Part,  Chapter, Paragraph

   1    -,     1            |               Assessment of the status of health through selected indicators
   2    -,     1            |                 period;~· Analysis of the health determinants underlying
   3    -,     1            |               underlying the evolution of health indicators, and related
   4    -,     1            |             identify priorities in public health on behalf of the European
   5    -,     1            |                  of what is the status of health in the European Union, the
   6    -,     1            |             European Union, the nature of health determinants and relevant
   7    -,     1            |               published:~a) in 2003, “The Health Status of the European Union -
   8    -,     1            |            European Union - Narrowing the Health gap”;~b) in 1996, “The State
   9    -,     1            |                    in 1996, “The State of Health in the European Community”.~
  10    -,     1            |        financially supported by the D.G. "Health and Consumers" of the European
  11    -,     1            |           designated by the Ministries of Health (or by the Scientific Institutions
  12    -,     1            |                  and disorders as well as health determinants and main policies
  13    -,     1            |                   understand well how the health status of each individual
  14    -,     1            |                  on public and individual health.~ ~It is important to highlight
  15    -,     1            |                caution. A European public health goal should therefore seek
  16    -,     1            |                  reports on the status of health in the European Union as
  17    -,     1            |                can be useful for EU D.G.Health and Consumers” and Health
  18    -,     1            |                 Health and Consumers” and Health Authorities of European
  19    -,     1            |                and information related to health status, health determinants,
  20    -,     1            |                 related to health status, health determinants, health systems
  21    -,     1            |              status, health determinants, health systems and health policies
  22    -,     1            |          determinants, health systems and health policies as well as to facilitate
  23    -,     1            |                   efficient manner public health priorities as well as adopt
  24    -,     1            |              tools to further improve the health conditions of their citizens.
  25    -,     1            |                 European Commission D. G. Health and Consumers (http://ec.
  26    -,     1            |                   http://ec.europa.eu/dgs/health_consumer/index_en.htm).~ ~
  27    -,     1            |             colleagues at the Ministry of Health and at the National Health
  28    -,     1            |                Health and at the National Health Institute: Nicola Begini,
  29    -,     1            |                   seconded from the World Health Organization - European
