Amended proposal for a EUROPEAN PARLIAMENT AND COUNCIL DECISION adopting a programme of Community action on healht monitoring in the context of the framework for action in the field of public health
Date: 1996-05-15
Institutions: European Commission
Subjects: EU policy, action programme, data collection, data processing, public health

COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels,  15.05.1996 
COM(96) 222 final 

95/0238 (COD) 

Amended  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  pursuant  to  Article  189 a  (2) 
of  the  EC-Treaty) 

EXPLANATORY  STATEMENT 

Amended 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  (1997-2001) 

1. 

2. 

3. 

4. 

5. 

The  initial  proposal  for  a  European  Parliament  and  Council  decision  adopting  a 
programme  of  Community  action  on  health  monitoring  was  adopted  by  the 
Commission  on  16 October  1995. 

The Economic  and  Social  Committee1  and the  Committee  of  the Regions2  delivered 
favourable  opinions  on this initial  Commission  proposal. 

In light of the European Parliament's opinion  after  its first reading on  17 April  1996, 
an amended proposal  for a decision was  submitted by the Commission  in accordance 
with  Article  189A  of  the  Treaty.  The  text  incorporates  essentially  two  types  of 
amendments: 

amendments that clarify  or broaden the recitals 

amendments  that  clarify  and broaden the  actions  covered  by  the programme. 
In particular,  a feasibility  study of a health observatory has been included, and 
an Annex  (II) has been added,  containing  a list of  potential  domains in which 
the health  indicators may be established. 

The European Parliament adopted 44 amendments when it voted on  17 April  1996, of 
which 28 were acceptable in toto (12,  16-18, 20, 23, and 29) or in part (1, 3, 4,  6-11, 
13,  19, 25,  33-40,  and 42)  by the Commission. 

The amendments which  are not acceptable by the Commission  can be divided  into 5 
groups: 

amendments  that  pose  legal  problems  because  they  do  not  conform  with  the 
wording or intent of Art.  129 (15, 21, 31), or because they are inconsistent with 
the  analogous provisions  of the other public health programmes (43, 46,  47) 
amendments that propose changes which fall  outside the scope of the proposed 
programme  (2,  32) 
amendments  that  propose  a  less  flexible  wording  than  that  proposed  by  the 
Commission and/or which unduly limite-the scope of the proposed programme 
(5,  14, 30,  and 45) 
amendments that are covered  elsewhere  (26-28) 
one  amendment  (22)  that would  result in  difficulties  over budgetary matters. 

1  Opinion delivered  on 27 March 1996. 

2  Opinion delivered on  18 January  1996. 

Amended  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 

COM(95) 449 

AMENDED PROPOSAL 

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. Whereas, in accordance with point (o) of 
Article 3 of the Treaty, Community action 
must 
the 
include  a  contribution  of 
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 
if 
necessary,  lending  support to their action; 

the  Member  States  and, 

collection, 

2.  Whereas  the  Council,  in  its  resolution4 
of  27  May  1993  on  future  action  in  the 
field  of  public  health,  considered  that 
and 
improved 
distribution  of  health  data,  as  well  as an 
improvement 
and 
compatibility  of  available  data,  are 
essential  for  the  preparation  of  future 
programmes; 

analysis 

quality 

the 

in 

i 

2 
3 

4 

OJNo. 
OJNo. 
OJ No. 
OJNo.  C  174, 25.6.1993, p.l 

for 

3. Whereas, the European Parliament, in its 
resolution  on  public  health  policy  after 
Maastricht5,  has stressed the importance of 
having  sufficient  and relevant  information 
the  development  of 
as  a  basis 
Community  actions  in  the  field  of  public 
health;  whereas 
the 
it 
Commission  to collect  and examine health 
data  from  the  Member  States  in  order  to 
assess  the effects  of public health policies, 
as well  as the  impact  of  other policies,  on 
in  the  European 
the  state  of  health 
Community. 

called 

on 

for 

3. Whereas, the European Parliament, in its 
report  on  public  health  policy  after 
Maastricht5,  has stressed the importance of 
having  sufficient  and relevant  information 
the  development  of 
as  a  basis 
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; 

in 

the  Commission, 

health6, 
on 

identified 
standardisation 

4.  Whereas 
its 
Communication  of  24  November  1993  on 
the  framework  for  action  in  the  field  of 
increased 
public 
and 
cooperation 
collection  of  comparable/compatible  data 
on health, and the promotion of systems of 
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; 

