Overview of recent developmental work in Europe Setting up a coherent set of indicators for the EU A project for the Hea

1. Overview of recent developmental work in Europe Setting up a coherent set of indicators for the EU A project for the Health Monitoring Programme Euro-Reves Washington, February 2002 Euro-reves: Setting up a coherent set of indicators

2. European CommunityHealth Monitoring Programme The objective is to contribute to the establishment of a Community health monitoring system allowing: • to measure health status, trends and determinants through the Community; • to facilitate the planning, monitoring and evaluation of Community programmes and actions; • to provide Member States with appropriate health information to make comparisons and support national health policies.

3. Health Monitoring Programme The actions and objectives were implemented under three headings: • Establishment of Community health indicators; • Development of a Community-wide network sharing health data; • Analyses and reporting.

4. Community health indicators Harmonization at post data collection point (selection subsets of items from instruments common to all surveys). Harmonization at this level produces as many questions as answers. The European Health Monitoring Programme is more ambitious and aims to select and develop a coherent set of health indicators for the EU.

5. Maximising world developments may not maximise developments for Europe (WHO aims to include measures for less developed countries). Nevertheless, it is hoped that the work of the European groups in the field of health indicators will contribute to the wider work of the WHO. Such a set of indicators has to be built: • on the national experience of the European countries • on other initiatives, such as World Health Organization developments based on the International Classification of Functioning, Activities, and Health (ICF). • on specific European Community needs and public health concerns

6. Setting up a coherent set of indicators for the EU A project for the Health Monitoring Programme

7. Euro-REVES The main goal of the Euro-REVES project for the HMP was to select or design instruments to monitor the health status of the European population. The need for truly comparable measures of health across European countries has been increasingly recognised if: • countries are to be able to learn from each other on national initiatives to improve health, • Community-wide initiatives are to be properly evaluated Health expectancies are at the heart of the project

8. Total life expectancy, life expectancy without disability and life expectancy without chronic disease (WHO, 1984)

9. Total survival, survival without disability and survival without chronic disease, France 1981-1991, females

10. Practical goals of Euro-REVES • to select the health dimensions for health expectancy calculations to fit the European Health Information System. • to define specifications for the health measures sought. … and for the future (mainly in collaboration with Eurostat) • to assess the best way to collect the data: HIS, HES, registers... • to design the required measurement instruments • to develop the required quality assessment procedures to assess comparability for future new Member States.

11. Underlying concepts of Euro-REVES • to cover the whole process of heath deterioration and its different approaches (perception, functional, morbidity) • toadopt cleardefinitionsandconceptual framework • to apply current and past scientific literature and the opinion of expertsto the issues. • to recommend a globalmeasure as well as a more detailed one: to both tap the 'problem' in each European country and to explain differences (or similarities). • to involve researchers from the different member states

12. Models of the disablement process Disease>Impairment>Functional limitation>Disability (Nagi, 1965,1976, 1991) Disease>Impairment>Functional limitation>Activity Restriction>Handicap (Wood, 1975) Disease>Impairment>Disability>Handicap (ICIDH, 1980)

13. Further developments Environmental approach of disability and the social disadvantage (eg. Canadian stream of research on the disablement process...) Functional limitations and activity restrictions Nagi (1965), Wood (1980), Verbrugge&Jette (1994) Wolinsky FD. et al. Journal of Gerontology: Social Sciences 1991 / Finch M, et al. Journal of American Geriatrics Society 1995 / Fried LP et al. Journal of Gerontology: Medical Sciences 1996 / Ferrucci L et al. Gerontologist 1998 / Harwood et al. International Journal of Epidemiology 1998 / Lawrence et al.Journal of Gerontology: Social Sciences 1998 / Spector et al. Journal of Gerontology: Social Sciences 1998... Disease - Impairment - Activity limitation & Restriction of Participation (ICF, 2001)

14. To maximise the approaches to measure health, we identified five main health domains Euro-REVES • Chronic morbidity • Functional limitation • Activity restriction • Perceived health • Mental health

15. DISABILITY Fonctional Limitations Activity Restrictions Physical, sensory, cognitive Feed, dress, work... to plan early interventions (technical aids, reeducation, accurate assistance) to understand how to maintain activity with functional limitations (compensatory strategy) Why distinguishing Functional limitation and activity restriction? Nagi (1965), Wood (1975)...

16. Research conducted on 11 instruments • Perceived health (global / detailed questions) • Chronic morbidity (global / detailed questions) • Functional limitations (detailed questions) • Physical & Sensory / Cognitive • Activity restrictions (global / detailed questions) • ADL type, IADL type, other major activities • Mental health instrument

17. Euro-reves participants Chronic morbidity EuroREVES group: V Egidi, L Frova, R Crialesi (Italia); JM Robine (France); R Gispert (Spain) In collaboration with the EuroHIS network: V Egidi, V Buratta, L Frova (Italia); M Heliövaara (Finland); JM Robine (France); R Gispert (Spain); A de Bruin (The Neteherlands) & H Meltzer (UK) Euro-reves: Setting up a coherent set of indicators

18. Euro-reves participants Functional limitations Vincent Coutton, France Jaap van den Berg, The Netherlands Jean-Marie Robine, France Carol Jagger, United Kingdom Euro-reves: Setting up a coherent set of indicators

19. Euro-reves participants Activity restrictions(a detailed approach) Emmanuelle Cambois, France Jean-Marie Robine, France Carol Jagger, United Kingdom Euro-reves: Setting up a coherent set of indicators

20. Euro-reves participants GALI: Global Limitation Indicator Rom Perenboom, The Netherlands Herman Van Oyen, Belgium Euro-reves: Setting up a coherent set of indicators

21. Euro-reves participants Health Perceptions Jeanette Nørlev, Denmark Niels Kr. Rasmussen, Denmark Rosa Gispert Magarolas, Spain Euro-reves: Setting up a coherent set of indicators

22. Euro-reves participants Mental health Karen Ritchie, France Michael Crawford, United Kingdom Euro-reves: Setting up a coherent set of indicators

23. Euro-reves participants A Method to Decompose Differences in Health Expectancy by Cause Wilma J Nusselder, The Netherlands Caspar WN Looman, The Netherlands Jan J Barendregt, The Netherlands Euro-reves: Setting up a coherent set of indicators