COMMISSION OF THE EUROPEAN COMMUNITIES 
Brussels, 16.10.1995 
COM(95) 449 final 
95/0238 (COD) 
COMMUNICATION FROM THE COMMISSION 
concerning a Community action programme on 
health monitoring in the context 
of the framework for action in 
the field of public health 
Proposal for a 
EUROPEAN PARLIAMENT AND COUNCIL DECISION 
adopting a programme of Community action on 
health monitoring in the context of the 
framework for action in the field of 
public health 
(presented by the Commission) 

TABLE OF CONTENTS 
I. INTRODUCTION 3 
II. A REVIEW OF EFFORTS ON EUROPEAN HEALTH DATA AND 
INDICATORS 5 
III. THE EUROPEAN COMMUNITY AND HEALTH MONITORING 6 
A. A NEW ROLE FOR THE COMMUNITY 6 
B. RECENT COMMUNITY INITIATIVES 
IN HEALTH INFORMATION 7 
C. OTHER COMMUNITY POLICIES 
AND AREAS OF ACTION .9 
IV. PURPOSE AND PRINCIPLES OF A COMMUNITY 
HEALTH MONITORING SYSTEM 12 
V. COMMUNITY HEALTH INDICATORS 13 
A. CORE INDICATORS 14 
B. BACKGROUND INDICATORS 14 
C. ADDITIONAL INDICATORS 15 
D. A HARMONISED SYSTEM OF STATISTICS ON HEALTH 
RESOURCES 15 
VI. METHODOLOGY OF HEALTH DATA COLLECTION AT 
COMMUNITY LEVEL • 15 
VII. SERVING THE COMMUNITY HEALTH MONITORING SYSTEM 17 
VIII. ANALYSES ..* .• 18 
IX. PROPOSED ACTIONS FOR A FIVE-YEAR PROGRAMME 19 
A. ESTABLISHMENT OF COMMUNITY 
HEALTH INDICATORS 19 
B. DEVELOPMENT OF A COMMUNITY-WIDE NETWORK FOR DATA 
COLLECTION AND DISSEMINATION 2 0 
C . ANALYSES '. 21 
X. CONSULTATION, ASSESSMENT, AND REPORTS . . . 21 
A. CONSULTATION AND PARTICIPATION MECHANISMS 21 
B. EVALUATION REPORTS 2 2 
C. GENERAL INFORMATION ACTIVITIES 2 2 
ANNEX A 23 
9? 
I. INTRODUCTION "'T 
1. By virtue of Articles 3(o) and 129 of the Treaty establishing the European Community, the 
Community has for the first time been given an explicit legal basis for undertaking action 
in the field of public health. The role of the Community is to contribute towards ensuring 
a high level of human health protection, directing actions towards the prevention of diseases, 
in particular by encouraging cooperation between Member States and, if necessary, lending 
support to their action, and by promoting coordination of their policies and programmes. 
2. In its communication of 24 November 19931 on the framework for Community action in 
the field of public health, the Commission defined a framework for Community action in 
order to attain the objectives on health protection laid down in Articles 3(o) and 129. The 
role of the Community is identified as underpinning the efforts of the Member States in 
the public health field, assisting in the formulation and implementation of objectives and 
strategies, and contributing to the provision of a high-level health protection across the 
Community, setting as a target the best results already obtained in a given area anywhere 
in the Community. 
3. In initiating action under Article 129, the Community has to address itself to preventing 
disease and protecting health. A prerequisite for such action is knowledge about existing 
problems, their nature, and their extent. It is therefore necessary to measure the changes 
in health as well as the impact of policies, programmes, and actions, both in the Member 
States and at the Community level, in order to ascertain that actions attain their objectives 
and actually lead to the improvements intended. Appropriate measures to monitor health 
and its determinants, as well as a capacity for the monitoring and evaluation of actions are 
therefore needed. Based on the criteria laid down in the above-mentioned Commission 
communication, health data and indicators have been identified as essential means to the 
acquisition of such knowledge and capacity, and, therefore, as a priority for Community 
action. 
4. Health data and indicators have also been singled out by the Council", the European 
Parliament3, and the Economic and Social Committee4 as an important area for Community 
action in public health. A long series of resolutions, conclusions, and opinions by these 
institutions culminated in June 1994 in the adoption of a Council resolution on the 
framework for future action in the field of public health, which identified health data and 
indicators as an area to which priority should be assigned and on which the Commission 
was invited to present proposals5. 
COM (93) 559 final 
OJ No. C 174, 25.6.1993, p.l. 
OJ No. C 329, 6.12.1993, p. 375 
6 May 1994, ENVI/379 
OJ No. C 165, 17.6.1994, p.l 
3 
5. The efforts of the Commission in this area concentrated on identifying the needs of tfîe 
Community and the Member States, and on determining how to obtain the maximum effect 
from the involvement of the Community while fully respecting the principle of subsidiarity. 
To this end, the Commission has, with the assistance of Member States' representatives, 
conducted a review of existing health data and indicators.at the Community level, their 
sources, coverage, and importance, and obtained valuable advice and recommendations. 
6. In this communication, health monitoring covers the following three elements: 
collection of health data at the Community level and development of Community 
health indicators. This includes the development of mechanisms for Community data 
collection, including surveys, as well as the development of agreed definitions and 
methodologies for Community health indicators. 
building a capacity for analysis of data obtained from the monitoring of developments 
in health, disease, other health problems, and health determinants. This includes 
analysis of the distribution of diseases and disability in human populations and of the 
factors which influence that distribution. 
dissemination of information on health and its determinants to enable the Community 
as well as the Member States to establish priorities, review policies and actions, and 
assist them in deciding on allocation of resources. 
7. Health monitoring is not meant to cover disease surveillance for control purposes which 
is undertaken with the aim of rapidly deciding on counter-measures and actions to be taken 
by the competent authorities in order to address acute health problems and control often 
rapidly evolving situations, especially in the area of communicable diseases. However, 
disease surveillance systems may provide appropriate input to an overall health monitoring 
system, especially as regards the incidence and prevalence of specific diseases. 
8. Health monitoring at the Community level would cover the areas of public health in which 
the Commission has already proposed a number of action programmes covering cancer6, 
health promotion, information, education, and training7, drug dependence', and AIDS and 
certain other communicable diseases , and would draw from the results of pertinent actions 
undertaken under these programmes. Moreover, Community health monitoring should also 
serve to assess the impact on health of Community programmes and other Community 
policies and also provide a means for comparisons between Member States and between 
the European Community and other parts of the world. 
8 OJNoC 139, 21.5.1994, p. 12 
OJNoC 252, 9.9.1994, p. 3 
OJNoC 257, 14.9.1994, p. 4 
OJ No C 333, 29.11.1994 and COM(94), p. 413 
9. Whether the impact of the actions taken at the Community and national levels caiTbë 
properly monitored and evaluated depends, inter alia, on the pertinence and quality of the 
indicators available. The aim of the action programme proposed in this document therefore 
is to develop a high-quality, policy-oriented health monitoring system to support the 
Community and Member States in health policy-making and evaluation. The starting point 
for such a system is, of course, what already exists in Member States, and what is 
transmitted by them to international organisations, notably the World Health Organization 
(WHO) and the Organization for Economic Cooperation and Development (OECD). Based 
on this, a careful selection has to be made of indicators covering agreed areas of interest, 
supplemented by new ones as appropriate, and a system developed for the purpose of 
underpinning the collection of data and making them available to the Member States and 
the Community. 
10. To be able to meet expectations in this area and yield the maximum added value, a 
Community health monitoring system would have to consist not only of carefully selected 
Community health data and indicators but also of a network for the collection and 
dissemination of Community data, mainly using the possibilities offered by telematics. In 
addition, an integral part of such a system will be the capacity to contribute to the analysis 
of health and health-related information, to respond to information requests and test 
hypotheses, and to disseminate, where appropriate, the results of these analyses. An over­
riding consideration in all of the work involved is the respect of data protection legislation 
requirements, and the implementation of appropriate confidentiality and security 
arrangements. 
II. A REVIEW OF EFFORTS ON EUROPEAN HEALTH DATA AND 
INDICATORS 
11. The search for objective measures of the health status of a population has a long tradition 
in public health and may be traced back to the foundation of demography in the second half 
of the 17th century. For more than a century, infant mortality and life expectancy at birth 
have been widely accepted as valid measures of the level of health in a population. It is 
only a relatively recent development that a wider range of indicators has been introduced 
to complement the picture, coupled with epidemiological research. 
12. This development has been brought about, inter alia, by a growing awareness within the 
health sector that, as a consequence of the rapid decline in previously important health 
scourges, in particular infectious diseases, such mortality-based measures could no longer 
be viewed as sufficient, and by the development and widespread adoption of quantitative 
measurements in the social sciences and in public health. 
13. The growing use of indicators for the formulation, implementation, and evaluation of social 
policies and programmes has been promoted by the work of the United Nations, particularly 
its efforts, since the 1950s, to develop a Level of Living Index and design a system of social 
accounts. The social indicators programme of the OECD has also had substantial impact 
on the establishment of indicators in OECD countries. 
14. As to health indicators, which are usually a constituent part of social indicators, the League 
of Nations, already in the 1930s, published a comprehensive review of "indices of health". 
After the second world war, many initiatives on health indicators were undertaken, especially 
in the United States. 
15. Internationally, the systematic use of health indicators and policy-oriented health information 
has been promoted by the WHO since the early eighties. In its Health For All strategy, a 
significant role has been assigned to the monitoring and evaluation of regional, national, 
and global health strategies. A minimal list of global indicators has subsequently been 
' introduced. In 1984, the WHO's Regional Office for Europe has added to this list regional 
indicators tailored to the specific needs and priorities in Europe. Countries have been invited 
to use additional national indicators in keeping with their own needs and capabilities10. On 
the basis of these indicators, WHO regularly undertakes monitoring exercises in order to 
measure progress in relation to the Health For All targets and to. assess its priorities. 
16. The OECD has also carried out valuable work on health indicators, especially in relation 
to indicators on the provision of health care. This work is to some extent complementary 
to the work of WHO. Finally, a number of specialised European institutions and networks, 
like the International Agency of Research on Cancer (IARC) in Lyon and the European 
Centre for the Epidemiological Monitoring of AIDS in Paris, have contributed to the 
production of valuable health information at the European level, with support from the 
Community, particularly in relation to relevant programmes and actions in the field of public 
health. 
17. In the first Biomedical and Health research programme (1990-1994), within the third RTD 
framework programme, research on health systems allowed the setting up of specific disease-
related databases and valuable European networks for health data exchange. 
18. The Statistical Office of the European Communities (Eurostat) has also collected statistical 
data on health and health-related issues for a number of years. In particular, a number of 
health indicators have been selected as part of the global framework for social indicators 
and social statistics. 