OJ No.  C 329,  6.12.1993,  p.375 
COM(93)  559 final 

OJNo.  C 329,  6.12.1993,  p.375 

and 

invited 

indicators  used 

5.  Whereas  in  its  resolution  of  2  June 
1994,  the  Council7 
indicated  that  the 
collection  of  health  data  should  be 
the 
accorded  priority 
Commission to present relevant proposals; 
whereas  the  Council  considered  that  data 
and 
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; 

should 

level 

6.  Whereas  health  monitoring  at  the 
Community 
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; 

6a.  (new)  Whereas  on  the  basis,  inter 
alia,  of  knowledge  of  the  facts  of  public 
health  in  Europe,  obtained  by  setting  up a 
Community  health  monitoring  system,  it 
will  be  possible  to  monitor  public  health 
trends  and  define  public  health  priorities 
and objectives; 

7.  Whereas  health  monitoring, 
in  this 
context,  encompasses  the  establishment  of 
the 
Community 
collection,  dissemination,  and  analysis  of 
Community  health  data and indicators; 

indicators, 

health 

OJNo.  C  165,  17.6.94,  p. 1 

in 

8.  Whereas 
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 
cohesion  and 
social 
consumer protection; 

and 

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 
and 
research 
comparison  of  European  health  data, 
including  nutritional  data, 
the 
Member States, and whereas this was taken 
research  work 
the 
in 
up 
programme; 

coordination 

relevant 

from 

task 

on 

should 

10.  Whereas  health  monitoring 
at 
enable 
level 
Community 
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; 

OJNo.  L219,  28.8.93,  p. 1 
OJNo.  L361,  31.12.94,  p. 40 

to 

options 

12.  Whereas 
and 
available 
possibilities  for  developing  the  various 
parts  of  a  Community  health  monitoring 
system  should  be  carefully  assessed  with 
respect 
performance, 
the  desired 
flexibility  and 
the  costs  and  benefits 
involved;  whereas  a  Community  health 
the 
monitoring  system  should 
definition  of  sets  of  Community  health 
indicators  and  the  collection  of  the  data 
necessary  for  the  establishment  of  such 
indicators; 

include 

from 

should  draw 

13.  Whereas,  Community  health  data  and 
indicators 
readily 
available  European  data  and  indicators, 
such  as  those  held  by  Member  States  or 
transmitted  by 
international 
them 
organisations,  so  as  to  avoid  unnecessary 
duplication  of  work; 

to 

a  Community 

14.  Whereas 
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; 

a  Community 

15.  Whereas 
health 
monitoring  system  should  be  capable  of 
encouraging and assisting in the production 
of  analyses  of  health  status,  trends,  and 
health 
the 
Community,  and  in  the  availability  and 
dissemination  of  health  information; 

throughout 

problems 

that  of 

including 

12.  Whereas  available  options  and 
possibilities  for  developing  the  various 
parts  of  a  Community  health  monitoring 
enhancing 
system, 
existing  capabilities  and/or  setting  up  an 
observatory,  should  be  examined  with 
respect to the desired  performance,  and  the 
costs  and benefits  involved;  and  whereas a 
flexible  system 
is  required  which  can 
incorporate  features  which  are  valuable  at 
present while adapting to new requirements 
or  other  priorities;  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  existing 
European 
data  and  indicators,  such  as 
those  held  by  Member  States  and/or 
transmitted  by 
international 
them 
organisations,  so  as  to  avoid  unnecessary 
duplication; 

to 

13a.  (new)  Whereas  the  situation  with 
regard  to the collection  of  data varies  from 
Member  State to Member  State: 

the  Community  health 
14.  Whereas 
monitoring  system  would  benefit 
from 
being based  on a network,  the backbone of 
which 
the 
collection  and  distribution  of  Community 
health  data  and  indicators; 

telematics, 

relies  on 

for 

15.  Whereas 
the  health  monitoring 
system  should  provide  material  for  regular 
reports  on  health  status  in  the  European 
Community,  analyses  of trends,  and  health 
problems,  and  assist  in  the availability  and 
dissemination  of  health  information; 