  30    I                   |                  PART I – THE CONTEXT FOR HEALTH~
  31    I,     2            |                  THE CHANGING CONTEXT FOR HEALTH IN THE EUROPEAN UNION~ ~ ~
  32    I,     2.Acr        |                Gross Domestic Product~HTA~Health technology assessment~ICT~
  33    I,     2.Acr        |                  Member States~PHG~Public Health Genomics~RFID~Radio Frequency
  34    I,     2.  1        |                 context in which citizens health has been and will be pursued.
  35    I,     2.  1        |                   same time, the national health policies and services of
  36    I,     2.  1        |                the growing challenges and health needs; the European (Economic)
  37    I,     2.  1        |               context in order to promote health and well being of the European
  38    I,     2.  1        |                 for their major impact on health outcomes, have become more
  39    I,     2.  1        |                  the increasing demand of health implies higher and higher
  40    I,     2.  1        |            important to keep in mind that health is not only a cost for Society,
  41    I,     2.  1        |                the economic importance of health in the labour market in
  42    I,     2.  1        |             studies exploring the role of health in a specific country over
  43    I,     2.  1        |                   to past achievements in health. In addition to the direct
  44    I,     2.  1        |                   to the direct effect of health on economy, there is also
  45    I,     2.  1        |                  is also an impact of the health system on the economy irrespective
  46    I,     2.  1        |                  of the ways in which the health system affects health. As
  47    I,     2.  1        |                 the health system affects health. As one of the larger service
  48    I,     2.  1        |                larger service industries, health represents one of the most
  49    I,     2.  1        |                  EU25 are employed in the health and social work sector.
  50    I,     2.  1        |                    the performance of the health sector will affect the competitiveness
  51    I,     2.  1        |                   to preserve and improve health take place in the EU is
  52    I,     2.  1        |          background conditions underlying health developments in the EU.
  53    I,     2.  3        |                   in the EU may impact on health services demand. Poverty
  54    I,     2.  3        |                 difficulties in accessing health care services, they may
  55    I,     2.  3        |         adequately and the quality of the health care services provided to
  56    I,     2.  3        |                   attitudes to and use of health care services. On the other
  57    I,     2.  3        |              services. On the other hand, health workers may be less able
  58    I,     2.  3        |                immigrant populations. The health status and the use of health
  59    I,     2.  3        |              health status and the use of health services among immigrants
  60    I,     2.  3        |                    which may face special health and social problems. Moreover,
  61    I,     2.  3        |            present specific challenges to health systems, not least if they
  62    I,     2.  4        |                 cure rates, and access to health services (Report prepared
  63    I,     2.  4        |                American Journal of Public Health).~ ~An independent comprehensive
  64    I,     2.  4        |           comprehensive expert Report on “Health inequalities “, commissioned
  65    I,     2.  4        |                 protective social, public health and healthcare institutions;
  66    I,     2.  4        |                  better against increased health risks, and/or have been
  67    I,     2.  4        |                from new opportunities for health gains. An example is provided
  68    I,     2.  4        |           suggests that a widening of the health gap in a period of important
  69    I,     2.  4        |             number of years lived in good health).~Inequalities are also
  70    I,     2.  4        |               significant improvements in health across the EU, access to
  71    I,     2.  4        |                 Few have begun to address health inequalities systematically
  72    I,     2.  4        |                    preventing the ensuing health differences, or addressing
  73    I,     2.  4        |                    or addressing the poor health that results. This would
  74    I,     2.  4        |             Finally, policies outside the health sector are also central
  75    I,     2.  4        |                  central to improving the health of the population and reducing
  76    I,     2.  5        |                implications for workplace health and safety. They can affect
  77    I,     2.  5        |              conditions can contribute to health problems, although traditional
  78    I,     2.  5        |                   management of workplace health and safety. The use of subcontractors,
  79    I,     2.  5        |            European Agency for Safety and Health at Work, 2002).~Detecting
  80    I,     2.  5        |                  traditional occupational health and safety hazards still
  81    I,     2.  5        |                administration; education; health and social work; community
  82    I,     2.  5        |                 an increase in delivering health and social services care
  83    I,     2.  5.  0(2) |            European Agency for Safety and Health at Work. Research on the
  84    I,     2.  5.  0(2) |                   occupational safety and health in some Member States of
  85    I,     2.  5        |                   attention is needed for health and safety issues because
  86    I,     2.  5        |                 stress and the associated health impact.~ ~Active inclusion
  87    I,     2.  5        |                 view of people’s improved health status and life expectancy,
  88    I,     2.  5        |                these jobs is that written health and safety notices are important
  89    I,     2.  5        |                  labour market puts their health and safety at increased
  90    I,     2.  5        |            European Agency for Safety and Health at Work, 2006).~Both case
  91    I,     2.  5        |                  in new risks to workershealth.~ ~New qualifications. The
  92    I,     2.  5        |              know-how to manage workplace health. In SMEs, particularly in
  93    I,     2.  5        |                 that will also affect the health and safety management process.
  94    I,     2.  5        |              negative impact on workplace health and safety. It is clear
  95    I,     2.  5        |                   It is clear that public health and workplace health interventions
  96    I,     2.  5        |               public health and workplace health interventions among workers
