Public health indicators for the EU: The joint action for ECHIM (European Community Health Indicators & Monitoring)
Abstract and Figures
Background
Public health policies aim to improve and maintain the health of citizens. Relevant data and indicators are needed for a health policy that is based on factual information. After 14 years of work (1998–2012), the multi-phase action on European Community Health Indicators (ECHI) has created a health monitoring and reporting system. It has generated EU added value by defining the ECHI shortlist with 88 common and comparable key health indicators for Europe.
Methods
In the 2009-2012 Joint Action for ECHIM project the ECHI shortlist was updated through consultation with Member State representatives. Guidelines for implementation of the ECHI Indicators at national level were developed and a pilot data collection was carried out.
Results
67 of the ECHI Indicators are already part of regular international data collections and thus available for a majority of Member States, 14 are close to ready and 13 still need development work. By mid-2012 half of the countries have incorporated ECHI indicators in their national health information systems and the process is ongoing in the majority of the countries. Twenty-five countries were able to provide data in a Pilot Data Collection for 20 ECHI Indicators that were not yet (fully) available in the international databases.
Conclusions
The EU needs a permanent health monitoring and reporting system. The Joint Action for ECHIM has set an example for the implementation of a system that can develop and maintain the ECHI indicators,, and promote and encourage the use of ECHI in health reporting and health policy making. The aim for sustainable public health monitoring is also supported by a Eurostat regulation on public health statistics requiring that health statistics shall be provided according to the ECHI methodology. Further efforts at DG SANCO and Eurostat are needed towards a permanent health monitoring system.
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Supplementary resources (5)
... Current research of how much physical activity is enough to keep diseases at bay (23) can serve as a foundation for improved monitoring and crafting new health policies to mitigate the burden of chronic NCDs (24,25). In that sense, the European Health Interview Survey (EHIS) is pivotal in public health surveillance to provide data on the prevalence and trends in physical activity, facilitating comparison between the EU countries. ...
The aim of this study was to determine the share of Croatian adults who walk 210 min or more a week and to explore the relationship between regular walking and demographic factors, health-related behaviours, and chronic non-communicable diseases/conditions. To this end, we used the EHIS-PAQ questionnaire and collected self-reported data on minutes spent walking during a typical week from a total of 3,496 respondents. The data were additionally analysed by gender, age, education, residence (urban/rural), counties and regions, smoking, other types of physical activity, and diseases/chronic conditions. The results show that, overall, 40.9 % of the adult Croatian population walks 210 or more minutes a week, with the largest share found among those from the Lika-Senj County (76.8 %), those who spend 300 min or more weekly on health-enhancing (non-work-related) aerobic physical activity (57.6 %), those who reported having diabetes (49.3 %), and those aged 65–74 years (44.7 %). Despite its limitations, our study gives a valuable insight into the frequency and factors determining healthy walking habits in a representative sample of Croatian adults and provides grounds for further research.
... Health Management Information System (HMIS) is a data collection, storage and analysis system speci cally designed to support planning, management, and decision making at all levels of the health care delivery system, including the community. Community health management information system (c-HMIS) is a type of health information system that links all community stakeholders, healthcare providers, consumers, providers, purchasers, Page 3/26 payers, and researchers in the community health system [2]. A community health systems is de ned as "the set of local actors, relationships, and processes engaged in producing, advocating for, and supporting health in communities and households outside of, but existing in relationship to, formal health structures" [3]. ...
Background: Increased attention has been put towards developing and implementing Community Health Management Information System (c-HMIS). It is for this reason that in 2012, Ministry of Health (MoH) with the support from Clinton Health Access Initiative (CHAI) developed a Community Health Management Information System (c-HMIS) in Zambia. There is limited data on the implementation, acceptability and use of c-HMIS in community health systems. Guided by the by Atun’s framework on integration of interventions in health systems. We explored the implementation and acceptability of c-HMIS in Mpongwe district.
Methodology:Qualitative data collected with 66 respondents namely members of health committees, community health assistants and their supervisors were analysed using thematic analysis.
Results: The nature of the problem which included poor quality of data /information due to lack of standardized data collection tools and delayed submission of reports motivated MoH and stakeholders to adopt the c-HMIS. Theattributes of the c-HMIS Intervention such as the provision of improved data collection tools, training stakeholders in using the tools, the perceived simplicity of the system and factors within the adoption system such as some health workers being familiar with c-HMIS, compatibility of the c-HMIS with existing tools, as well as improved collaboration and communication among actors facilitated the adoption process. Further, health system characteristics such as timely availability of data and improved health information feedback processes, improved mapping of key health issues in communities; as well as the broader context such as community engagement promoted community ownership of the c-HMIS. The c-HMIS implementation barriers included challenges with completing some sections in the tools due to missing data, limited gender inclusiveness in the tools, inadequate availability of digital platforms to enter and store data, limited incentives for community health workers, poor phone network/ internet connection as well as the COVID-19 pandemic.