15a.  (new)  Whereas importance must be 
attached  to  cooperation  in  the  field  of 
health  and  occupational  health  and  safety, 
from  which  a picture  of  the prevalence  of 
occupational diseases and accidents at work 
can be built up; 

16.  Whereas  it  is  necessary  to  ensure 
the respect of legislative provisions on data 
protection,  and  the 
implementation  of 
appropriate  confidentiality  and  security 
arrangements; 

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; 

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,  by  reason  of  its  scale  and 
effects,  Community  action  in  support  of 
health  monitoring  enables  the  desired 
objectives to be reached more  effectively; 

the 

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 
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 
telematic 
projects 

field  of 

the 

in 

closely 

coordinated  with 

interchange of data between administrations 
(IDA) and G-7 health-related  projects  must 
be 
the 
implementation  of  Community  actions  on 
the  work 
health  monitoring;  whereas 
undertaken  by  the  specialised  European 
agencies,  such  as  the  EMCDDA  and  the 
European  Environment  Agency,  should  be 
taken  into  account; 

20.  Whereas  cooperation  in  this  area  with 
the  competent  international  organisations 
and with third countries should be  fostered; 

it 

is 

important 

the 
21.  Whereas 
Commission  ensure  implementation  of  the 
programme  in  close  cooperation  with  the 
Member  States; 

that 

point  of  view, 

20a.  (previously  recital  23)  Whereas,  from 
an  operational 
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; 

21.  Whereas  it  is  important  that  the 
Commission  implement  this programme  in 
close cooperation  with  the Member  States; 

22.  Whereas  an  agreement  on  a  "modus 
vivendi" between the European  Parliament, 
the  Commission 
the  Council 
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; 

and 

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; 

23. 

Deleted 

10 

24.  Whereas  at  present  data  are 
insufficiently  comparable, and unnecessary 
duplication  of  effort  should be avoided by 
the  joint  development  of  methodologies, 
comparison  and  conversion  criteria  and 
techniques,  progressively  harmonized  data 
collection 
surveys, 
questionnaires or parts thereof, and content 
specifications  for  health  information  to be 
shared  using  in  particular  a  telematics 
network; 

tools 

such 

as 

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 
and,  where 
the  necessary  adjustments 
appropriate, 
should be made; 

level 

framework 

constituting 

26.  Whereas  this  Decision  lays  down,  for 
the  entire  duration  of  the  programme,  a 
financial 
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 
in  order  to  allow 
five-year  duration 
sufficient 
to  be 
for 
implemented  to  achieve the objectives  set, 

actions 

time 

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. 

11 

is  to 
2.  The  aim  of  this  programme 
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  comparisions 
and 
their  national  health 
policies. 

to  support 

programme 

3.  The  actions  to  be  implemented  under 
this 
specific 
objectives  are  set  out  in  the  Annex  under 
the headings: 

their 

and 

The  actions  to  be 

3. 
implemented 
under  this  programme  and  their  specific 
objectives are set out in Annex  1  under the 
headings: 

A. 

B. 

C. 

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

Article  2 

Implementation 

ensure 
1.  The  Commission 
implementation,  in  close  cooperation  with 
the Member  States, of the actions set out in 
the Annex  in  accordance  with  Article  5. 

shall 

ensure 
1.  The  Commission 
implementation,  in  close  cooperation  with 
the Member  States, of the actions set out in 
Annex  I  in  accordance  with  Article  5. 

shall 

2.  The  Commission  shall  cooperate  with 
institutions  and  organisations  active  in  the 
field  of  health  monitoring. 

Article 3 

Budget 

total 

appropriation 

for 
1.  The 
implementation  of  this  programme  for  the 
period  referred  to  in  Article  1  shall  be 
ECU  13.8  Million. 