  97    I,     2.  6        |                   to preserve and promote health. Significant differences
  98    I,     2.  6        |           majority of those graduating in health and welfare and teacher
  99    I,     2.  7        |                 mechanisms that influence health status and mortality of
 100    I,     2.  7        |                  such as the provision of health care. Key dimensions of
 101    I,     2.  7        |             direct or indirect effects on health, it is up to the health
 102    I,     2.  7        |                   health, it is up to the health system to provide adequate
 103    I,     2.  7        |                  inhabitants but also the health and sustainability of the
 104    I,     2.  7        |             cities and settlements public health would benefit from an improved
 105    I,     2.  7        |             identifying the environmental health determinants in rural places
 106    I,     2.  8        |                   may increase the public health effects. Various forms of
 107    I,     2.  8        |                   public and occupational health impacts along the production
 108    I,     2.  8        |               order to analyze the public health impacts of energy production
 109    I,     2.  8        |                The WHO has summarized the health impacts of different forms
 110    I,     2.  8        |                 Table 2.4.~ ~ ~Table 2.4. Health impacts of different forms
 111    I,     2.  8        |       Energy-generating~Resource~ ~Direct health impacts~ ~ ~ ~ ~Indirect
 112    I,     2.  8        |                  impacts~ ~ ~ ~ ~Indirect health impacts (contribution to
 113    I,     2.  8        |               pollution, but magnitude of health impact depends on combustion
 114    I,     2.  8        |              climate change and resultant health impacts difficult to quantify;
 115    I,     2.  8        |                and hence probably greater health impacts~As for coal~ ~As
 116    I,     2.  8        |                   other fossil fuels, but health effects primarily from air
 117    I,     2.  8        |                      change and resultant health impacts difficult to quantify
 118    I,     2.  8        |               pollution, but magnitude of health impaci depends on combustion
 119    I,     2.  8        |                 Source: WHO (2004)~ ~Many health outcomes depend on the technology
 120    I,     2.  8        |             technology used, occupational health and safety practices, measures
 121    I,     2.  8        |                  influence the associated health effects. We have to make
 122    I,     2.  8        |        environment and therewith on human health. Renewable sources, such
 123    I,     2.  8        |                 are associated with fewer health effects in general. There
 124    I,     2.  8        |                energy, will have positive health benefits. The production
 125    I,     2.  8        |                  concerns about the human health consequences of nuclear
 126    I,     2.  8        |                   also very important for health; in fact, significant increases
 127    I,     2.  9        |                    flora, fauna and human health have been recently reviewed
 128    I,     2.  9        |              status of lakes and enhanced health risks, particularly in water
 129    I,     2.  9        |                  various effects on human health. Heat waves are projected
 130    I,     2.  9        |              behaviour and the quality of health care services and their
 131    I,     2.  9        |                  and act.~ ~The impact on health of extreme weather events (
 132    I,     2. 10.  1    |                   promotion of population health which will lead to fundamental
 133    I,     2. 10.  1    |              systems. Medicine and public health get an increasing insight
 134    I,     2. 10.  1    |                   in the understanding of health and diseases as well as
 135    I,     2. 10.  1    |                concepts of prevention and health service delivery, the emerging
 136    I,     2. 10.  1    |                  paradigm shift in public health. As a consequence, we can
 137    I,     2. 10.  1    |                 how it can include public health aspects in its work programme,
 138    I,     2. 10.  1    |                   programme, while public health needs to analyse how genomics
 139    I,     2. 10.  1    |             changes the concept of public health. The second approach is
 140    I,     2. 10.  1    |                   the core task of Public Health Genomics (PHG). Still there
 141    I,     2. 10.  1    |                directions, e.g. as Public Health services, surveillance,
 142    I,     2. 10.  1    |               professions and the genetic health literacy of the lay population.~ ~
 143    I,     2. 10.  1    |              concepts of surveillance and health statistics. So far, there
 144    I,     2. 10.  1    |                   of genomics into public health. Indicators and statistical
 145    I,     2. 10.  1    |                  are needed for secondary health data such as the exposure
 146    I,     2. 10.  1    |                the impact o food on human health (nutrigenomics). Current
 147    I,     2. 10.  1    |                   nutrigenomics). Current health statistics and surveillance
 148    I,     2. 10.  1    |              future use of indicators and health statistics will also depend
 149    I,     2. 10.  1    |        technological applications. Public Health Genomics advocates the interdisciplinary
 150    I,     2. 10.  2    |                and feed additives, animal health, veterinary drugs, pesticides
 151    I,     2. 10.  2    |               drugs, pesticides and plant health.~ ~The existing and/or foreseen
 152    I,     2. 10.  2    |                prevention of the possible health and environmental risks (
 153    I,     2. 10.  3    |               tools include:~ ~Electronic health cards. Building on the agreement
 154    I,     2. 10.  3    |                   Council that a European health insurance card should replace
 155    I,     2. 10.  3    |              paper based forms needed for health treatment in another Member
 156    I,     2. 10.  3    |                identifiers and electronic health record architecture through
 157    I,     2. 10.  3    |                 secure access to personal health information.~ ~Health information
 158    I,     2. 10.  3    |            personal health information.~ ~Health information networks. Member
 159    I,     2. 10.  3    |              Member States should develop health information networks between
 160    I,     2. 10.  3    |            information networks of public health data and co-ordinate actions
 161    I,     2. 10.  3    |            Europe-wide rapid reactions to health threats.~ ~On-line health
 162    I,     2. 10.  3    |                 health threats.~ ~On-line health services. Commission and
 163    I,     2. 10.  3    |                  will ensure that on-line health services are provided to