19. Significant international experience has already been gathered in the field of health 
information and the use of health indicators. The Community has played a role in this 
process, but its involvement needs to be stepped up if an appropriate contribution to ensuring 
a high-level of health protection is to be made. 
III. THE EUROPEAN COMMUNITY AND HEALTH MONITORING 
A. A NEW ROLE FOR THE COMMUNITY 
20. Member States are becoming more closely interdependent in many areas. In the area of 
economic integration, this takes place at a fast pace, but also in other areas, such as free 
circulation, the environment, professional education and research and social provisions, in 
particular health and safety at work, common approaches to existing problems are 
10 HANSLUWKA, HE, "Measuring health of populations-Indicators and 
Indications," Social Sciences and Medicine, 1985, Vol. 20, No. 12, pp. 1207-1224. 
increasingly being sought and implemented. The impact of the Community is, in this respect, 
preponderant. 
21. Health is no exception to this. Not only do health problems cross borders, but they appear 
to be growing more alike in each country. Moreover, European cooperation on health has 
made important strides and attempts are increasingly being made to find common solutions 
and to step up the exchange of expertise and the sharing of experience. As a result of such 
internationalisation, interest in other countries' problems and policies has grown and 
international comparisons are becoming an important tool in national and Community health 
policy-making. The Member States of the European Community have over the last decade 
steadily increased their cooperation in the public health field to cover a wide range of areas, 
and the Community has played an increasingly important role in this process, especially 
after the coming into force of the Treaty on the European Union. 
22. Community actions implementing Article 129 of the Treaty establishing the European 
Community must have as objective to make a contribution towards ensuring a high level 
of human health protection, focus on the prevention of diseases, promote coordination of 
Member States' policies and programmes and foster cooperation with third countries and 
international organisations competent in the sphere of public health. The elaboration of such 
actions in a way that maximises the Community's contribution, and the assessment of these 
actions to determine whether they have accomplished their objectives, presupposes the 
existence of quantitative measures and of a system which permits the measurement of the 
changes in health and its determinants, and the impact on health of policies, programmes, 
and actions at the level of Member States as well as the Community. 
B. RECENT COMMUNITY INITIATIVES IN HEALTH INFORMATION 
23. In a number of documents, in particular in the Report on Public Health Policy after 
Maastricht11, the European Parliament has stressed the importance of having sufficient and 
relevant information as a basis for the development of Community actions in the field of 
public health. 
24. In the resolution adopted with the report, the European Parliament called on the Commission 
to establish a European epidemiological investigation unit to collect and examine health data 
from Member States and to begin work on a "State of Health in the Community" report 
which will analyse trends and assess the effects of public health policies, as well as the 
impact of other policies on health. Moreover, it requested the Commission to collect, analyse 
•and disseminate Member State data on notifiable diseases and to work with national and 
international agencies in these matters. 
25. The Commission, in its Communication of 24 November 1993 on the framework for action 
in the field of public health, identified increased cooperation on standardisation and 
collection of comparable data on health, and the promotion of systems of monitoring and 
surveillance, as a prerequisite for the establishment of a framework for supporting and adding 
value to Member States' policies and programmes, in compliance with the principle of subsidiarity. 
il OJNo. C329, 6.12 93, p.375 
26. In its resolution of 2 June 1994 on the framework for Community action in the field of 
public health, the Council stressed the importance of the development of Community health 
information and indicated that data and indicators used should include measures relating 
to the quality of life of the population, accurate assessments of health needs, estimations 
of the avoidable deaths frorn the prevention of diseases, socio-economic factors on health 
among different population groups, and, where appropriate and if the Member States judge 
it necessary, health aid, medical practices, and the impact of reforms. 
27. In December 1993, the High-Level Committee on Health, which advises the Commission 
on health matters and comprises senior representatives of the Health Ministries of the 
Member States, set up a working party on health data and indicators to assist in the 
development of a Community health monitoring system. The working party was charged 
with the following tasks: 
to assess the validity and comparability of health data available in the Community. 
to assess the feasibility of uniform basic data sets for the purpose of monitoring health 
status and formulating and measuring the impact of prevention policies. 
to examine the conversion of existing health data into effective health indicators for 
specific measures. 
to define possible actions for further co-operation at Community level in this field. 
28. On the basis of the report of the Working Party, which included a comprehensive review 
of definitions and sources of the available indicators at the European level collected by 
Eurostat, WHO, and OECD, the High Level Committee adopted a number of 
recommendations, the main elements of which are as follows: 
sets of Community core and background indicators are necessary as instruments at 
Community level as well as for national health policy-making; 
the available health data are very diverse as far as comparability and validity are 
concerned; 
with the necessary resources becoming available, substantial progress can be achieved 
within a 5-to-10-year period on making uniform basic data sets at Community level 
to measure health status and the impact of public health policies; 
in some areas the available data can be converted into usable specific indicators. In 
other areas, however, data do not exist or are inadequate to establish specific indicators 
of an acceptable quality. 
29. The report of ihe Working Party and the recommendations of the High Level Committee 
have been used extensively in the preparation of the present communication and the 
Commission proposals in the field of health monitoring. 
C. OTHER COMMUNITY POLICIES AND AREAS OF ACTION 
30. Community policies and actions in areas outside public health often have direct and indirect 
health impacts. In its report on the integration of health protection requirements in 
Community policies , the Commission presented an overview of programmes, actions and 
instruments having an impact on health. 
31. In the area of social policy, health information is mainly linked to questions relative to the 
follow-up of Member States's policies regarding social protection, particularly with respect 
to the risk of illness. In its recommendation 3 on convergence of social policies aiming at 
guiding the policies of the Member States, the Council set, inter alia, the following 
objectives: 
to ensure that people legally residing in the Member States have access to necessary 
health care as well as to measures aimed at disease prevention; 
to maintain, and if necessary, develop a health care system that is adapted to the 
changing needs of the population. 
32 The Commission closely follows the developments in this area and analyzes and reports 
on the convergence or divergence of social policies. Regarding health systems, the 
monitoring of measures taken to try to keep costs reasonable and to evaluate performance 
also requires the evaluation of the consequences that they may have on the quality of 
services provided and the equality of access to care. 
33 In the area of health and safety at work, sustained efforts have been made at the Community 
level to obtain harmonised data concerning occupational diseases (EODS) and accidents 
at work (ESAW). The process which was followed involved the development of similar 
criteria and methodology for recording statistics in all Member States. When these are put 
into effect, they are expected to produce a more accurate picture of the extent of 
occupational diseases and injuries. 
34. Within the statistical framework programme 1993-1997, laid down by the Council in its 
decision 93/464/EEC14, Eurostat produces statistical data in areas, such as health and safety, 
employment, living conditions and social protection, as fields of priority action under the 
sectoral programmes for social policy, for economic and social cohesion and consumer 
protection. Community statistics in areas such as environment, industry, national accounts 
and transport are also collected under the statistical framework programme. In addition, 
Eurostat collects data on certain other social indicators which are of interest to public health. 
In 1994, a Community Household Panel Survey (ECHP) was launched, covering, inter alia, 
1 COM(95) 196, 29.5.1995 
r- Council Recommendation 92/442/EEC, OJ No L 245, 26.8.1992, p. 49 
1,1 OJ No. L 219, 28.8.1993, p.l 
9 
demographics, income, labour force participation, education, housing, and certain health 
aspects. 
35. In the area of Trans-European networks, the Commission proposal for a Council Decision 
on support for the telematic interchange of data between administrations in the Community 
(IDA)15 foresees three projects in the field of health, namely CARE (two projects : early 
warning system and pharmacovigilance) and REITOX (European Information Network on 
Drugs and Drug Addiction which will link with the European Monitoring Centre for Drugs 
and Drug Addiction). The two CARE projects retained in IDA are spin-offs of earlier efforts 
on the European Nervous System (ENS-CARE). Under current IDA plans, CARE-Early 
warning system (CARE-EWS) work and the work on a pharmacovigilance network, to which 
the European Medicines Evaluation Agency will be linked, will concentrate over the next 
two years on further development of the pilot systems between national administrations and 
the passage to exploitation phase, while strictly adhering to the general system architecture 
foreseen for IDA. 
36. In the area of research and technological development, activities under the third RTD 
framework programme included research on quality of care, avoidable deaths (deaths that 
could be avoided by prevention), a European stroke database (EUROSTROKE), 
harmonisation of health expectancy calculations in Europe, comparison and harmonisation 
of denominator data for primary health care research in Member States of the European 
Community', and the establishment of a European Clearing House on Health Outcomes. 
Concerning equality of access to care according to the level of income, research has been 
carried out on comparing health care consumption and morbidity for certain groups of 
individuals (the COMAC Project), the future development of which w?ould benefit from the 
existence, at the Community level, of indicators on the relationship between income and 
morbidity. Under Area 6 of the Biomedical and Health research programme1 (BIOMED 2) 
within the 4th RTD framework programme, research will focus initially on methodologies 
linked to health data on demographic changes, methods of evaluating the effectiveness of 
prevention strategies, and assessment of the socio-economic impact and performance 
measurement of health policy initiatives including the development of health information 
systems. Finally, under the fourth RTD framework programme, activities initiated previously 
on health telematics (ENS-CARE), which involved pilot projects on electronic exchange 
of health data concerning communicable diseases, statistics, poison control and 
pharmacovigilance, are to be pursued in certain selected areas. 
37. The environment plays an important role in the health of citizens. Appropriate and accurate 
information on the state of the environment and on emissions and waste disposal into its 
compartments is indispensible. There is a need, in particular, for data on the concentration 
of pollutants in the environment in order to estimate the impact of such pollutants on public 
health. Examples of such data include data on air quality in urban and rural areas and on 
concentration of dangerous substances in the soil and ground water, in particular from the 
ib OJ NoC 105, 16.4.1993 
Council Decision 94/913/EEC of 15 December 1994, OJ No L 361 of 31.12.1994, 
p. 40 
10 
use of pesticides. Moreover, data on the effects on humans from the incorporation of 
pollutants, and on the pathways for such incorporation are required if sound 
interventions are to be made. The European Environment Agency has, in its 5-year 
Work Programme, a project on "Threats to Human Health" which involves an analysis 
of the current situation and information/data bank linking with the WHO. 
38. In the area of transport, the need for information is firstly linked to the problem of 
achieving accessible public transport for everybody, which requires in turn information 
on the patterns and geographical distribution of various types of disability, mobility-
restricting illnesses, and age-specific health factors, and secondly to road accidents, for 
which the Council decided to establish a Community database1, the development of 
which will serve as a basis for the improvement of information at Community level 
in this field. 
39. As regards consumer protection, efforts to organise and coordinate the collection of 
data on home and leisure accidents is being pursued in the context of the programme 
EHLASS2. 