Conclusion: Strengthening the implementation and acceptability of c-HMIS may require introducing electronic data capture and transmission using simple digital tools such as android phones. Electronic systems would help address logical challenges related to inadequate data collection tools, data entry challenges, and delayed transmission of data.
... These results support the important roles of fruits in a healthy diet and in the design of food shopping indicators. Th European Commission also recommends its member states to track their consumers' intake of fruits within their European Core Health Indicators (ECHIM) list of health-relevant policy indicators [68]. ...
In light of the globally increasing prevalence of diet-related chronic diseases, new scalable and non-invasive dietary monitoring techniques are urgently needed. Automatically collected digital receipts from loyalty cards hereby promise to serve as an objective and automatically traceable digital marker for individual food choice behavior and do not require users to manually log individual meal items. With the introduction of the General Data Privacy Regulation in the European Union, millions of consumers gained the right to access their shopping data in a machine-readable form, representing a historic chance to leverage shopping data for scalable monitoring of food choices. Multiple quantitative indicators for evaluating the nutritional quality of food shopping have been suggested, but so far, no comparison has validated the potential of these alternative indicators within a comparative setting. This manuscript thus represents the first study to compare the calibration capacity and to validate the discrimination potential of previously suggested food shopping quality indicators for the nutritional quality of shopped groceries, including the Food Standards Agency Nutrient Profiling System Dietary Index (FSA-NPS DI), Grocery Purchase Quality Index-2016 (GPQI), Healthy Eating Index-2015 (HEI-2015), Healthy Trolley Index (HETI) and Healthy Purchase Index (HPI), checking if any of them performs differently from the others. The hypothesis is that some food shopping quality indicators outperform the others in calibrating and discriminating individual actual dietary intake. To assess the indicators’ potentials, 89 eligible participants completed a validated food frequency questionnaire (FFQ) and donated their digital receipts from the loyalty card programs of the two leading Swiss grocery retailers, which represent 70% of the national grocery market. Compared to absolute food and nutrient intake, correlations between density-based relative food and nutrient intake and food shopping data are stronger. The FSA-NPS DI has the best calibration and discrimination performance in classifying participants’ consumption of nutrients and food groups, and seems to be a superior indicator to estimate nutritional quality of a user’s diet based on digital receipts from grocery shopping in Switzerland.
... First, it is necessary to define what is intended to be assessed. The indicators' definition must be precise, straightforward to interpret, consistent over time and with well-established methods of analysis (Bird et al., 2005;Flowers et al., 2005;Verschuuren et al., 2013). Indicators can collect data from different sources, namely administrative data, population surveys or the use of already defined indicators available for other settings/countries (Evans et al., 2009;Kaltenthaler et al., 2004). ...
Objective
There is still a lack of health indicators for monitoring and evaluating health planning at the local level. In Portugal, local health plans (LHP) include a prioritized set of health priorities, which should be monitored and evaluated. This study is an example of a low-resource method to identify and reuse indicators for LHP monitoring and evaluation already collected for other purposes.
Design and sample
A modified Delphi consensus method was applied, with three rounds of email rating questionnaires and a final meeting, between January 2018 and January 2019. The Delphi panel consisted of eight members from the Planning and Administration Group of the Espinho/Gaia Local Public Health Unit.
Measurements
Panelists were asked to assess the indicators’ validity for monitoring diseases/determinants from a pre-selected list of potential binomials between 140 PHC indicators and 15 diseases/determinants.
Results
After four rounds, there was consensus in considering 141 binomials (34.0%) as appropriate, diabetes mellitus being the disease with more appropriate indicators.
Conclusion
This study portrays the applicability of a commonly used, easy and low-resource method in a Portuguese Local Public Health Unit to select and reuse primary health care indicators for LHP monitoring and evaluation.
... A renewed centrality of health within the debate has hence emerged surrounding the crisis both given the overall challenge of budgetary discipline and ensuring sustainability in healthcare spending trends especially given the budgetary pressures of consolidation on one side and demography and ageing on the latter (Seychell and Hackbart, 2013). At the same time, the broader question has been raised of the added value of EU action (Clemens et al., 2014), especially relevant in public health as a transnational issue with relevance for several existing policy areas (Verschuuren et al., 2013;Greer, 2020b;Greer and Holly, 2021). ...