 164    I,     2. 10.  3    |            illness prevention, electronic health records, teleconsultation,
 165    I,     2. 10.  3    |             e-reimbursement). Some of the health and related preventative
 166    I,     2. 10.  3    |                  by Member States to make health information as accessible
 167    I,     2. 10.  3    |                  criteria for websites.~ ~Health Telematics. The High Level
 168    I,     2. 10.  3    |                   High Level Committee on Health established a Working Group
 169    I,     2. 10.  3    |            established a Working Group on Health Telematics to review the
 170    I,     2. 10.  3    |                   technology (ICT) in the health sector, the factors promoting
 171    I,     2. 10.  3    |         particular applications of ICT in health, namely health cards, virtual
 172    I,     2. 10.  3    |                  of ICT in health, namely health cards, virtual hospitals
 173    I,     2. 10.  3    |             health-related information to health professionals and patients.~ ~
 174    I,     2. 10.  3    |                  of direct interest to DG Health and Consumer Protection'
 175    I,     2. 10.  4    |                 realisation of associated health and economic benefits: reducing
 176    I,     2. 10.  4(12)|                   carUK Departament of Health16 Febrauary 2007~
 177    I,     2. 10.  4(13)|                                     World Health OrganizationFact sheet
 178    I,     2. 10.  4(15)|                                     World health OrganizationFact sheet
 179    I,     2. 10.  4(16)|                              The European Health Management Association~
 180    I,     2. 10.  4(17)|                             Creation of a Health Care Value Chain through
 181    I,     2. 10.  4(19)|                  careUK Depertament of health16 February 2007~
 182    I,     2. 10.  4(20)|              Vertical Integration ibn the Health Value Chain “, Dr. Alberto
 183    I,     2. 10.  4    |            standards21. The Department of Health in the UK already called
 184    I,     2. 10.  4    |                  fully. The Department of Health is recommending that the
 185    I,     2. 10.  4(22)|            patient careUK Department of Health16 February 2007~
 186    I,     2. 10.  5    |                                   2.10.5. Health technology assessment~ ~
 187    I,     2. 11        |                   and spatial behavior in health care utilization among residents
 188    I,     2. 11        |              residents of a rural region. Health Services Research, 40, 135-
 189    I,     2. 11        |            European Agency for Safety and Health at Work (2002): Research
 190    I,     2. 11        |                   occupational safety and health in some Member States of
 191    I,     2. 11        |            European Agency for Safety and Health at Work (2006). Research
 192    I,     2. 11        |                   Occupational Safety and Health. htt m (accessed 21.11.06).~
 193    I,     2. 11        |                   Promoting Finnish Heart Health for the Years 2005-2011.
 194    I,     2. 11        |                 Understanding barriers to health care: a review of disparities
 195    I,     2. 11        |                  review of disparities in health care services among indigenous
 196    I,     2. 11        |            populations. Int J Circumpolar Health. 2007 Jun;66(3):188-98.~
 197    I,     2. 11        |                   2006): NIOSH Safety and Health Topic: Nanotechnology. htt ch~
 198    I,     2. 11        |             ultrafine particles. Environ. Health Perspectives, 113(7), 823-
 199    I,     2. 11        |                   the Workplace. Environ. Health Perspectives, 115(1), 5-
 200    I,     2. 11        |                   J (2005): The impact of health on economy: theoretical
 201    I,     2. 11        |                   In: The contribution of health to the economy in the European
 202    I,     2. 11        |                 in the European Union. DG Health and Consumer Protection,
 203   II                   |                                 PART IIHEALTH CONDITIONS~
 204   II,     4            |                                4.~OVERALL HEALTH TRENDS~
 205   II,     4.Acr        |            Household Panel~EHEMU~European Health Expectancy Monitoring Unit~
 206   II,     4.Acr        |             Monitoring Unit~EHIS~European Health Interview Survey~EHSS~European
 207   II,     4.Acr        |            Interview Survey~EHSS~European Health Survey System~EUROPOP 2004~
 208   II,     4.Acr        |                Care~MEHM~Minimum European Health Module~NCHS~National Center
 209   II,     4.Acr        |                  NCHS~National Center for Health Statistics~SES~Socio-Economic
 210   II,     4.  1        |                being spent in good or bad health is a crucial question both
 211   II,     4.  1        |                 infer improvements in the health of populations. This was
 212   II,     4.  1        |              development of indicators of health expectancies, such as disability-free
 213   II,     4.  1        |            various states of good and bad health (Robine, Jagger and Euro-REVES,
 214   II,     4.  1        |              Healthy Life Years” (HLY), a health expectancy indicator among
 215   II,     4.  1        |                   Structural Indicator on health and in its 2005 annual report
 216   II,     4.  1        |                  at age 50 and 65) as key health indicators for the EU27
 217   II,     4.  1        |                  expectancy lived in good health.~ ~In this chapter we present
 218   II,     4.  1        |                longer life implies better health.~ ~All calculations where
 219   II,     4.  1        |               online through the European Health Expectancy Monitoring Unit (
 220   II,     4.  1        |             contains the Minimum European Health Module (MEHM) which was
 221   II,     4.  1        |                  is to be a subset of the health module in the European Health
 222   II,     4.  1        |             health module in the European Health Interview Survey (EHIS).
 223   II,     4.  1        |              chronic morbidity, perceived health and disability, the latter
 224   II,     4.  1        |                 last 6 months, because of health problems (Robine, Jagger
 225   II,     4.  1        |                chronic physical or mental health problem, illness or disability
 226   II,     4.  1        |                  these physical or mental health problems, illnesses or disabilities.~ ~
 227   II,     4.  1        |                   2005 (see above).~ ~All health expectancy calculations
 228   II,     4.  1        |                 Methodological reports on health expectancies can be found
 229   II,     4.  1        |        differences in reporting one’s own health, this indicator is likely
 230   II,     4.  1        |                  comparing time trends in health in individual countries
 231   II,     4.  1        |            available because the European Health Survey System (EHSS) is
 232   II,     4.  1        |                more than 60 years in good health, as estimated by the HLY