40. The Commission has also recognised the importance of a level playing field of data 
protection rules as being a necessary pre-requisite to the free exchange of data. In 
1990, it proposed a framework directive on the protection of individuals with regard 
to the processing personal data, with the aim of ensuring the free morvement of such 
data. This directive, which includes specific provisions on health data, has been 
adopted on 24.7.95 by the Council and the Parliament. The Commission has also 
committed itself to applying the principles of this directive to its own data processing. 
41. With regard to the Community Agricultural Policy, three information systems (ADNS, 
ANIMO and SHIFT) are being developed using telematics as essential tools in the 
Community veterinary control strategy. 
42. Finally, in the area of drugs, the European Monitoring Centre for Drugs and Drug 
Addiction (EMCDDA) has as its main task to furnish "overall information...on the drug 
and drug addiction phenomenon". This will involve providing the Community and its 
Member States with "objective, reliable and comparable information at [the] European 
level concerning drugs and drug addiction and their consequences". Moreover, through 
the European information network on drugs and drug addiction (REITOX) data will 
be collected which will be used, inter alia, in the preparation of a yearly report on the 
state of the drugs problem. 
OJ No L 329 of 30.12.93, p.63 
OJ No. L 331 of 21.12.94 
IV. THE PURPOSES AND PRINCIPLES OF A COMMUNITY-WIDE HEALTH 
MONITORING SYSTEM 
43. Health information has been identified in Article 129 as a specific area of action; moreover, 
as explained above, it has been recognised, in the form of health data and indicators, as a 
fundamental instrument in the Community policy-making process, and an essential part of 
a health monitoring system which will be required to serve the following purposes: 
to monitor health and health determinants throughout the Community, and permit 
comparisons with third countries; 
to facilitate planning, monitoring, implementation, and evaluation of Community 
programmes and actions; 
to provide Member States with high quality, comparative indicators and information 
which support and add value to their national health monitoring systems and contribute 
to the development of national health policies. 
44. The development of a health monitoring system should be based on the following principles: 
the system should build on readily available European data and indicators, such as 
those held by Member States, international organisations, notably the WHO, the 
OECD, the EMCDDA and the European Environment Agency, European networks, 
and the Commission. In a first stage, these data will be used for heafth monitoring 
and policy appraisal purposes and should also serve as a basis for identifying the 
inevitable gaps in quality and ways to overcome them, as well as for developing new 
data and indicators that are considered necessary. 
any unnecessary duplication of work should be avoided. The work already being 
carried out by international organisations, European networks, and the Commission 
should be mutually complementary and congruent. On the one hand, existing work 
of relevance to the Community being carried out by Member States and the relevant 
international organisations should be consolidated and progressively harmonised, thus 
minimising the risk of wasteful overlap and competing demands on scarce resources. 
On the other hand, the health monitoring system should as a matter of priority cover 
areas of importance to Community programmes and policies which are not yet fully 
developed or are developed insufficiently. 
the system should not impose unnecessary burdens on Member States which already 
transmit health data to a number of international organisations, networks, and the 
Commission. Serving the needs of a Community health monitoring system should 
therefore not imply Member States having to duplicate work carried out in the context 
of existing international arrangements. 
available options and possibilities for developing the various parts of the system 
whether with respect to the choice of health indicators, the extent and quality of 
coverage, the means used, and the routine or ad hoc analyses to be undertaken, should 
be carefully assessed with respect to the costs and benefits involved; 
12 
the system should be designed to have as much flexibility as possible so as to be 
capable of incorporating existing useful elements and of adapting to changes in 
coverage as well as to changes in the priorities for action, whilst maintaining its 
characteristics of comparability and progressive harmonisation. Furthermore, it is also 
important that the collection and distribution mechanisms for health data and indicators 
are equally flexible and do not demand undue administrative burdens. 
45. In establishing a Community health monitoring system, it is important to ensure that 
the information which should be collected and disseminated is specified in close 
collaboration with the potential users and suppliers in Member States and at the 
Community level, and that data protection requirements are fully respected. 
V. COMMUNITY HEALTH INDICATORS 
46. On the basis of the needs of the proposed and planned programmes and actions in the field 
of public health, requirements stemming from other Commission policies, the needs of 
Member States, and the expected developments in health status and determinants, the 
Commission has selected a number of domains in which indicators would have to be 
established as part of the Community health monitoring system. These domains are listed 
in Annex A. It is important to note that data are already being collected in these domains 
but they have to be carefully assessed with a view to establishing relevant health indicators. 
47. Community health indicators would consist of two types: core indicators and background 
indicators. Core indicators are considered to be those which are essential to Community 
public health programme actions, and to measuring health status as well as health 
determinants, e.g., alcohol and tobacco consumption. Background indicators are those linked 
indirectly to public health but which are nevertheless important for health policy purposes. 
They include indicators which concern other Community policies. They also include 
indicators which may be of particular use to Member States but are not essential for 
Community policy purposes. 
48. The indicators, both core and background, to be used in the Community health monitoring 
system will be selected from those existing at the international level and already reviewed 
by the High-Level Committee on Health, and those existing at national level but deemed 
appropriate for Community use; moreover, new ones will have to be created, if necessary. 
This process will be carried out in close coordination with the Member States and, where 
appropriate, with the cooperation of international organisations competent in this area. 
Community indicators would have to be continually evaluated and updated in order to ensure 
that they fulfil the current needs of the Community and Member States. This may involve 
developing new indicators and/or reclassifying indicators from background to core, and vice 
versa. 
49. Community indicators would consist of: 
indicators that provide both the Community and the Member States with an instrument 
for making comparisons between Member States and also facilitate coordination by 
and among the Member States themselves; 
13 
indicators that facilitate the measurement of health status and major heàltlî 
determinants in the Community, including outcomes and use of resources. 
50. Depending on the quality and availability of data needed, Community indicators will fall 
into the following categories: 
those for which good quality data are readily available in all Member States; 
those for which d^ta are available in all Member States but for which the quality needs 
to be improved; 
those for which data are not currently available in the Community but which would 
have to be collected under the Community programme on health monitoring. 
A. CORE INDICATORS 
51. To support Community action in the field of public health a core set of basic indicators 
should be developed. These indicators would represent the basic information needed to 
monitor health status in the Community and would also reflect: key public health priorities 
as defined in the Commission communication on the framework for action in the field of 
public health1. Over time, these indicators could be adapted to reflect changing priorities. 
52. Consequently, the core indicators would be divided into the following two inter-related types: 
indicators for measuring health status and determinants of health in the Community; 
indicators for measuring the impact of Community policies and actions in public 
health. 
B. BACKGROUND INDICATORS 
53. Since priorities change over time, the health monitoring system should be sufficiently 
comprehensive and flexible to respond to shifting demands arising from emerging issues. 
As a means of obtaining the desired coverage and flexibility, a number of indicators, in 
addition to the core ones, should be established as background indicators. Such indicators 
are intended to provide both more in-depth information in the areas covered by the core 
indicators and to cover a wider range of areas. 
54. The set of background indicators would include the following four types of indicators: 
indicators that provide additional information on issues raised by the core indicators, 
including the assessment of relations between health outcomes and health determinants; 
indicators that provide information regarding other Community policies; 
indicators that support public health policies in Member States; 
indicators that provide Member States with information for making comparisons in 
areas not covered by the core set of indicators. 
C. ADDITIONAL INDICATORS 
55. In areas where health data are of use only to national and/or regional authorities, 
coordination of definitions and collection methods will have to be promoted in order to 
achieve a higher degree of comparability between regions and Member States. 
D. A HARMONISED SYSTEM OF STATISTICS ON HEALTH RESOURCES 
56. In the light of the recommendations of the High-Level Committee on Health, which 
emphasised the assessment of the feasibility and cost-effectiveness of developing 
standardised health resource statistics, the Commission intends to give support to efforts 
aiming at incorporating such statistics into a future Community health monitoring system. 
This would provide an important input to the work currently being done at European level 
on the development of satellite national accounts for health. 
VI. METHODOLOGY OF HEALTH DATA COLLECTION AT COMMUNITY 
LEVEL 
57. In developing a Community health monitoring system, a methodology needs to be followed 
to ensure that the data obtained from the Member States are comparable, i.e., defined in 
the same manner and of similar (good) quality. In addition, the data must also be timely 
or they will lose much of their usefulness. Finally, the methodology employed must follow 
the principles set out in Chapter IV for the establishment of a Community health monitoring 
system. 
58. Avoiding unnecessary duplication of Member States' data collection efforts points in 
particular to the need of building on existing national databases validated by Member States' 
authorities. Data held in these databases may have to be supplemented by specific surveys 
in order to collect data that are not available by other means or that are needed for specific 
analyses. Such a two-tier approach holds the promise of fast and cost-effective 
implementation. In addition, this approach ensures the maximum use of existing data and 
allows Member States to obtain improvements in the comparability and quality of their data. 
This approach creates, however, a number of methodological questions which must be 
addressed. 
59. In particular, the comparability of existing data from Member States is currently inadequate, 
because Member States often define their health data and indicators differently. However, 
comparability may be improved in three ways: 
creating data dictionaries which could serve to establish correspondences between data 
defined in different ways; 
converting national data to Community network definitions according to a commonly 
agreed set of rules; 
15 
harmonising the definition and collection methods of the health data collected in the 
Member States. : 
60. Data dictionaries serve to explain how different Member States define similar concepts. Thus, 
they provide a way to establish correspondences between data while retaining individual 
definitions. This approach is likely to be used when it is impossible to either convert or 
harmonise existing data. In addition, this method may also be employed while conversion 
and/or harmonisation methods are being developed. 
61. Comparability may also be improved by devising and agreeing Community network 
definitions enabling Member States to convert their data accordingly. Thisapproach improves 
comparability of data at Community level without requiring Member States to change the 
definitions they use for their internal purposes. 
62. Harmonisation of national data definition and routine collection has the greatest potential 
for improving the comparability and quality of Community data.. However, in some cases 
harmonisation may require changes in statutory stipulations or long-established traditions 
and practices. For this reason, harmonisation is both a difficult and time- and resource 
consuming process and should therefore be carefully evaluated in each case to assess the 
costs and benefits involved. While harmonisation of existing data may be seen as a long-term 
goal, and is being pursued in several areas as mentioned in paragraphs 30 to 35, the need 
for progress to be made on developing the Community health monitoring system means that 
recourse should be made, in the short-term, to both data dictionaries and conversion 
processes. 