Covid-19 highlights the inadequacy of EU governance cross-border challenges, especially transnational health challenges, supporting the call for a Health Union. Health policy remains a near-exclusive national competence whose budget was heavily impacted by EU-driven austerity, especially in Southern Europe. The work provides a comprehensive empirical assessment of the pandemic case evidencing the limits of the current governance framework and tabled reform proposals. The analysis contributes an extended understanding of the implications of the lack of an effective EU public health competence. We assess comparatively (austerity-induced) geographic heterogeneities in health-care preparedness, outbreak, crisis management and outcomes, delineating the extent to which inequalities remain in the absence of a Health Union. Findings evidence an empirically grounded case for sovereignty pooling in the core transnational domain of public health while providing a preliminary policy evaluation of the proposal for a Health Union.
... The european Health Interview survey (eHIs) is a health survey that serves as an instrument to collect such reliable and comparable health data across all european union (eu) member states among individuals aged ⩾15 years [6]. Hence, the eHIs is the preferred data source for many of the european Core Health Indicators [7]. The Danish Health and Wellbeing survey is the Danish part of the eHIs. ...
Aims
This study aimed to describe the study design and respondent characteristics (including non-response analyses) of the Danish Health and Wellbeing Surveys in 2015 and 2019 and a follow-up survey that was carried out during the COVID-19 pandemic in 2020.
Methods
The Danish Health and Wellbeing Survey is the Danish part of the European Health Interview Survey (EHIS). The samples in 2015 ( N=12,000) and 2019 ( N=14,000) were both based on a simple random selection of individuals aged ⩾15 years from the Danish Civil Registration System. All individuals from the sample in 2019 who were still alive and living in Denmark were reinvited for a follow-up survey in 2020 ( N=13,474). Data in all surveys were collected via self-administered questionnaires (web or paper based). The questionnaires in 2015 and 2019 included the EHIS model questionnaire as well as national questions, whereas the questionnaire in 2020 mainly focused on physical and mental health, employment and working lives, and health behaviour.
Results
The overall response proportion declined slightly between 2015 (48.4%) and 2019 (47.4%) but went up to 49.8% in the follow-up survey in 2020. Unit non-response was associated with, for example, male sex, younger age, being unmarried and lower educational level but not with degree of urbanisation. In all, 5000 individuals completed the questionnaire in both 2019 and 2020.
Conclusions
The results are in line with most previous research on non-response in health surveys. However, an association between degree of urbanisation and non-response has been suggested in previous studies. This association was not found in our study.
In this article we argue that the Member States of the European Union (EU) have consistently, since its inception, developed a shared framework to measure, monitor and intervene to improve the health status of its population, while invoking the subsidiarity principle for the health sector. As a result, a European Health Union (EHU) has been emerging insidiously and consistently, following the concept of a system for health. Using the World Health Organisation Building Blocks Framework, we analyse the normative and institutional developments related to EU citizens' health that have created a de facto EHU. Developments towards an EHU remain unequally distributed among the different building blocks analysed. The existing EHU is the result of a fragmented and incremental process, mostly grounded in governance, health intelligence and services' development. Health crisis, the Commission's agenda-setting activities and market pressures have been the most important push factors for these step-by-step processes.
Background
Knowledge management (KM) emerged as a strategy to promote evidence-informed decision-making. This scoping review aims to map existing KM tools and mechanisms used to promote evidence-informed health decision-making in the WHO European Region and identify knowledge gaps.
Methods
Following the Joanna Briggs Institute (JBI) guidance for conducting scoping reviews, we searched Medline, PubMed, EMBASE, the Cochrane library, and Open Grey. We conducted a descriptive analysis of the general characteristics of the included papers and conducted narrative analysis of the included studies and categorized studies according to KM type and phase.
Results
Out of 9541 citations identified, we included 141 studies. The KM tools mostly assessed are evidence networks, surveillance tools, observatories, data platforms and registries, with most examining KM tools in high-income countries of the WHO European region. Findings suggest that KM tools can identify health problems, inform health planning and resource allocation, increase the use of evidence by policymakers and stimulate policy discussion.
Conclusion
Policymakers and funding agencies are called to support capacity-building activities, and future studies to strengthen KM in the WHO European region particularly in Eastern Europe and Central Asia. An updated over-arching strategy to coordinate KM activities in the WHO European region will be useful in these efforts.