 233   II,     4.  1        |                divergences coincided with health crises across the EU27 but
 234   II,     4.  1        |                 data from the Ministry of Health and Welfare for Japan (Ministry
 235   II,     4.  1        |            Welfare for Japan (Ministry of Health and Welfare, 2006).5~ ~ ~
 236   II,     4.  1        |         significantly throughout European health strategies and the Public
 237   II,     4.  1        |                 strategies and the Public Health programme as the means by
 238   II,     4.  1        |                  means by which improving health of European citizens are
 239   II,     4.  1        |                   aimed at increasing the health of European citizens. The
 240   II,     4.  1        |                 White Paper “Together for Health: A Strategic Approach for
 241   II,     4.  1        |              objectives that of promoting health and preventing disease in
 242   II,     4.  1        |                 be to redress many of the health inequities which currently
 243   II,     4.  1        |                 and not simply to improve health of all MS equally.~ ~Moreover,
 244   II,     4.  1        |                   Moreover, improving the health of European citizens has
 245   II,     4.  1        |                  of an ageing population. Health means wealth and therefore
 246   II,     4.  1        |                means wealth and therefore health is fundamental for economic
 247   II,     4.  1        |                  the indicator to monitor health within the EU must be recognised
 248   II,     4.  1        |                  two overarching national health goals are to increase the
 249   II,     4.  1        |                healthy life and eliminate health disparities. In this framework,
 250   II,     4.  1        |                the US National Center for Health Statistics (NCHS) developed
 251   II,     4.  1        |                  a contribution to global health, one of the fundamental
 252   II,     4.  1        |            summary measures of population health to meet the EU political
 253   II,     4.  1        |                   20 years of research on health expectancies (Robine et
 254   II,     4.  1        |                  ECHP are resolved in the health questions in SILC (and further
 255   II,     4.  1        |                 process to the underlying health concept will minimise cultural
 256   II,     4.  1        |                  Eurostat, and the Public Health Executive Agency) are working
 257   II,     4.  1        |                   through a Task Force on Health Expectancies and through
 258   II,     4.  3        |                  U.S. National Center for Health Statistics.~ ~Ministry of
 259   II,     4.  3        |                 Statistics.~ ~Ministry of Health and Welfare (2006): Abridged
 260   II,     4.  3        |                  Secretariat, Ministry of Health and Welfare.~ ~Riley, J.
 261   II,     4.  3        |                 Plan of the Task Force on Health Expectancies, 2007-2010.
 262   II,     4.  3        |                  of indicators to monitor health across Europe: the Euro-REVES
 263   II,     4.  3        |                European Journal of Public Health 13(3): 6-14.~ ~Robine, J.-
 264   II,     4.  3        |                  Eds. (2003): Determining health expectancies. Chichester,
 265   II,     4.  3        |                  of indicators to monitor health across Europe: The Euro-REVES
 266   II,     4.  3        |                European Journal of Public Health 2003; 13:6-14.~ ~Robine,
 267   II,     4.  3        |                  mortality and morbidity. Health Services Mental Health Administration
 268   II,     4.  3        |                    Health Services Mental Health Administration Health Reports
 269   II,     4.  3        |              Mental Health Administration Health Reports 86( ): 347-354.~ ~
 270   II,     4.  3        |                 354.~ ~U.S. Department of Health and Human Services (2006):
 271   II,     4.  3        |                    DC, U.S. Department of Health and Human Services: 34.~ ~
 272   II,     4.  3        |                   51(3): 153-161.~ ~World Health Organization (1997): The
 273   II,     4.  3        |            Organization (1997): The World Health Report 1997. Conquering
 274   II,     5            |                                        5.~HEALTH IMPACTS OF NON COMMUNICABLE
 275   II,     5.  1.  1    |                 to the promotion of those health determinants related to
 276   II,     5.  1.  1    |              factors influencing personal health and may contribute to fall
 277   II,     5.  1.  1    |             periodontal disease and other health problems, including heart
 278   II,     5.  1.  2    |                 are promoted by the World Health Organization, national health
 279   II,     5.  1.  2    |             Health Organization, national health organizations, medical schools,
 280   II,     5.  1.  2    |         Organizations. At national level, health decision makers are also
 281   II,     5.  1.  2    |         recommendations of their national health policy. There are other
 282   II,     5.  1.  2    |                closely linked to personal health beliefs as well as to the
 283   II,     5.  1.  3    |               between the patient and his health care professional in order
 284   II,     5.  1.  3    |         continuous process, integrated in health care. Moreover, it is patient-centered
 285   II,     5.  1.  3    |                  care, hospital and other health care settings, organizational
 286   II,     5.  1.  3    |                  and behaviour related to health and illness. Therapeutic
 287   II,     5.  1.  3    |                 treatment, cooperate with health care providers, live healthily,
 288   II,     5.  1.  3    |             learning process, provided by health care providers trained in
 289   II,     5.  1.  3    |                disease, locus of control, health beliefs, and socio-cultural
 290   II,     5.  1.  3    |                  process and its effects. Health care providers tend to talk
 291   II,     5.  1.  3    |                   is education managed by health care providers trained in
 292   II,     5.  1.  4    |             insurance company or national health service, specific courses
 293   II,     5.  2.Acr    |                 Pressure~WHO MONICA~World Health Organization MONItoring
 294   II,     5.  2.Acr    |     CArdiovascular diseases~WHO-HFA~World Health Organization – Health for
 295   II,     5.  2.Acr    |               World Health OrganizationHealth for All~
 296   II,     5.  2.  1    |                Employment, Social Policy, Health and Consumer Affairs Council
 297   II,     5.  2.  1    |                  greatest contributors to health expenditures. Stroke is
 298   II,     5.  2.  1    |                   life long dependence on health services and medications.
 299   II,     5.  2.  1    |                  only directly related to health care and social services,