63. Member States also collect health data through surveys, such as data on self-perceived health 
status which must be obtained directly from the population, or particular types of health 
care provider data. The advantages of the survey method are that data are collected at the 
same point in time and that it allows the establishment of interrelations between the different 
variables. Survey data could be made comparable by agreeing on the content of present or 
future health surveys or by agreeing modules or agreed forms of words for questions in 
existing surveys. Harmonisation in the case of surveys is likely to be less time- and resource 
consuming, in part because it is easier to harmonise survey questions/instruments and 
methodologies than elements in existing registries and national databases, which are 
sometimes linked to statutory requirements, and in part because work has already been 
initiated in this area. 
64 In certain areas, survey information would have to be obtained from Member States which 
do not currently conduct health surveys. This could be done by developing supplements to 
other types of national surveys (e.g., labour force surveys, household surveys), which take 
account of the need for comparable data throughout the Community, or through Community-
wide surveys, including EUROBAROMETER surveys. 
65. In addition to the health information which can be obtained from Member States' sources, 
as described above, specific health information may be needed to address the needs of the 
Community which might require the conduct of specific Community-wide surveys. 
16 
66. In addition to determining the data collection method, the frequency with which the data 
must be collected must also be decided. Data needed for the core indicators should be 
collected on a regular basis (annually for most) and processed and transmitted rapidly in 
order to ensure the availability of the most recent data possible. Data needed for the 
background indicators, however, will be collected at such intervals as are necessary, 
depending on the nature of the indicator and the usage to which it will be put. 
VII. SERVING THE COMMUNITY HEALTH MONITORING SYSTEM 
67. As stated previously, European health data are currently collected by the WHO (causes of 
death), the WHO Regional Office for Europe in its Health for All database, the OECD 
(health resource data) and by Eurostat. Moreover, data on specific scourges are collected 
by centres like IARC in Lyon for cancer, the European Centre for the Epidemiological 
Monitoring of AIDS in Paris, and the EMCDDA in Lisbon for drugs and drug addiction.. 
In view of this, and in order not to impose unnecessary burdens on Member States, the 
Commission will take into account the work carried out for, and by, the various European-
level operators in the domain of the production, processing, and dissemination of Community 
data, so as to obtain a judicious division of labour between the various servers of the 
Community health monitoring system. 
68. In any case, a Community health monitoring system has to rely primarily on health data 
from Member States. At the same time, the system would have to be served by an efficient 
and cost-effective means for the transmission, sharing, and dissemination of Community 
health data. 
69 There are various means to achieve availability and transfer of health data and indicators. 
To ensure, however, that the role of the constituent parts of the future Community system 
is preserved and played to full advantage as regards the means of processing, storage, and 
rapid transmission of data, these are best accomplished by means of an electronic network 
of distributed, or disseminated, databases. In such a network, data would be made available 
by independent data producers (i.e., national administrations and/or institutions under their 
auspices) in accordance with a set of commonly agreed rules covering data specifications. 
70. A network of distributed databases has a number of advantages: 
it is future-oriented, flexible, and less costly compared to traditional collection 
methods; 
it reduces current duplication of data collection efforts at the international level; 
Member States only have to supply data once (i.e., to the network); 
it does not require a major new administrative structure; 
Member States will be responsible for entering the data into the system. The data can 
therefore be updated continually; and 
it offers the opportunity to be multilingual. 
17 
71. It should be emphasised that a network of distributed databases is desirable not only because 
of the technical advantages it offers, but also because it maintains the sound practice of 
doing the work as close as possible to the source. This would also ensure compliance with 
the principle of subsidiarity. 
72. An electronic network of distributed health databases has over the last three years been 
developed to a pilot level through the ENS-CARE project, which received financial support 
from the Commission. The establishment of a network of this kind aiming at facilitating 
the telematic interchange of data between national administrations is the object of the IDA 
project, which includes health monitoring as one of several sectors to be covered. 
73. A network of distributed databases would, therefore, be the preferred method for the 
purposes of the Community health monitoring system. As such it would have to build on 
the experience gathered so far from the interchange of certain comparable health data and 
indicators, and would rely on the infrastructure currently being developed under the IDA 
programme. The present programme would allow the content of the information in this 
system to be properly specified with respect to all data and indicators included in the 
Community health monitoring system. The Commission will encourage the Member States 
to participate and collaborate closely in the development of a network of distributed 
databases. Relevant international organisations will be invited to participate as appropriate. 
VIII. ANALYSES 
74. Measuring health status and health determinants is only a first step, under the Community 
health monitoring system to be put in place through this programme, towards contributing 
to ensuring a high level of health protection. To achieve maximum usefulness, the 
information contained in the system must be fully utilised. This will require a variety of 
analyses to be performed, some annually, some periodically, and others on an ad-hoc basis. 
75. On an annual basis, it will be necessary to monitor a set of health indicators which together 
provide an overall picture of health in the Community. This will help in the elaboration of 
Community health status reports. In addition, it will be necessary to analyze indicators by 
population subgroups (e.g., sex- and age-group, residence, socio-economic status) in order 
to ascertain whether there are unacceptable differences across subgroups, and problem areas, 
and to make appropriate inputs to the planning of programmes and actions which address 
such problems. 
76. The indicators will also have to be analyzed with respect to trends over time to determine 
whether or not the trends are reflecting the objectives desired by policy. 
77. An important task will be to identify the major sources of mortality and morbidity in the 
Community. This will also include identifying variations in mortality and morbidity by 
region and population subgroup. Such identification will then have to be supplemented by 
analysis of the determinants of these sources of morbidity and mortality in order to develop 
effective policy tools. In this context, it may be necessary to identify and analyze national 
health policies that have been shown to be effective. 
78. Analyses of the relationship between various health determinants will also be important «and 
may require the fielding of ad-hoc surveys to obtain the necessary information if the latter 
is not routinely available. Whilst fully respecting data protection legislation requirements, 
as stated at the outset, it would be possible to use data at the level of the individual in order 
to validate, in the context of such analyses, existing and proposed health indicators. However, 
the data used should not be such as to make possible the identification of any particular 
individual. 
79. Having valid indicators will also contribute to improving the information available for 
epidemiological studies of the major causes of mortality and morbidity. This will be of use 
not only in the design of new health policies but also in the evaluation of past and current 
policies. 
80. The Community health monitoring system will also assist in the analysis of the health impact 
of other Community policies, as stated in the Commission communication on the framework 
for action in the field of public health, help in identifying conflicting requirements, and 
contribute in cost-benefit evaluations of particular programmes and actions. 
81. The analyses described above will have to be carried out in a coordinated manner, requiring 
the contribution of and coordination with several actors, including specialised European 
agencies and centres, such as the EMCDDA and the European Environment Agency. This 
type of activity will require the further development of an appropriate administrative capacity 
at the Community level capable of conducting high-quality analysis and responding timely 
to diverse requests and queries. 
LX. PROPOSED ACTIONS FOR A FIVE-YEAR PROGRAMME 
82. The Commission believes that the work on establishing a Community health monitoring 
system covering three strands of action, namely the establishment of Community health 
indicators, the development of a Community-wide network for data collection and 
dissemination, and the capacity for and conduct of analyses, should be initiated by means 
of a five-year Community action programme. The actions involved are described below. 
A. ESTABLISHMENT OF COMMUNITY HEALTH INDICATORS 
83. A Community set of health indicators is proposed to be established, in the domains set out 
in Annex A, consisting of: 
a sub-set of core indicators for the monitoring of Community actions in public health, 
and 
a sub-set of background indicators for monitoring other Community policies and for 
providing Member States with a better means for making international comparisons. 
84. The establishment of the indicators would involve both identification and analysis of existing 
indicators at Member State and European level, in particular as regards quality and coverage, 
as well as the selection and/or creation of specific Community indicators, and the 
development of definitions for these indicators. 
19 
85. The Community health indicators will be so selected as to provide the necessary instruments 
for: 
monitoring areas of Community priority; 
monitoring the impact of action programmes on specific health problems, e.g., AIDS 
and other communicable diseases, cancer, drugs, accidents, health promotion, rare 
diseases; 
monitoring developments in health status and its determinants in the Community. 
86. The establishment of Community indicators would have to take account of: 
user needs and specifications; 
inventories of the data currently available in Member States; 
definition and methodologies of collection used in Member States, in the Community, 
and in relevant international organisations; 
proposals for definitions and quality norms, such as validity, reliability, and 
comparability. 
87. The Commission intends to ensure that the set of Community indicators is kept under review 
to ensure that it is capable of responding, if required, to new priorities and changing needs. 
88. The Commission will also support the assessment of the feasibility and cost-effectiveness 
of developing health resource statistics, including an examination of the possibility of using 
satellite national accounts as ajramework. 
B. DEVELOPMENT OF A COMMUNITY-WIDE NETWORK FOR DATA 
COLLECTION AND DISSEMINATION 
89. In order to make Community health data and indicators readily available to Member States, 
the Commission intends, as the best means of health data collection and dissemination, to 
promote the establishment of a Community-wide network, the backbone of which relies on 
telematics, and which links the competent authorities in the Member States, and would assist, 
under this programme, in the content specifications for the network using distributed 
databases. The relevant work would take place in parallel with the effort under the IDA and 
the G-7 health projects. However, as the electronic network for interchange of data may 
not be fully operational in the early stages of the programme, other appropriate mechanisms 
may, as necessary, be considered as a stop gap for the purposes of data collection and 
dissemination. 
20 
C. ANALYSES T ~ 
90. Each year, the Commission publishes a report on the health status of the Community. This 
health status report will draw, as appropriate, from the health data and indicators collected 
through the Community health monitoring system.. 
91. The Commission intends to draw on information generated through the system in analysing 
and reporting on selected health determinants (e.g., smoking, alcohol consumption) and 
comment, if appropriate, on the need for action. Similarly, the Commission intends to use 
data available through the system in analysing the impact on health of Community public 
health programmes and actions, as well as the impact of other policies. 
92. Finally, the Commission intends to make available information material on matters arising 
out of this work which may serve the needs of Member States, international organisations, 
health professionals and bodies, interest groups, and the general public. 
X. CONSULTATION, ASSESSMENT, AND REPORTS 
A. CONSULTATION AND PARTICIPATION MECHANISMS 
93. In seeking to establish a Community health monitoring system through an initial 5-year 
programme, the Commission will rely on close collaboration with the Member States in all 
questions relating to reporting, conversion, harmonisation, description of data and selection 
of specific indicators. Most of the data needed for the establishment of indicators relevant 
to a Community health monitoring system will have to be made available from Member 
States sources. Moreover, much of the work related to the harmonisation, conversion, and 
description of data must be carried out by the competent authorities in Member States. 
94. In implementing the programme, the Commission intends to have recourse to a Committee 
made up of Member States experts, representing both users and producers of health 
information. In the domain of Community health and safety statistics, existing Committees, 
such as the Statistical Programme Committee19, and the European Advisory Committee on 
statistical information in the economic and social spheres20 (CEIES) will be associated» to 
the work as appropriate. Furthermore, other existing Community committees, such as the 
EFILASS Committee21, and the Programme committee of the Biomedical and Health research 
programme22, will be associated to the work as appropriate. 