Demographic change, new health threats and inequalities in health and healthcare provision in and between European Union (EU) member states pose a great challenge to European health care systems. Not only for these reasons does it make sense to collect comparable European health data. Such information provides insights on the distribution of risk and protection factors, the prevalence of chronic diseases and the levels of care provided in the member states and supports the planning and implementation of (health) policy measures. Since 2013, in the context of the European Health Interview Survey (EHIS), all EU member states are obliged to collect data on the health status, the provision of healthcare, health determinants and socio-economic conditions of their populations. In Germany, the EHIS is integrated into health monitoring at the Robert Koch Institute (RKI). The RKI is thus Germany's interface to the European health monitoring presented here. European health monitoring relies on different indicator systems such as the European Core Health Indicators (ECHI), EU social indicators and the health indicators of the European Sustainable Development Strategy. These are based on administrative and survey data, which stem for example from the EHIS or the European Union Statistics on Income and Living Conditions (EU-SILC) survey. Comparative data analyses must take into account the differences between health care systems, socioeconomic conditions and the age structures of societies. Variances in the prevalence of allergies for example are also due to differences in the available diagnostic tools. Significant differences in the prevalence of hypertension in Europe (with a range of 20% for women and 17% for men) are also related to different levels of awareness of hypertension. Comparative analyses can support the planning of and provide information for policy measures, and enhance the sharing of experiences between EU member states. A forthcoming EU regulation aims to harmonise the content of and intervals between health and social statistical data collection. Moreover, plans exist to establish a European Research Infrastructure Consortium (ERIC), which is set to develop and institutionalise European health monitoring.
The story of the implementation of the joint EU health indicators (ECHI indicators) began in the 1990s after the Amsterdam Treaty. The first concrete step in establishing a health monitoring capacity for EU was the Commission working group set up in 1997. Several consecutive and parallel projects, notably the health indicator projects ECHI-1 and ECHI-2 between the years 2000 and 2005 led to a preparedness to implement the jointly agreed health indicators (ECHI shortlist) in all European countries. ECHIM (2005 -- 2008) and the Joint Action for ECHIM (2009 - ) laid the foundation for the implementation of health indicators, and initiated Europe wide implementation proper. After the European recession of 2008 the circumstances in different countries were not optimal. Also the collaboration with the Commission could have been better. Nevertheless, the implementation process of the ECHI indicators is now well underway in most countries. By June 2012 half of the Member States had incorporated the ECHI indicators into their national health information system, and, if work can continue, by 2014 most countries are likely to have done so. Unfortunately, a gap may occur between the current programme and the next public health programme. The current momentum must not be lost. Therefore, all those responsible need to urge that the Commission (DG SANCO) together with the Member States helps to bridge the gap from June 2012 to January 2014. The new Public Health Programme provides the necessary financial instruments for setting up a permanent EU health information and reporting system.
Background:
Before extraction and synthetic chemistry were invented, musculoskeletal complaints were treated with preparations from medicinal plants. They were either administered orally or topically. In contrast to the oral medicinal plant products, topicals act in part as counterirritants or are toxic when given orally.
Objectives:
To update the previous Cochrane review of herbal therapy for osteoarthritis from 2000 by evaluating the evidence on effectiveness for topical medicinal plant products.
Search methods:
Databases for mainstream and complementary medicine were searched using terms to include all forms of arthritis combined with medicinal plant products. We searched electronic databases (Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, CINAHL, ISI Web of Science, World Health Organization Clinical Trials Registry Platform) to February 2013, unrestricted by language. We also searched the reference lists from retrieved trials.
Selection criteria:
Randomised controlled trials of herbal interventions used topically, compared with inert (placebo) or active controls, in people with osteoarthritis were included.
Data collection and analysis:
Two review authors independently selected trials for inclusion, assessed the risk of bias of included studies and extracted data.