 300   II,     5.  2.  1    |                lead to an increase in the health burden of CVD and consequent
 301   II,     5.  2.  1    |            priority to reduce the growing health burden and lessen its socio-economic
 302   II,     5.  2.  2    |                projects such as the World Health Organization MONItoring
 303   II,     5.  2.  2    |               were published by the World Health Organization of United Nations (
 304   II,     5.  2.  3    |                the environment exposures, health behaviours, diagnosis and
 305   II,     5.  2.  4    |                   due to the high cost of health examination surveys. Table
 306   II,     5.  2.  4    |                   habit collected through health interview surveys. Prevalence
 307   II,     5.  2.  4    |                   attached European Heart Health Charter Annex 1). Interestingly,
 308   II,     5.  2.  5    |                   order to improve public health through planning and implementing
 309   II,     5.  2.  5    |                  promoting cardiovascular health, emphasize the importance
 310   II,     5.  2.  5    |                 out in the European Heart Health Charter and its working
 311   II,     5.  2.  5    |               help reduce inequalities in health and in accessing healthcare.
 312   II,     5.  2.  5    |                  promoting cardiovascular health in the Health Council conclusions~·
 313   II,     5.  2.  5    |              cardiovascular health in the Health Council conclusions~· The
 314   II,     5.  2.  5    |                 of National Ministries of Health, European and National representatives
 315   II,     5.  2.  5    |                    The purpose to protect health and improve the quality
 316   II,     5.  2.  5    |           prospects of the integration of health in all policies expressed
 317   II,     5.  2.  5    |                Employment, Social Policy, Health and Consumer Affairs Council
 318   II,     5.  2.  5    |                2006)~· The European Heart Health Charter was developed with
 319   II,     5.  2.  5    |            European Commission, the World Health Organization (WHO-Europe),
 320   II,     5.  2.  5    |          Cardiology.~· The European Heart Health Charter was officially launched
 321   II,     5.  2.  6    |                   the escalating costs of health services. Therefore, we
 322   II,     5.  2.  6    |                 problem for both adequate health planning and clinical decision
 323   II,     5.  2.  6    |                   increase among women as health benefits of smoking cessation
 324   II,     5.  2.  6    |                    WHO, 2007) establishes health, nutrition, food safety
 325   II,     5.  2.  6    |                 own national policies and health system governance and for
 326   II,     5.  2.  6    |          nutrition and food safety in the health sector, and monitoring and
 327   II,     5.  2.  7    |            EUROCISS Project. Eur J Public Health 13: 55-60~European society
 328   II,     5.  2.  7    |                Employment, Social Policy, Health and Consumer Affairs Council
 329   II,     5.  2.  7    |               countries, 1968-1977. World Health Stat Q. 35 (1):1147.~Pol ):
 330   II,     5.  2.  7    |           diseases. Bulletin of the World Health Organization 76:419-425.~Sac p.
 331   II,     5.  2.  7    |               countries since 1950. World Health Stat Q 41(3-4):155178.~
 332   II,     5.  2.  7    |                    1981-2000. Am J Public Health 95 (1): 103-108.~WHO Expert
 333   II,     5.  3.Acr    |                  EUROCHIP~European Cancer Health Indicator Project~FACT~Fighting
 334   II,     5.  3.Acr    |                 Human Papilloma Virus~HTA~Health Technology Assessment~IARC~
 335   II,     5.  3.Acr    |                   National Expenditure on Health~WCRF~World Cancer Research
 336   II,     5.  3.Acr    |                   Research Fund~WHO~World Health Organisation~ ~
 337   II,     5.  3.  1    |                  cancers for their public health relevance. Table 5.3.1 shows
 338   II,     5.  3.  2    |                 the burden and the public health impact of cancer: the minimal
 339   II,     5.  3.  2    |              playing a key role in public health, but not all the EU-27 Member
 340   II,     5.  3.  2    |                 of their impact on public health. As a consequence, several
 341   II,     5.  3.  2    |                 in the interest of public health. This would create harmonised
 342   II,     5.  3.  2    |                   requirement as a public health tool for evaluation of cancer
 343   II,     5.  3.  2    |          epidemiological research, public health programme planning, and
 344   II,     5.  3.  2    |             essential to implement Cancer Health Information System in the
 345   II,     5.  3.  2    |                 IARC is part of the World Health Organization and its mission
 346   II,     5.  3.  2    |             establishing or strengthening health information systems. See:
 347   II,     5.  3.  4    |                 to the promotion of those health determinants related to
 348   II,     5.  3.  6    |                   national expenditure on health (TNEH) for most countries.
 349   II,     5.  3.  6    |              efficiently allocating their health resources.~ ~Patients diagnosed
 350   II,     5.  3.  7    |                  important area of public health. The cessation of smoking,
 351   II,     5.  3.  7    |                  informed one. The public health effects of a screening programme,
 352   II,     5.  3.  7    |            subjects may lead to important health benefits, especially for
 353   II,     5.  3.  7    |                  or overall investment in health care (Coleman et al, 2003).~
 354   II,     5.  3.  7    |               treatment and investment in health care (Coleman et al, 2003).
 355   II,     5.  3.  7    |                any economic evaluation or Health Technology Assessment (HTA)
 356   II,     5.  3.  7    |                drugs is available for the health care system and hospital
 357   II,     5.  3.  7    |                 to be addressed up front. Health care systems and the pharmaceutical
 358   II,     5.  3.  7    |         innovative drugs, it comes to the health care system to integrate
 359   II,     5.  3.  7    |          Organising and delivering public health programmes designed both
 360   II,     5.  3.  7    |                  at all levels within the health system.~Cancer control plans (
 361   II,     5.  3.  7    |            collaboration between national health authorities, research organisation,
 362   II,     5.  3.  7    |                  on Cancer as part of its Health Strategies in Europe conference,
 363   II,     5.  3.  7    |                priorities in the field of health, and promoted the adoption
 364   II,     5.  3.  7    |         internationally recognised public health institutes in the EU, under
 365   II,     5.  3.  7    |         palliative care. The Parliament’s health committee has now called
 366   II,     5.  3.  8    |           sustained collaboration between health authorities, research organizations,