Council Decision 89/382/EEC, OJ No L 181, 28.6.89, p. 47 
Council Decision 91/116/EEC, OJ No L 59, 6.3.91, p. 21 
1 Council Decision of 7 December 1994, OJ No L 331 21.12.94, p.l 
Council decision 94/382/ EC, OJ No L 361, 31.12.94, p 42 
21 
95. In view of the important role of the WHO and the OECD in the development of international 
health information, the Commission will maintain appropriate links with them. It also intends 
to foster cooperation in this field with other international organisations and with third 
countries. 
96. Where appropriate,'the Commission will encourage participation of professionals, non­
governmental organisations engaged in health monitoring and European networks for the 
• exchange of health data by drawing upon their experience in specific areas when initiating 
and implementing actions on the development of health data and indicators under the 
proposed programme. ' 
B. EVALUATION REPORTS 
97. Assessment of the programme will be provided in two reports: 
a mid-term report to the Council, the European Parliament, the Economic and Social 
Committee, and the Committee of the Regions. The purpose of the mid-term report 
is to ensure that the Community institutions and, through them, all the parties 
concerned, are kept fully informed on the progress of the actions undertaken in the 
context of this action plan. It will include information on the projects supported under 
the different actions. 
a final report on the implementation of the programme, which will include an 
evaluation of the actions undertaken, will be submitted to the above-mentioned 
institutions by the Commission after the completion of the programme. 
C. GENERAL INFORMATION ACTIVITIES 
98. In addition to the information activities contained in the programme, the Commission will 
ensure that the general public and all parties concerned have access to reports on the actions, 
studies, and assessments undertaken. 
o? 
ANNEX A 
Domains in which Health indicators may be established under a future Community health 
monitoring system 
A. Health Status 
1. Life expectancy: 
life expectancy at certain ages 
health expectancies 
2. Mortality: 
overall 
causes of death 
disease-specific survival 
3. Morbidity: 
disease-specific morbidity 
co-morbidity 
4. Functioning and quality of life: 
self-perceived health 
physical disability 
activity limitations 
functional status/ability 
health-related work loss 
mental health 
5. Anthropometric characteristics 
B. Life Style and Health Habits 
1. Tobacco consumption 
2. Alcohol consumption 
3. Illicit drug consumption 
4. Physical activities 
5. Diet 
6. Sexual behaviour 
7. Other health promotion-related activities 
23 
C. Living and working conditions 
1. Employment/unemployment: 
- . occupation 
2. Work environment: 
accidents 
exposure to carcinogenic and other dangerous substances 
occupational health 
3. Housing conditions 
4. Home and leisure activities: 
- accidents at home 
leisure 
5. Transport: 
automobile accidents 
6. External environment. 
air pollution 
water pollution 
other types of pollution 
radiation 
exposure to carcinogenic and other dangerous substances outside the work environment 
D. Health Protection 
1. Sources of financing 
2. Facilities / Manpower 
Health resource utilisation 
Health care personnel 
3. Cost / Expenditure 
In patient care 
Out patient care 
Pharmaceutical products 
4. Consumption / uses 
In patient care 
Out patient care 
Pharmaceutical products 
5. Health promotion and disease prevention 
24 
E. Demographic and Other Social Factors 
1. Gender 
2. Age 
3. Civil status 
4. Region of residence 
5. Education 
6. Income 
7. Population subgroups 
8. Health insurance status 
F. Miscellaneous 
1. Product safety 
2. Others 
25 
Proposal for a 
EUROPEAN PARLIAMENT AND COUNCIL DECISION 95/0238 (COD) 
adopting a programme of Community action on 
health monitoring in the context of the 
framework for action in the field of 
public health 
ik 
EXPLANATORY MEMORANDUM 
1. In its Communication of 24 November 1993 on the framework for action in the field of 
public health, the Commission defined a framework for future Community action in order 
to attain the objectives on health protection laid down in Articles 3(o) and 129 of the Treaty 
establishing the European Community. The role of the Community is identified as 
underpinning the efforts of the Member States in the public health field, assisting in the 
formulation and implementation of objectives and strategies, and contributing to the provision 
of health protection across the Community, setting as target the best results already obtained 
in a given area anywhere in the Community. 
2. In initiating action under Article 129, the Community has to address itself to preventing 
disease and protecting health. A prerequisite for such action is knowledge about existing 
problems, their nature, and their extent. It is therefore necessary to measure the changes 
in health as well as the impact of policies, programmes, and actions both in the Member 
States and at Community level. There is also a need to promote the sharing and 
dissemination of relevant information. Based on the criteria laid down in the above-
mentioned Commission communication, health monitoring at Community level, and in 
particular health data and indicators, has been identified as an essential means for the 
acquisition and sharing of such knowledge, and, therefore, as a priority for Community 
action. 
3. The European Parliament and the Council have also, in a number of resolutions, stressed 
the importance of having adequate and valid health data to map out health situations and 
trends, and to assist in the development of Community and Member States' actions in the 
field of public health. The European Parliament underlined, in particular, the need for 
collection and examination of health data from the Member States and the assessment of 
the effects of various policies on health. Similarly, the Council, has emphasised that it is 
necessary to have an accurate assessment of health needs, an estimation of avoidable deaths, 
and an evaluation the effects of socio-economic factors on health. 
4. The efforts of the Commission in this area have concentrated so far on the needs of the 
Community and the Member States, and on identifying ways to obtain maximum value from 
the involvement of the Community. To this end, the Commission has consulted experts in 
this field and, with the assistance of Member States' representatives, conducted a review 
of existing health data and indicators at the Community level, their sources, coverage, and 
importance, and obtained advice and recommendations on the development of a Community 
action programme on health monitoring. 
5. The overall aim of the proposed 5-year action programme is to develop a high-quality, 
policy-oriented health monitoring system. This system should allow the measurement of 
health status and health determinants throughout the Community. It should provide Member 
States with indicators and data for supporting their national health policies and should also 
facilitate the planning, monitoring, and evaluation of Community programmes and actions, 
in compliance with the principle of subsidiarity. 
27 
6. The Community health monitoring system would also involve the development of a networlc 
for the purpose of collection and dissemination of health data and indicators, in particular 
using the possibilities offered by telematics, and the development of a capacity to undertake 
the analysis of health data and the production of reports, reviews and other health 
information material. 
7. The principles underlying the development of such a system include building on readily 
available European health data and indicators, such as those held by Member States, 
international organisations, and European networks, avoiding both any unnecessary 
duplication of work and the placing of unnecessary burdens on Member States which already 
transmit health data to a number of international organizations and networks, assessing the 
costs and benefits of developing the various parts of the system, and allowing as much 
flexibility as possible to permit adaptation whilst encouraging data comparability and 
progressive harmonisation. 
8. The health indicators to be collected through the Community health monitoring system may 
be divided into two types: core indicators and background indicators. Core indicators are 
those indicators which are essential to Community health policy. These include data on 
health status as well as on health determinants, e.g., alcohol and tobacco consumption. 
Background indicators are those indicators which are linked indirectly to public health but 
which are nevertheless important for health policy purposes. As priorities are likely to change 
over time, the indicators to be collected (both core and background) will have to cover a 
wide range to permit a good understanding of the interplay of various factors impinging 
on health and enable anticipation of future problems. 
9. The Commission attaches major importance to makingCommunity health information readily 
available to Member States. Therefore, the Commission will, as the best means of health 
data collection and dissemination, promote the development of a Community-wide network 
using in particular, telematics, which would link the competent authorities in the Member 
States. Such a system would minimise the burden of data collection imposed on Member 
States, provide easy and timely adaptation and access to the information placed on it, and 
be more cost-effective compared to alternative collection methods. 
10. Under the ENS-CARE programme of the third framework programme on Research and 
Technological Development, the infrastructure for such a system has already been developed 
in apilot project. This infrastructure is now being further developed under the project of 
telematic interchange of data between administrations (IDA) and under the Information 
* Society health projects of the G-7 Member States. Under the proposed 5-year programme 
on health monitoring, the Commission will encourage the Member States to participate and 
collaborate closely in the content specifications of this system, which will use distributed 
databases as its backbone, and would promote participation of competent international 
organizations and third countries as appropriate. 
11. The Community health monitoring system will provide an opportunity for a variety* of 
analyses to be undertaken on a regular or on an ad hoc basis. These analyses could include 
health status and health trends reports, analyses of specific health problems and health 
determinants, and analyses of thé health impacts of other policies. The dissemination of 
relevant information material will be supported. 
28 
12. Assessment of the action programme on health monitoring will be provided in two reports. 
A mid-term report reviewing progress and a final report on the implementation of the 
programme. These reports will incorporate information on Community financing in the 
various fields of action as well as the results of the evaluations and will be transmitted to 
the Council and the European Parliament, as well as to the Economic and Social Committee 
and the Committee of the Regions. 
29 
ADDENDUM 
with respect to the principle of subsidiarity 
to the explanatory memorandum of the proposal for a 
European Parliament and Council decision 
adopting a programme of Community action on 
health monitoring in the context of the 
framework for action in the fields of 
public health. 
a. Quels sont les objectifs de l'action envisagée par rapport aux obligations pesant sur la 
Communauté? 
In accordance with Article 129 of the Treaty establishing the European Community, the 
Commission is presenting proposals for adoption by the European Parliament and the Council 
of incentive measures, having as their objective to contribute towards ensuring a high level of 
human health protection by encouraging cooperation between the Member States, lending 
support to their action, promoting coordination of their policies and programmes, and fostering 
cooperation with third countries and the competent international organisations in the sphere 
of public health. The objective of the present proposal by the Commission is the development 
of a health monitoring system through a 5-year programme of action which, through the full 
participation of the Member States in its design and implementation, would permit their mutual 
• cooperation and coordination in collecting, processing and sharing health data and indicators 
necessary for measuring the impact of health policies, health status and trends and health 
determinants, both at the Community and Member State level, thus permitting a better 
planning and implementation of their actions aiming at ensuring a high-level of human health 
protection. 
b. L'action envisagée relève-t-elle d'une compétence exclusive de la Communauté ou 
d'une compétence partagée avec les Etats membres? 
The proposed decision for a programme of action on health monitoring, pursuant to Article 
129 of the E.C. Treaty, comes under the mixed competence of the Community and the 
Member States. 
c. Quelle est la dimension communautaire du problème? 
The situation at present is that neither the international organisations competent in the sphere 
of public health, nor the Community or the Member States possess appropriate and sufficient 
data and indicators about health status and the impact of health actions and policies. 