Main results:
Seven studies (six different medicinal plant interventions; 785 participants) were included. Single studies (five studies) and non-comparable studies (two studies) precluded pooling of results.Moderate evidence from a single study of 174 people with hand osteoarthritis indicated that treatment with Arnica extract gel probably results in similar benefits as treatment with ibuprofen (non-steroidal anti-inflammatory drug) with a similar number of adverse events. Mean pain in the ibuprofen group was 44.2 points on a 100 point scale; treatment with Arnica gel reduced the pain by 4 points after three weeks: mean difference (MD) -3.8 points (95% confidence intervals (CI) -10.1 to 2.5), absolute reduction 4% (10% reduction to 3% increase). Hand function was 7.5 points on a 30 point scale in the ibuprofen-treated group; treatment with Arnica gel reduced function by 0.4 points (MD -0.4, 95% CI -1.75 to 0.95), absolute improvement 1% (6% improvement to 3% decline)). Total adverse events were higher in the Arnica gel group (13% compared to 8% in the ibuprofen group): relative risk (RR) 1.65 (95% CI 0.72 to 3.76).Moderate quality evidence from a single trial of 99 people with knee osteoarthritis indicated that compared with placebo, Capsicum extract gel probably does not improve pain or knee function, and is commonly associated with treatment-related adverse events including skin irritation and a burning sensation. At four weeks follow-up, mean pain in the placebo group was 46 points on a 100 point scale; treatment with Capsicum extract reduced pain by 1 point (MD -1, 95% CI -6.8 to 4.8), absolute reduction of 1% (7% reduction to 5% increase). Mean knee function in the placebo group was 34.8 points on a 96 point scale at four weeks; treatment with Capsicum extract improved function by a mean of 2.6 points (MD -2.6, 95% CI -9.5 to 4.2), an absolute improvement of 3% (10% improvement to 4% decline). Adverse event rates were greater in the Capsicum extract group (80% compared with 20% in the placebo group, rate ratio 4.12, 95% CI 3.30 to 5.17). The number needed to treat to result in adverse events was 2 (95% CI 1 to 2).Moderate evidence from a single trial of 220 people with knee osteoarthritis suggested that comfrey extract gel probably improves pain without increasing adverse events. At three weeks, the mean pain in the placebo group was 83.5 points on a 100 point scale. Treatment with comfrey reduced pain by a mean of 41.5 points (MD -41.5, 95% CI -48 to -34), an absolute reduction of 42% (34% to 48% reduction). Function was not reported. Adverse events were similar: 6% (7/110) reported adverse events in the comfrey group compared with 14% (15/110) in the placebo group (RR 0.47, 95% CI 0.20 to 1.10).Although evidence from a single trial indicated that adhesive patches containing Chinese herbal mixtures FNZG and SJG may improve pain and function, the clinical applicability of these findings are uncertain because participants were only treated and followed up for seven days. We are also uncertain if other topical herbal products (Marhame-Mafasel compress, stinging nettle leaf) improve osteoarthritis symptoms due to the very low quality evidence from single trials.No serious side effects were reported.
Authors' conclusions:
Although the mechanism of action of the topical medicinal plant products provides a rationale basis for their use in the treatment of osteoarthritis, the quality and quantity of current research studies of effectiveness are insufficient. Arnica gel probably improves symptoms as effectively as a gel containing non-steroidal anti-inflammatory drug, but with no better (and possibly worse) adverse event profile. Comfrey extract gel probably improves pain, and Capsicum extract gel probably will not improve pain or function at the doses examined in this review. Further high quality, fully powered studies are required to confirm the trends of effectiveness identifed in studies so far.
Within the EU Health Monitoring Programme (HMP), the ECHI project has proposed a comprehensive list of 'European Community Health Indicators'.
In the design of the indicator set, a set of explicit criteria was applied. These included: i) be comprehensive and coherent, i.e. cover all domains of the public health field; ii) take account of earlier work, especially that by WHO-Europe, OECD and Eurostat; and iii) cover the priority areas that Member States and Community health policies currently pursue. Flexibility is an important characteristic of the present proposal. In ECHI, this has been emphasized by the definition of 'user-windows'. These are subsets from the overall indicator list, each of which should reflect a specific user's requirement or interest.
The proposed indicators are, in most cases, defined as generic indicators, i.e. their actual operational definitions have not yet been attempted. This work has been, and is being carried out to a large part by other projects financed under the HMP, which cover specific areas of public health or areas of data collection. Apart from indicators covered by regularly available data, indicators (or issues) have been proposed for which data are currently difficult to collect but which from a policy point of view would be needed.
All this points to the fact that establishing an indicator list which is actually used by Member States is a continuously developing process. This process is now continued by the first strand of the new EU Public Health Action Programme.
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European commission´s directorate general for health & consumers; DPS: Data presentation system; ECDC: European centre of disease prevention and control; ECHI: European community health indicators
- Dg Abbreviations
- Sanco
Abbreviations DG SANCO: European commission´s directorate general for health & consumers; DPS: Data presentation system; ECDC: European centre of disease prevention and control; ECHI: European community health indicators;
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