# Presentation: 183536

## Overview of recent developmental work in Europe

**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: Setting up a coherent set of indicators

**Euro-Reves**
- Washington, February 2002

## European CommunityHealth 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.

## Health Monitoring Programme

- The actions and objectives were implemented under three headings:

**Health Monitoring Programme**

- Establishment of Community health indicators;
- Development of a Community-wide network sharing health data;
- Analyses and reporting.

## 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.

**Community health indicators**

**The European Health Monitoring Programme is **
**more ambitious and aims to select and develop a coherent set of health indicators for the EU****.**

## 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

## Setting up a coherent set of indicators for the EU

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

## Euro-REVES

**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:

**Health expectancies are at the heart of the project**

- countries are to be able to learn from each other on national initiatives to improve health,
- Community-wide initiatives are to be properly evaluated

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

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

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

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

## 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.

- 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.

**Practical goals of Euro-REVES**

## Underlying concepts of Euro-REVES

**Underlying concepts of Euro-REVES**

- to cover the **whole process** of heath deterioration and its **different approaches** (perception, functional, morbidity)
- to** **adopt clear** ****definitions**** **and** ****conceptual framework**
- to apply current and past **scientific literature** and the opinion of **experts** to the issues.
- to recommend a **global**** **measure 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**

## Models of the disablement process

**Disease>Impairment>Functional limitation>Disability**
***(Nagi, 1965,1976, 1991)***

**Models of the disablement process**

**Disease>Impairment>Functional limitation>Activity Restriction>Handicap**
***(Wood, 1975)***

**Disease>Impairment>Disability>Handicap**
***(******ICIDH******, 19******80******)***

## Further developments 

*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**)*

**Further developments **

- Environmental approach of disability and the social disadvantage
*(eg. Canadian stream of research on the disablement process...)*

## To maximise the approaches to measure health, we identified five main health domains

- To maximise the approaches to measure health, we identified five **main health domains**

-  Chronic morbidity
-  Functional limitation
-  Activity restriction
-  Perceived health
-  Mental health

- _Euro-REVES_

## Why distinguishing Functional limitation and activity restriction?

**Why distinguishing Functional limitation and activity restriction?**

- Nagi (1965), Wood (1975)...

## 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

**Research conducted on 11 instruments**

## 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

**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

**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

**Euro-reves participants**

## GALI: Global Limitation Indicator

- Rom Perenboom, The Netherlands
- Herman Van Oyen, Belgium

- Euro-reves: Setting up a coherent set of indicators

**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

**Euro-reves participants**

## Mental health

- Karen Ritchie, France
- Michael Crawford, United Kingdom

- Euro-reves: Setting up a coherent set of indicators

**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

**Euro-reves participants**