The proposed programme sets up a series of mechanisms which will facilitate the gathering 
ÔMLM 
and analysis of data at Community level and also be of assistance to Member States in 
information collection and evaluation of health data and indicators. 
d. Quelle est la solution la plus efficace par comparaison entre les moyens de la 
Communauté et ceux des Etats membres? 
The proposed programme of action involves the development of a health monitoring system 
using as a basis what already exists at the European level on health data and indicators, 
including those held by Member States, international organisations, and European networks,and 
building on it while avoiding any unnecessary duplication of work by carefully selecting and 
checking with the Member States the data and indicators needed, and by associating to this 
work the international organisations and networks to which the Member States already transmit 
data. 
e. Quelle plus-value concrète apporte Taction envisagée de la Communauté et quel serait 
le coût de l'inaction? 
The actions to be implemented under the proposed programme will yield added value in a 
number of ways. 
l.They will facilitate the production of health data and indicators, not currently 
existing, which are valuable in the assessment of Community programmes and actions 
in the field of health. 
2.They will assist in the development of more accurate, comparable and compatible 
health data and indicators at national level. This will enable better comparisons to be 
made and should make it easier for Member States to exchange and share important 
information. 
3.They will lead to the establishment of a network for the exchange of data and 
indicators and this will be undertaken in the framework on the Community programme 
in the Interchange of Data between Administrations (IDA). 
4 They will enable the production of comprehensive and detailed reports on health 
status and trends and on the impact of health policies. Existing reports on suGh matters 
are generally not of a high enough quality since the required data and indicators are 
not available. The programme is intended to support the production of these. 
In the absence of the proposed programme of action and the development of the high-quality 
information and indicators that is its aim, neither the Community nor the Member States will 
have a fully adequate basis on which to plan future health policies and programmes and 
evaluate those which currently exist. Controlling the rising costs of health is a central issue 
across the Community. The absence of accurate information and indicators on health status and 
health activities makes it all the more difficult to address this issue, and to achieve a high level 
of health protection efficiently and effectively. 
& c 
f. Quelles modalités d'action sont à la disposition de la Communauté? 
The action envisaged in the area covered by the Commission proposals can only be undertaken 
by a European Parliament and Council decision adopting incentive measures, that is by the 
financial support of the activities contained in the 5-year programme. 
g. Une réglementation uniforme est-elle nécessaire ou suffit-il d'une directive.posant des 
objectifs généraux en renvoyant l'exécution au niveau des Etats membres? 
There is no need for regulatory provisions in this matter; the actions envisaged by the 
proposed programme aim at the development of a health monitoring system which requires 
cooperation of the Member States and lending support to their action. According to Article 
129, no harmonisation measures can be taken in this respect. 
£<5 ^ 
Proposal for a 
EUROPEAN PARLIAMENT AND COUNCIL DECISION 95/0238 (COD) 
adopting a programme of Community action on 
health monitoring in the context of the 
framework for action in the field of 
public health 
THE EUROPEAN PARLIAMENT AND THE COUNCIL OF THE EUROPEAN UNION, 
Having regard to the treaty establishing the European Community, and in particular Article 129 
thereof, 
Having regard to the proposal from the Commission1, 
Having regard to the opinion of the Economic and Social Committee2, 
Having regard to the opinion of the Committee of the Regions3, 
Acting in according with the procedures referred to in Article 189b of the Treaty, 
1 OJ No 
2 OJ No 
3 OJ No 
he 
1. Whereas, in accordance with point (o) of Article 3 of the Treaty, Community action must 
include a contribution of the Community towards the achievement of a high level of health 
protection; whereas Article 129 expressly provides for Community competence in this field, 
in particular by encouraging cooperation between the Member States and, if necessary, 
lending support to their action; 
2. Whereas the Council, in its resolution4 of 27 May 1993 on future action in the field of public 
health, considered that improved collection, analysis and distribution of health data, as well 
as an improvement in the quality and comparibility of available data, are essential for the 
preparation of future programmes; 
3. Whereas, the European Parliament, in its report on public health policy after Maastricht5, 
has stressed the importance of having sufficient and relevant information as a basis for the 
development of Community actions in the field of public health; whereas the European 
Parliament called on the Commission to collect and examine health data from Member States 
and analyse trends and assess the effects of public health policies, as well as the impact 
of other policies; 
4. Whereas the Commission, in its Communication of 24 November 1993 on the framework 
for action in the field of public health6, identified increased cooperation on standardisation 
and collection of comparable/compatible data on health, and the promotion of systems of 
4 OJNo. C174, 25.6.1993, p.l 
OJ No. C329, 6.12.93, p.375 
COM(93) 559 final 
31 
health monitoring and surveillance as a prerequesite for the establishment of a framework 
for supporting Member States' policies and programmes; and whereas the area of health 
monitoring, including health data and indicators, has been identified as a priority area for 
proposals on multi-annual Community programmmes in the field of public health; 
5. Whereas in its resolution of 2 June 19947, the Council indicated that the collection of health 
data should be accorded priority and invited the Commission to present relevant proposals; 
whereas the Council considered that data and indicators used should include measures 
relating to the quality of life of the population, accurate assessments of health needs, 
estimations of the avoidable deaths from the prevention of diseases, socio-economic factors 
in health among different population groups, and, where appropriate and if the Member 
States judge it necessary, health aid, medical practices, and the impact of reforms; 
6. Whereas health monitoring at the Community level is essential for the planning, monitoring, 
and assessment of Community actions in the field of public health, and the monitoring and 
assessment of the health impact of other Community policies; 
7. Whereas health monitoring, in this context, encompasses the establishment of Community 
health indicators, the collection, dissemination, and analysis of Community health data and 
indicators; 
OJNo. C165, 17.6.94, p.l 
32 
8. Whereas in its Decision on the framework programme for priority actions in the field of 
statistical information 1993 to 1997 the Council8 has identified under the heading "health 
and safety" analysis of mortality and morbidity by cause as one of the fields of priority 
actions under the sectoral programmes for social policy, for economic and social cohesion 
and consumer protection; 
9. Whereas the Council9 in its Decision adopting a specific programme on research and 
technological development, including demonstration, in the field of biomedicine and health 
(1994-1998) identified a specific research task on coordination and comparison of European 
health data, including nutritional data, from the Member States, and whereas this was taken 
up in the relevant research work programme; 
10. Whereas health monitoring at Community level should enable measurements of health status, 
trends and determinants to be carried out, facilitate the planning, monitoring and evaluation 
of Community programmes and actions, and provide Member States with health information 
supporting the development and evaluation of their health policies; 
11. Whereas, in order to give full effect to requirements and expectations in this area a 
Community health monitoring system should be developed, comprising the establishment 
of health indicators and the collection of health data, a network for transmission and sharing 
of health data and indicators, and a capacity for analysis and dissemination of health 
information; 
OJ No. L 219, 28.8.93, p.l 
OJ No L 361, 31.12.94, P.40 
33 
12. Whereas available options and possibilities for developing the various parts of a Community 
health monitoring system should be carefully assessed with respect to the desired 
performance, flexibility and the costs and benefits involved; whereas a Community health 
monitoring system should include the definition of sets of Community health indicators and 
the collection of the data necessary for the establishment of such indicators; 
13. Whereas, Community health data and indicators should draw from readily available European 
data and indicators, such as those held by Member States or transmitted by them to 
international organisations, so as to avoid unnecessary duplication of work; 
14. Whereas a Community health monitoring system would benefit from the establishment of 
a network, the backbone of which relies on telematics, for the collection and distribution 
of Community health data and indicators; 
15. Whereas a Community health monitoring system should be capable of encouraging and 
assisting in the production of analyses of health status, trends, and health problems 
throughout the Community, and in the availability and dissemination of health information; 
16. Whereas overriding considerations in the development of a Community health monitoring 
system are the respect of legislative provisions on data protection, and the implementation 
of appropriate confidentiality and security arrangements; 
34 
17. Whereas a multiannual programme should be launched within the context of the framework 
for action in the field of public health, in order to permit the development of a Community 
health monitoring system and of appropriate mechanisms for its evaluation; 
18. Whereas, in accordance with the principle of subsidiarity, action on matters not under,the 
exclusive competence of the Community, such as action on health monitoring, must be 
undertaken by the Community only when, by reason of their scale or effects, it may be better 
carried out at Community level; 
19. Whereas policies and programmes formulated and implemented at Community level, in 
particular those undertaken in the context of the framework for action in the field of public 
health, should be compatible with the targets and objectives of Community action on health 
monitoring; whereas the implementation of Community actions on health monitoring should 
be coordinated with and take account of relevant research activities under the Community's 
Framework Programme for Research and Technological Development; whereas projects on 
telematics applications in the health field under the Community's RTD Framework must 
be closely coordinated with Community actions on health monitoring; whereas actions under 
the Community's framework programme for statistical information, the Community projects 
in the field of telematic interchange of data between administrations (IDA) and G-7 health-
related projects must be closely coordinated with the implementation of Community actions 
on health monitoring; whereas the work undertaken by the specialised European agencies, 
such as the EMCDDA and the European Environment Agency, should be taken into account; 
35 
20. Whereas cooperation in this area with the competent international organisations ancTwith 
third countries should be fostered; 
21. Whereas it is important that the Commission ensure implementation of the programme in 
close cooperation with the Member States; 
22. Whereas an agreement on a "modus vivendi" between the European Parliament, the Council 
and the Commission concerning measures implementing acts adopted in accordance with 
the procedure laid down in Article 189b of the EC Treaty was reached on 20 December 
1994; 
23. Whereas, from an operational point of view, the investments made in the past both in terms 
of the development of Community networks and cooperation with international organisations 
competent in this field should be safeguarded and further developed; 
24. Whereas unnecessary duplication of effort should be avoided by the joint development of 
methodologies, comparison and conversion criteria and techniques, progressively harmonised 
data collection tools such as surveys, questionnaires or parts thereof, and content 
specifications for health information to be shared using in particular a telematics network; 
25. Whereas, in order to increase the value and impact of the programme, a continuous 
assessment of the measures undertaken should be carried out, with particular regard to their 
effectiveness and the achievement of objectives both at national and Community level and, 
where appropriate, the necessary adjustments should be made; 
36 
26. Whereas this Decision lays down, for the entire duration of the programme, a financial 
framework constituting the principal point of reference, within the meaning of point 1 of 
the Declaration of the European Parliament, the Council and Commission, of 6 March 1995, 
for the budgetary authority during the annual budgetary procedure; 
27. Whereas this programme must be of five-year duration in order to allow sufficient time for 
actions to be implemented to achieve the objectives set, 
HAVE DECIDED AS FOLLOWS: 
Article 1 
Establishment of the programme 
1. A programme of Community action on health monitoring, hereinafter referred to as "this 
programme", is hereby adopted for the period 1 January 1997 to 31 December 2001 within the 
framework for action in the field of public health. 