 367   II,     5.  3.  8    |                   variation in demand for health services as a function of
 368   II,     5.  3.  8    |            collaboration between national health authorities, private sectors,
 369   II,     5.  3.  8    |            implementation of the “Gaining Healthpolicy and outline for
 370   II,     5.  3.  8    |                 find ways of reducing the Health Systems expenditures in
 371   II,     5.  3.  9    |                 EU (JulyDecember 2007) Health Strategies in Europe, 12 –
 372   II,     5.  3.  9    |                 EU (JulyDecember 2007) Health Strategies in Europe, 12 –
 373   II,     5.  3.  9    |           proposed set of European cancer health indicators. Eur J Public
 374   II,     5.  3.  9    |                  indicators. Eur J Public Health 13(3 Suppl):116-118.~ ~Parkin
 375   II,     5.  4.Acr    |                   ECHI~European Community Health Indicators~ESRF~End Stage
 376   II,     5.  4.Acr    |           European Nurses in Diabetes~HIS~Health Interview Surveys~HES~Health
 377   II,     5.  4.Acr    |              Health Interview Surveys~HES~Health Examination Surveys~IDF~
 378   II,     5.  4.  1    |             CODE-2 study has measured the health care costs of people with
 379   II,     5.  4.  1    |          estimated at €2,834 in 1999. The health care costs of diabetes as
 380   II,     5.  4.  1    |                  even greater than direct health care costs (WHO 2002). Unfortunately,
 381   II,     5.  4.  2    |           representatives of Governmental Health Departments and Patients’
 382   II,     5.  4.  2    |         acknowledged the need to optimise health care in all EU countries
 383   II,     5.  4.  2    |                  for which the support of health professionals is crucial,
 384   II,     5.  4.  2    |                major and growing European health problem, a problem at all
 385   II,     5.  4.  2    |                   It causes prolonged ill health and early death.~It currently (
 386   II,     5.  4.  2    |                  national governments and health departments to create conditions
 387   II,     5.  4.  2    |            provision and quality audit of health care~-> National, regional
 388   II,     5.  4.  2    |          disseminating~ information about health maintenance~-> Promoting
 389   II,     5.  4.  2    |                glucose tolerance. Data of health expenditure are also provided.
 390   II,     5.  4.  2    |                                  5.4.2.4. Health Surveys~ ~Health Interview
 391   II,     5.  4.  2    |                   4.2.4. Health Surveys~ ~Health Interview Surveys (HIS)
 392   II,     5.  4.  2    |                 the participants, whereas Health Examination Surveys (HES)
 393   II,     5.  4.  2    |                 of national/international health monitoring for different
 394   II,     5.  4.  2    |                 been described by the HMP Health surveys in the EU: HIS and
 395   II,     5.  4.  2    |                 through national/regional health departments.~Several methodological
 396   II,     5.  4.  2    |            obtained through hospitals and health insurances only includes
 397   II,     5.  4.  2    |                 having been hospitalised.~Health examination surveys detect
 398   II,     5.  4.  2    |              patients which is impossible health interview surveys. Whether
 399   II,     5.  4.  2    |            Diabetes mellitus E10–14; HES: Health Examination Survey; HIS:
 400   II,     5.  4.  2    |                  Examination Survey; HIS: Health Interview Survey; UNN: Unique
 401   II,     5.  4.  2    |                   the long term impact of health policies. This indicator
 402   II,     5.  4.  3    |                   of the different public health policies.~Levels of BMI
 403   II,     5.  4.  4    |                   analysis of the current health status and represent a fundamental
 404   II,     5.  4.  4    |           diabetes seem to highlight that health systems in Europe are not
 405   II,     5.  4.  4    |                  order to push the entire health sector towards a tight control
 406   II,     5.  4.  6    |                the possible impact public health intervention programs may
 407   II,     5.  4.  6    |                Community Action on Public Health targeted the need for comparative
 408   II,     5.  4.  6    |            following aspects:~- measuring health status trends/determinants
 409   II,     5.  4.  6    |                   States with appropriate health information to compare and
 410   II,     5.  4.  6    |                and support their national health policies.~The European Commission,
 411   II,     5.  4.  6    |                   has now become a public health issue. We can curtail the
 412   II,     5.  4.  6    |            seriously. The required public health measures include promotion
 413   II,     5.  4.  6    |                   that must be ensured by health services in each country
 414   II,     5.  4.  6    |          inequalities in life expectancy, health status and access to high-quality
 415   II,     5.  4.  6    |                and access to high-quality health services for people living
 416   II,     5.  4.  6    |             number of documents:~· the EU Health Council in 2004, under the
 417   II,     5.  4.  6    |                made Type 2 diabetes a key health priority during its Presidency
 418   II,     5.  4.  6    |                were adopted by the formal Health Council in June 2006 as
 419   II,     5.  4.  6    |                Employment, Social Policy, Health and Consumer Affairs Council
 420   II,     5.  4.  6    |               measurable targets to track health outcomes and cost-effectiveness,
 421   II,     5.  4.  6    |              delivery of their respective health services, ethical, legal,
 422   II,     5.  4.  6    |          Identifying diabetes as a public health challenge in Europe and
 423   II,     5.  4.  6    |             actions in order to emphasise health determinants, promote healthy
 424   II,     5.  4.  6    |                 comprehensive approach to health determinants at European
 425   II,     5.  4.  6    |           addressing the impact on public health of the promotion, marketing
 426   II,     5.  4.  6    |               Diet, Physical activity and Health and encouraging the development
 427   II,     5.  4.  6    |                and measures;~· Taking the health determinants and risk factors
 428   II,     5.  4.  6    |                   in particular the World Health Organisation and the OECD,
 429   II,     5.  4.  6    |                   the disease as a global health threat in December 2006
 430   II,     5.  4.  7    |            actions. Diabetes is a complex health problem, requiring multi-disciplinary
 431   II,     5.  4.  7    |                   as a network collecting health information according to
 432   II,     5.  4.  7    |                diabetes complications);~· health system (structures, structural
 433   II,     5.  4.  7    |               training and involvement of health professionals that represent
