression for men and women and the Netherlands and Portugal showing expansion for both, there is considerable heterogeneity between the genders. These gender differences may be a result of differential reporting of disability or the omission of the institutionalized population (which will adversely affect older women more than older men).  However if real, they may reflect different stages of health transitions as populations age as suggested by Robine and Michel (2004).

In the first assessment to be a Structural Indicator, HLY was awarded a grade B. The two main issues were shortcomings with regard to comparability between Member States/Candidate Countries/US and Japan (including the lack of data), and a break in the series which hampers comparison over time. Indeed the ECHP ended in 2001 and no European data was available for 2002 or 2003. However a new survey, the Statistics of Income and Living Conditions (SILC) began in 2004 in several Member States and from 2005 in the EU25 and 2006 in the EU27 (Robine and Jagger, in press).

 

Figure 12.A1.1a Trend in the proportion of life spent disability-free at age 65 years for selected EU Member States - men.

 

Figure 12.A1.1b Trend in the proportion of life spent disability-free at age 65 years for selected EU Member States - women.

 

These data sources regularly produce a large amount of data that is usually distributed over a number of agencies and institutes. The processing and analyses is performed in diverse organisational structures, usually under the responsibility of different authorities. The integration of this fragmented information and the underlying distributed data sources are one of the important issues that have to be solved in the development of a national health information system.

 

The added value of a comprehensive system of data gathering, interpretation and reporting has been reconfirmed by the parliamentary decision (34/2001/EC, adopted by the Council on 31.July 2001). In this decision the European Union defines the tasks for the establishment of a sustainable health information and knowledge system in the following way: “There is a particular need to ensure, relying on competent and relevant expertise, appropriate sustainable co-ordination, in the area of health information, of activities in relation to the following: definition of information needs, development of indicators, collection of data and information, comparability issues, exchange of data and information with and between member states, continuing development of databases, analyses and wider dissemination of information.” These needs have been taken up by several projects co-funded by the European Commission. Especially in the field of indicator development an important result could be achieved, leading to the establishment of the European Community Health Indicators (ECHI). Current activities focus at the implementation of these indicators in the EU member states. This ongoing work is performed in a number of working groups established under the Public Health Action Programme of DG Sanco (e.g. ECHIM and the Working Party Health Indicators) and the European Health Survey System under the responsibility of DG Eurostat.

 

A significant step towards a comprehensive health information and knowledge system has been the official launch of the EU Health Portal in 2006 (http://ec.europa.eu/health-eu/). The portal is an initiative of the Community Public Health Programme 2003-2008 intended to permit greater involvement of individuals, institutions, associations, organisations and bodies in the health sector by facilitating consultation and participation. In this framework, attention is given to the right of the EU population to receive simple, clear and scientifically sound information about measures to protect health and prevent diseases. One of the main aims of the portal is to convey that citizens share responsibility for improving their health. The objective is to continue the work on specific indicators in order to complete the European Community Health Indicators list that will serve Part II - Health policies and action programmes of the European Union as a basis for the European health information and knowledge system including their operational definitions. As in the past, the programme will support the elaboration of regular European health status reports.

 

The European Commission has also launched public health reporting projects under the guidance of the panel on Health Information and Knowledge. The reports deal with topical public health issues that provide material for further policy developments. As they are launched annually it is the objective to have a steady flow of solid reports finalised every year during the new public health programme. The launching of reports aims at bringing together top European scientists from all EU countries and thus contributing to the creation of the European Research Area. The reports are made in close cooperation with the Working Parties on health indicators and data collection. Reports will be published both electronically – the European Public Health Report Series and in a high quality printed format.

 

The first project in this framework is the present EUGLOREH project.