2. The aim of this programme is to establish a Community health monitoring system which allows 
the measuring of health status, trends and determinants throughout the Community, facilitates the 
planning, monitoring, and evaluation of Community programmes and actions, and provides Member 
States with appropriate health information to make comparisons and to support their national 
health policies. 
37 
3. The actions to be implemented under this programme and their specific objectives are set out in 
the Annex under the headings: 
A. Establishment of Community health indicators 
B. Development of a Community-wide network for sharing health data 
C. Analyses and reporting 
Article 2 
Implementation 
1. The Commission shall ensure implementation, in close cooperation with the Member States, of 
the actions set out in the Annex in accordance with Article 5. 
2. The Commission shall cooperate with institutions and organisations active in the field of health 
monitoring. 
Article 3 
Budget 
1. The total appropriation for implementation of this programme for the period referred to in Article 
1 shall be ECU 13.8 Million. 
38 
2. The annual appropriations shall be established by the Budgetary Authority in accordance with 
the financial perspectives. 
Article 4 
Consistency and complementarity 
The Commission and the Member States shall ensure that there is consistency and complementarity 
between actions to be implemented under this. programme and other relevant Community 
programmes and initiatives, including the framework programme for statistical information, the 
projects in the field of telematic interchange of data between administrations, and the framework 
programme for research and technological development and in particular the telematics applications 
of the latter. 
Article 5 
Committee 
1. The Commission shall be assisted by a Committee composed of two members designated by each 
Member State and chaired by a representative of the Commission, hereinafter referred to as "the 
Committee". 
2. The representative of the Commission shall submit to the Committee draft measures concerning, 
in particular: 
39 
(a) the Committee's rules of procedure; 
(b) an annual work programme indicating the priorities for action; 
(c) the arrangements, criteria, and procedures for selecting and financing projects under this 
programme, including those involving cooperation with international organisations competent 
in the field of public health and participation of the countries mentioned in Article 6(2); 
(d) the evaluation procedure; 
(e) the arrangements for reporting, conversion, and harmonisation of the data; 
(f) the arrangements for the definition and selection of indicators; 
(g) the arrangements for the content specifications necessary for the development and operation 
of the relevant networks. 
3. In addition, the Commission may consult the Committee on any other matter concerning the 
implementation of this programme. 
The representative of the Commission shall submit to the Committee a draft of the measures to 
be taken. The committee shall deliver its opinion on the draft within a time limit which the 
chairperson may lay down according to the urgency of the matter, if necessary by taking a vote. 
40 
The opinion shall be recorded in the minutes; in addition, each Member State shall have the rigfit 
to ask to have its opinion recorded in the minutes. 
The Commission shall take the utmost account of the opinion delivered by the Committee. It shall 
inform the Committee of the manner in which its opinion has been taken into account: 
4. The representative of the Commission shall keep the Committee regularly informed about: 
financial assistance granted under this programme (amounts, duration, breakdown, and 
recipients); 
Commission proposals or Community initiatives and the implementation of programmes 
in other policy areas which are relevant to the achievement of the objectives of this 
programme, with a view to ensure the consistency and complementarity required under 
Article 4. 
Article 6 
International cooperation 
1. In the course of implementing this programme, cooperation with non-member countries and with 
international organisations competent in the field of public health, in particular the World Health 
Organization and the Organization for Economic Cooperation and Development shall be fostered 
and implemented in accordance with Article 5. 
41 
2. This programme shall be open to participation by the associated countries of Central and Eastern 
Europe (CCEE), in accordance with the conditions laid down in the Additional Protocols to the 
Association Agreements relating to participation in Community programmes to be concluded with 
those countries. This programme shall be open to participation by Cyprus and Malta on the basis 
of additional appropriations in accordance with the same rules as those applied to the EFTA 
countries, in accordance with procedures to be agreed with those countries. 
Article 7 
Monitoring and evaluation 
1, The Community, taking into account the reports drawn up by the Member States and with the 
participation, where necessary, of independent experts, shall ensure that an evaluation is made 
of the actions undertaken. 
42 
2. The Commission shall submit to the European Parliament and the Council an interim report 
halfway through, and a final report on completion of this programme. It shall,incorporate into 
these reports information on Community financing in the various fields of action and on 
complementarity with the other actions referred to in Article 4, as well as the results of the 
evaluations. It shall also send them to the Economic and Social Committee and the Committee 
of the Regions. 
Done at Brussels, 
For the European Parliament For the Council 
The President The President 
43 
ANNEX 
SPECIFIC OBJECTIVES AND ACTIONS 
A ESTABLISHMENT OF COMMUNITY HEALTH INDICA TORS 
Objective To establish Community health indicators by a critical review of existing health data 
and indicators, and develop appropriate methods for the collection of comparable and 
progressively harmonised health data. 
1. Carrying out an identification, review and critical analysis of existing health indicators and 
data at the European and Member States' level in order to identify their relevance, quality 
and coverage with regard to the establishment of Community indicators. 
2. Creation of a set of Community health indicators, including a sub-set of core indicators for 
the monitoring of Community programmes actions in public health, and a sub-set of 
background indicators for the monitoring of other Community policies programmes and 
actions, and for providing Member States with common measures for making comparisons. 
3. Development of the routine collection of comparable and/or progressively harmonised data 
in the Member States, including support for the elaboration of data dictionaries, and the 
establishment of appropriate conversion methods and rules, 
44 
4. Contributing to the collection of comparable data by supporting the elaboration of surveys 
including Community-wide surveys in support of Community policies, or modules or agreed 
forms of words for questions in existing surveys. 
5. Foster co-operation with international organizations competent in the field of European health 
data and indicators and networks for the exchange of health data covering specific areas 
in public health, in order to enhance comparability of data. 
6. Support for the assessment of the feasibility and cost-effectiveness of developing 
standardised health resource statistics with the aim of including them in a future Community 
health monitoring system. 
II DEVELOPMENT OF A COMMUNITY-WIDE?NETWORK FOR SHARING HEALTH 
DATA 
Objective To enable the establishment of effective and reliable transfer and sharing of health 
data and indicators using telematic interchange of data as the principal means. 
7. Encourage and support the development of a network for sharing health data, mainly using 
telematic interchanges and a system of distributed databases, in particular by the 
establishment of data specifications and of procedures with regard the to the access, retrieval, 
confidentiality and security for the different types of information to be included in the 
system. 
45 
C ANAL YSES AND REPORTING 
Objective : To develop methods and tools necessary for analysis and reporting, and support 
analyses and reporting on health status, trends, determinants, and the effect of policies 
on health. 
8. Encourage the development of a capacity for analyses, including comparative and predictive 
methodologies and tools, the testing of hypotheses and models and the evaluation of health 
scenarios and outcomes. 
9. Support for the analysis and evaluation of the impact of Community actions and programmes 
in public health. 
10. Support for the production and dissemination of reports and other information material on 
health status and trends, health determinants and the impact on health of other policies. 
46 
FINANCIAL STATEMENT 
1 TITLE OF OPERATION 
Proposal for a European Parliament and Council Decision adopting a programme of Community 
action on health monitoring in the context of the framework for action in the field of public health 
2 BUDGET HEADING INVOLVED 
B3-4306: Health data and indicators 
3 LEGAL BASIS 
Article 3(o) and Article 129 of the Treaty establishing the European Community. 
European Parliament and Council Decision adopting a programme of Community action on health 
monitoring in the context of the framework for action in the field of public health. 
4 DESCRIPTION OF OPERATION 
4.1 General objective 
Implementation of a programme aiming at contributing to the establishment of a Community-wide 
health monitoring system, in particular by the development, availability and dissemination through 
a network of health data and indicators, and to the establishment of a capacity for analysis, 
evaluation, and comparisons. Both the European Parliament and the Council have stressed the 
importance of having sufficient and relevant information as a basis for the development of 
Community actions in the field of public health. The European Parliament has called on the 
Commission to collect and examine health data from the Member States and analyse trends and 
assess the effects of public health policies as well as the impact of other policies on health; and 
the Council has, in several acts, and most recently in its resolution from 2 June 1994 on the 
framework for Community action in the field of public health, stressed the importance of the 
development of Community health data and indicators. 
The aim of the proposed action programme on health data and indicators is to contribute to the 
development of a high-quality, policy-oriented health monitoring system. This system should serve 
three purposes: 1) to enable measurement of health status, trends and determinants throughout 
the Community; 2) to facilitate the planning, monitoring, and evaluation of Community 
programmes and actions, and 3) to provide Member States with high quality, comparative health 
indicators and data which add value to their national health information systems and thus support 
the development of national health policies, whilst fully respecting the principle of subsidiarity. 
Measurement of health status, trends and determinants will be made possible by the development 
of core and background Community health indicators, whereas the provision of information to 
47 
Member States will require the development of a mechanism for the collection and dissemination 
of Community health information. 
The method for achieving these objectives consists of providing support for the establishment of 
mechanisms for collaboration among Member States, the Commission, and relevant international 
organisations in order to assess the quality and coverage of existing health data and indicators 
at the Community level and at the level of Member States and to define a set of core and 
background Community health indicators; providing support for the development of a network 
with agreed procedures and data specifications necessary for effective and reliable exchange of 
information using, as the principal means, an electronic network already under development as 
part of a wider Community project on interchange of data between administrations; and providing 
support for comparative analyses and reporting on health status and determinants and the impact 
of policies. 
4.2 Period covered and arrangements for renewal or extension 
5 years: 01.01.1997 to 31.12.2001 
Report on implementation to be transmitted to the Council and European Parliament during 
the third year of the programme indicating the need for any modifications, if any. 
Report to the Council and European Parliament after completion of the programme with 
conclusions on renewal or need for extension or revision of actions. 
5 CLASSIFICATION OF EXPENDITURE OR REVENUE 
Non-compulsory expenditure 
Differentiated appropriations 
6 TYPE OF EXPENDITURE OR REVENUE 
Subsidy for joint financing with other sources in the public and/or private sector (not exceeding 
a certain percentage of the total cost of the proposed projects). 
The level of funding granted depends on the scope of the measure to be financed and on the extent 
to which the action programme is reflected in the various activities planned. 
Such funding will not exceed 70% of the total budget earmarked for the proposed projects except 
in the case of networks and work ordered and of direct use to the Commission, where the subsidy 
may amount to 100%. 
48 
7 FINANCIAL IMPACT 
7.1 Method of calculating the total cost of operation (definition of unit cost) 
The method of calculation is the result of experience acquired in previous activities related to 
health data and indicators such as the European System of accidents at work statistics (ESAW) 
and projects under ENS-CARE. The specific cost estimates are based on the assumption that half 
of the activities to be undertaken under this programme will require 100 percent funding while 
the other half will require 50 percent funding and that the activities to be undertaken will involve 
most or all Member States. A total amount rounded off to ECU 13.8 million during the period 
1997-2001 is deemed necessary for these activities. The annual allocations will be decided in 
accordance with the normal budgetary procedures. 