 434   II,     5.  4.  8    |                 Collection Update Report, Health Care Quality Indicators
 435   II,     5.  4.  8    |               Quality Indicators Project, Health Working Papers No. 29, OECD
 436   II,     5.  4.  8    |                      1995) A computerized health screening and follow-up
 437   II,     5.  4.  8    |                  towards an active use of health information, Diabetes Research
 438   II,     5.  4.  8    |                Employment, Social Policy, Health and Consumer Affairs Council
 439   II,     5.  4.  8    |                European Journal of Public Health.~Dia A (2007): How does
 440   II,     5.  4.  8    |                   of Diabetes Care at the health systems level in OECD countries,
 441   II,     5.  4.  8    |                   in OECD countries, OECD Health Technical Papers NO. 15~
 442   II,     5.  4.  8    |                 system for diabetes, Stud Health Technol Inform. 2002;90:
 443   II,     5.  4.  8    |                       2007): Economics of Health and Mortality Special Feature:
 444   II,     5.  4.  8    |                  the socioeconomic status health gradient. Proc Natl Acad
 445   II,     5.  4.  8    |             review and economic modelling Health Technol Assess. 2007 May;
 446   II,     5.  4.  8    |                 978 92 4 159493 6 © World Health Organization 2006 [http://
 447   II,     5.  5.Acr    |                 Development~WHO HFA~World Health Organisation Health for
 448   II,     5.  5.Acr    |                 World Health Organisation Health for All database~
 449   II,     5.  5.Int    |                suffer some form of mental health problem (European Commission
 450   II,     5.  5.Int    |                  EU economy of mental ill health is estimated to be equivalent
 451   II,     5.  5.Int(8) |                2004): The State of Mental Health in the European Union. Directorate
 452   II,     5.  5.Int(8) |                   Directorate General for Health and Consumer Protection. [
 453   II,     5.  5.Int(8) |                   at: http://ec.europa.eu/health/ph_projects/2001/monitoring/
 454   II,     5.  5.Int(9) |            Liimatainen M-R (2000): Mental health in the workplace: Introduction.
 455   II,     5.  5.Int    |                 to seek specialist mental health care and are the main users
 456   II,     5.  5.Int(10)|             development centre for mental health. Available at: htt f.~
 457   II,     5.  5.Int(11)|                Austbury J. (2002): Mental Health: Gender Bias, Social Position,
 458   II,     5.  5.Int(11)|                 Engendering International Health: The Challenge of Equity.
 459   II,     5.  5.Int    |                 further impacts on mental health.~ ~Four of the six leading
 460   II,     5.  5.Int    |                common forms of mental ill health in the EU are anxiety disorders
 461   II,     5.  5.Int(12)|              Gender differences in mental health. In P. Östlin, M. Danielsson,
 462   II,     5.  5.Int(12)|                    Gender Inequalities in Health (Boston: Harvard School
 463   II,     5.  5.Int(12)|                  Harvard School of Public Health, 117-135).~
 464   II,     5.  5.Int(13)|                        WHO (2002): Mental Health: Responding to the Call
 465   II,     5.  5.Int    |               developed world14.~ ~Mental health services in Europe have
 466   II,     5.  5.Int    |             policy challenge by the World Health Organisation and the European
 467   II,     5.  5.Int    |                average around 6% of their health budgets on mental health,
 468   II,     5.  5.Int    |                  health budgets on mental health, while mental ill-health
 469   II,     5.  5.Int    |              greater.~ ~The burden of ill health can be reduced by addressing
 470   II,     5.  5.Int    |                  have an impact on mental health and wellbeing such as social
 471   II,     5.  5.Int    |              people with long-term mental health problems are working, a
 472   II,     5.  5.Int    |                   individuals with mental health problems. Countries such
 473   II,     5.  5.Int(14)|                         WHO (2001): World Health Report 2001. [on-line publication
 474   II,     5.  5.Int    |                   places a huge burden on health care resources. More data
 475   II,     5.  5.Int    |                 attempts.~The Community’s health policy has covered mental
 476   II,     5.  5.Int    |                 policy has covered mental health since 1997 through specific
 477   II,     5.  5.Int    |                   The EU 2003-2008 Public Health Programme provides limited
 478   II,     5.  5.Int    |                 of people with mental ill health, the social inclusion of
 479   II,     5.  5.Int    |               European research on mental health21. An example is the “MHEDEA-2000”-
 480   II,     5.  5.Int(20)|                  2004): Action for Mental Health. Activities co-funded from
 481   II,     5.  5.Int(20)|                 European Community Public health Programmes 1997-2004. htt m.
 482   II,     5.  5.Int    |             European assessment of mental health disability; Information
 483   II,     5.  5.Int    |         infrastructure investments in the health sector that is beneficial
 484   II,     5.  5.Int    |                   policy addresses mental health as part of its policy work (
 485   II,     5.  5.Int    |                 violence can cause mental health problems.~ ~However, a comprehensive
 486   II,     5.  5.Int    |          comprehensive strategy on mental health, which would link all these
 487   II,     5.  5.Int    |        cooperation in the field of mental health. The Council Conclusions
 488   II,     5.  5.Int    |          Ministerial Conference on Mental Health. The Commission was invited
 489   II,     5.  5.Int    |                  on 'Promoting the Mental Health of the Population' which
 490   II,     5.  5.Int    |                   a EU strategy on mental health. The document outlined the
 491   II,     5.  5.Int    |                   the relevance of mental health for some of the EU's strategic
 492   II,     5.  5.Int    |                   of a strategy on mental health at Community-level and brought
 493   II,     5.  5.Int    |                organizations (e.g. Mental Health Europe, EUFAMI, EnterMentalHealth,)
 494   II,     5.  5.Int    |                 of people with mental ill healthPrevention of mental distress~·
 495   II,     5.  5.Int    |              Promotion of positive mental healthAchieving a continuous
 496   II,     5.  5.Int    |               throughout Europe in mental health, the quality of care and
 497   II,     5.  5.Int    |                  their efforts to improve health conditions in their own
 498   II,     5.  5.Int    |                   of training courses for health and social care professionals;
 499   II,     5.  5.  1    |                 had a contact with formal health services in the previous
 500   II,     5.  5.  1    |             disorders (Thornicroft 2008), health service access hurdles and