49 
7.2 Itemized breakdown of cost (in ECU million) 
Objective Action Area YEARS 
1997 1998 1999 2000 2001 TOTAL 
1997-
2001 
Community 
Health Data and 
Indicators Identification, 
review, and critical 
analysis of existing 
data and indicators 
and assessment of 
future needs 0.7 
Creation of a set of 
Community health 
indicators 0.2 
Development of 
routine collection of 
comparable, 
progressively 
harmonised data in 
Member States 
(including data 
dictionaries, 
conversions and 
harmonisation of 
definition and 
collection methods 0.2 
Elaboration of 
specific surveys and 
modules or agreed 
questions in existing 
surveys 
Cooperation with 
international 
organizations 
Support for the 
development of 
standardised health 
resource statistics 0.1 
0.1 Indicative programming 
0.3 
0.3 
0.3 
0.2 0.4 0.1 
0.2 
0.4 0.1 
0.1 
0.1 
0.1 0.1 
0.1 0.5 
0.6 0.1 
0.1 
0.5 
0.7 1.3 
0.9 
1.9 
2.0 
0.1 
0.1 0.1 
0.1 0.5 
0.4 
50 
network 
development 
Analysis and 
reporting Development of 
data specifications 
and procedures to 
be used in 
networking, 
focusing on 
Community-wide 
electronic 
interchange of data 
Development of a 
capacity for 
analyses, including 
methodologies and 
tools 
Support to the 
analysis and 
evaluation of the 
impact of 
Community actions 
and programmes in 
public health 
Support to the 
production and 
dissemination of 
reports and other 
information material 
on health status and 
trends, health 
determinants, and 
the impact of other 
policies 
TOTAL 0.7 
0.2 
0 
0.1 
2.3 0.7 
0.2 
0.1 
0/2 
2.5 0.8 
0.2 
0.2 
0.2 
2.7 0.8 
0.2 
0.3 
0.2 
3.0 0.8 
0.2 
0.4 
0.3 
3.3 3.8 
1.0 
1.0 
1.0 
13.8 
51 
7.3 Indicative schedule of appropriations (in ECU million) 
Commitment 
appropriations 
Payment 
appropriations 
1997 
1998 
1999 
2000 
2001 
Subsequent years 
TOTAL 1997 
2.3 
1.15 
.0.81 
0.34 
2.3 -1998 
2.5 
1.25 
0.88 
0.37 
2.5 1999 
2.7 
1.35 
0.95 
0.4 
2.7 2000 
3.0 
1.5 
1.05 
0.45 
3.0 2001 
3.3 
1.65 
1.65 
3.3 TOTAL 
13.8 
• 
1.15 
2.06 
2.57 
2.82 
3.10 
2.10 
13.8 
8 FRAUD PREVENTION MEASURES; RESULTS OF MEASURES TAKEN 
The grant application forms will require information on the identity and nature of potential 
beneficiaries so that their reliability can be assessed in advance. 
Fraud prevention measures (checks, intermediate reports, final report) are included in the 
agreements or contracts between the Commission and beneficiaries. The Commission will 
check reports and ensure that work has been properly carried out before intermediate and 
final payments are made. 
In addition, spot checks are carried out by the Commission to verify how funds have been 
used. Checks have already been carried out in other public health budget lines in relation 
to the financial years 1991, 1992, 1993, and 1994 and have shown their effectiveness. 
52 
9 ELEMENTS OF COST-EFFECTIVENESS ANALYSIS 
9.1 Specific and quantifiable objectives; 
The Community measures aim at establishing a Community health monitoring system by 
the accomplishment of the following specific objectives: 
the establishment of a set of Community (core and background) health indicators 
which can be used to monitor health in the Community, which can facilitate planning, 
monitoring and evaluation of Community programmes and actions, and which can 
provide added value to Member States' own health information systems and thus 
support the development of national health policies; 
the establishment of content specifications for a network for the purpose of collection 
and dissemination of the health data and indicators, mainly using telematics; 
the establishment of a capacity to undertake analyses, and support to the preparation 
and dissemination of reports on health status, trends and determinants and the impact 
of policies. 
Target Population 
1. Competent health authorities of the Member States, at national, regional and local level 
and competent international organisations; 
2. Health professionals, health epidemiological and/Statistical services, health and medical 
associations, academic institutions, especially schools of public health (especially for 
the first and third objectives); 
3. NGO's and other bodies interested in health matters, and the public in general (third 
objective). 
9.2 Grounds for the operation 
Health information is specifically mentioned in Article 129 as an area to which Community 
action should be directed. The Council (Resolution of the Council and the Ministers for 
Health meeting within the Council of 27 May 1993 on future action in the field of public 
health, OJ No C 174, 25.6.1993 p.l; Council Resolution of 2 June 1994 on the framework 
for action in the field of public health OJ No CI 65,17.6.1994, p. 1), the European Parliament 
(Report and Resolution of the European Parliament on public health after Maastricht OJ 
No C 329, 6.12.93, p.375), and the Commission (Communication on the framework for 
action in the field of public health, COM (93) 559final of 23.11.93), have identified health 
data and indicators as a fundamental instrument in the Community policy-making process 
and an invaluable tool in supporting Member States' policies, and as an essential part of 
a health monitoring system which will serve to monitor health and health determinants, and 
permit comparisons to be made and facilitate the planning, monitoring and implementation 
of actions. 
The proposed 5-year programme is to develop such a health monitoring system to support 
the Community and the Member States in health policy-making and evaluation, to permit 
Member States to carry out meaningful comparisons and to assist them in allocating 
53 
resources to the various problem areas more effectively. In accordance with the principle 
of subsidiarity, such a system would have to be developed at Community level since it only 
can serve the needs of the Member States both with regard to information in support of their 
national policies and with regard to their role in Community policy-making. In view of the 
scale of the operation involved, i.e. comparable health data and common indicators, and 
network creation and development linking competent authorities in all Member States, the 
pertinent activities can only take place at Community level. 
As regards the intervention methods and the allocation of funds, the following will apply: 
specific application of the principle of subsidiarity when identifying measures to be 
undertaken and co-financed; 
identification and selection of projects for co-financing in the fields of health 
monitoring. These projects will be selected and implemented, where necessary, with 
the assistance of national coordinating committees that may be established in the 
Member States, with participation of persons and bodies involved in the production 
and use of health data and indicators; 
the concept of added Community value, which will continue to be realised in particular 
through the coordination of national measures, the dissemination of information and 
experiences, the establishment of priorities, the development of networking as 
appropriate, selection of European projects and the motivation and mobilisation of 
all involved. 
Two methods will be employed to implement the programme. One is to support 
projects carried out in Member States and at the Community level. The selection of 
priority projects is based largely on general and intermediate objectives, and 
implementation of the measures themselves depends on the quality and effectiveness 
of projects submitted to the competent department during the course of the year. The 
other is to undertake specific activities necessary to achieve the objectives of the 
programme, which will be fully financed by the programme. 
The selection criteria for projects are as follows: 
Compatibility with the objectives and conformity with at least one of the established 
objectives; 
Examination of the "added Community value" of the projects (transnational 
participation, development of a model applicable in other Member States, information 
usable in other Member States, etc.); 
Presumed effectiveness and profitability; 
Clarity and justification of requirements; 
Relevance of selected methodology; 
Organizational competence and experience; 
Suitability of budget for objectives; 
Support for projects from national partners; 
Objective assessment; 
Opinion of the advisory committee involved; 
54 
9.3 Monitoring and evaluation of the operation 
9.3.1 Monitoring of the operation 
Monitoring at the Community level is to be carried out by the Commission, which 
will submit a report half-way through the implementation of the programme, and a 
final report after its completion to the Council, the European Parliament, the Economic 
and Social Committee, and the Committee of the Regions, drawing from national 
reports as well as evaluations of the actions under the programme and of individuals 
projects. 
9.3.2 Evaluation 
Evaluation will be by means of: 
An evaluation of the main measures and of subsidised proj ects involving, where 
necessary, the participation of indépendant experts; 
An overall report on the quality and effectiveness of projects implemented under 
the action plan, to be submitted by the Commission to the other Community 
institutions after completion of the programme. 
Performance indicators selected for this evaluation: 
Evaluation of projects by Commission officials and/or those cooperating with 
them; 
Analysis of intermediate reports on measures scheduled and financed, allowing 
a shifting of emphasis where possible; 
Impact studies by external bodies 
Relevance of the methodology used by organizers; 
Suitability of the budget for the objectives; 
Skills and experience of bodies; 
Dissemination of results; 
Evaluation procedures and intervals: 
Drawing up of intermediate and final reports on the various measures undertaken 
in the field; 
Development of a "standard" evaluation form for the measure, to be forwarded 
by the beneficiaries with their final reports, and checking of these documents 
by officials either at the Commission or in the field. 
10 ADMINISTRATIVE EXPENDITURE (PART A OF THE BUDGET) 
Actual mobilisation of the necessary administrative resources will be conditioned by the 
Commission's annual decision on the allocation of resources, having regard in particular 
to additional staff and funds provided by the budgetary authority. 
55 
10.1 Impact on the number of employees 
Types of employees 
Officiais or 
temporary 
agents A 
B 
C 
Other resources 
Total staff carrying out action 
permanent 
employees 
1 
1 
1 
3 temporary 
employees 
0 
0 source of employee 
from within 
DG or service 
1 
1 
1 
3 supplemen­
tary staff 
0 
0 
0 
0 duration 
10.2 Financial impact of supplementary staff 
10.3 Increase in other running costs arising from the action 
Budget line Amounts Method of calculation 
Meetings A2510 231,000 *2 meetings of advisory committee, 2 
reps./Member State 
2 x 30 x 770 ecu x 5 years 
The resources necessary to cover the expenditure below for the 5-year period will be obtained by re-deployment 
of existing financial resources and the use of supplementary resources will not be required. 
a) Personnel Expenses (Title Al, A2 and A5) 
3 x 100,000 ecus x 5 years = 1,500,000 ecus 
b) Operational Expenses 
Expenses for meetings (A-250) 
2 meetings x 15 experts x 879 ecus x 5 years = 131,850 ecus 
Expenses for travel (A-130) 
24 missions Brussels-Luxembourg x 5 years = 240,000 ecus 
60 missions to Member States x 5 years = 300,000 ecus 
c) Total: 2,171,850 ecus 
56 



ISSN 0254-1475 
COM(95) 449 final 
DOCUMENTS 
EN 17 05 
Catalogue number : CB-CO-95-490-EN-C 
ISBN 92-77-93851-X 
Office for Official Publications of the European Communities 
L-2985 Luxembourg 
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