12 

The  Commission  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 
statistical 
framework  programme 
information,  the  projects  in  the  field  of 
interchange  of  data  between 
telematic 
administrations, 
framework 
the 
and 
programme  for  research  and technological 
development 
the 
in  particular 
and 
telematics  applications  of the latter. 

for 

of 

1.  The  Commission  shall  be  assisted  by a 
Committee 
an  advisory  nature. 
composed  of  two  members  designated  by 
each  Member  State  and  chaired  by  a 
the  Commission, 
representative 
hereinafter  referred to as "the Committee". 

of 

2.  The  annual  appropriations  shall  be 
established  by  the  Budgetary  Authority  in 
accordance with the financial perspectives. 

Article 4 

Consistency  and  complementarity 

including 

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 
framework 
initiatives, 
programme  for  statistical  information,  the 
projects 
telematic 
interchange 
between 
of 
framework 
and 
administrations, 
programme  for  research  and technological 
development 
the 
in  particular 
and 
telematics  applications  of the latter. 

field  of 
data 
the 

the 

the 

in 

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: 

(a) 

the Committee's rules of procedure; 

(b) 

annual  work 

an 
programme 
indicating  the priorities for action; 

13 

(c) 

including 

the  arrangements,  criteria,  and 
and 
procedures 
selecting 
for 
this 
financing  projects  under 
programme, 
those 
cooperation  with 
involving 
international 
organisations 
competent  in  the  field  of  public 
health  and  participation  of  the 
countries mentioned in Article 6(2); 

(d) 

the evaluation procedure; 

(e) 

(f) 

(g) 

the  arrangements  for  reporting, 
conversion,  and  harmonisation  of 
the data; 

the  arrangements  for  the  definition 
and selection  of indicators; 

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 
implementation  of  this 
concerning  the 
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. 

The  opinion  shall  be  recorded  in  the 
minutes;  in  addition,  each  Member  State 
shall  have  the  right  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. 

14 

4.  The  representative  of  the  Commission 
shall  keep 
the  Committee  regularly 
informed  about: 

financial  assistance  granted  under 
this programme (amounts, duration, 
breakdown,  and recipients); 

proposals 
initiatives  and 

or 
Commission 
Community 
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 

and  with 

1.  In  the  course  of  implementing  this 
programme,  cooperation with non-member 
countries 
international 
organisations  competent  in  the  field  of 
public  health, 
in  particular  the  World 
Health  Organization  and  the  Organization 
and 
for  Economic  Cooperation 
Development 
fostered  and 
shall  be 
implemented  in accordance with Article 5. 

and  with 

In the  course  of  implementing  this 
1. 
third 
cooperation  with 
programme, 
countries 
international 
organisations  competent  in  the  field  of 
public  health, 
in  particular  the  World 
Health  Organization  and  the  Organization 
and 
for  Economic  Cooperation 
Development, 
fostered  and 
shall  be 
implemented  in accordance with Article 5. 

to 
relating 

the  Additional  Protocols 

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 
the 
in 
Association  Agreements 
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 
in  accordance  with 
EFTA  countries, 
procedures 
those 
countries. 

to  be  agreed  with 

15 

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 
the  actions 
undertaken. 

is  made  of 

into 

these 

incorporate 

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 
reports 
information on Community financing in the 
on 
various 
complementarity  with  the  other  actions 
referred  to  in  Article  4,  as  well  as  the 
results of the evaluations. It shall  also send 
the  Economic  and  Social 
them 
Committee  and  the  Committee  of  the 
Regions. 

action 

fields 

and 

of 

to 

ANNEX 

ANNEX I 

SPECIFIC OBJECTIVES AND ACTIONS 

A. 

OF 
E S T A B L I S H M E NT 
C O M M U N I TY  H E A L TH 
INDICATORS 

Objective: 

To  establish  Community 
health 
indicators  by  a 
critical  review  of  existing 
health  data  and  indicators, 
and  develop  appropriate 
methods  for  the  collection 
and 
of 
progressively 
harmonised 
health data. 

comparable 

16 

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. 

for 

the  monitoring 

2.  Creation  of  a  set  of  Community  health 
indicators,  including  a  sub-set  of  core 
indicators 
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. 

and/or 

3. Development  of the routine collection of 
comparable 
progressively 
harmonised  data  in  the  Member  States, 
including  support  for  the  elaboration  of 
data dictionaries,  and the  establishment  of 
appropriate conversion  methods  and rules. 

Creation  of  a  set  of  Community 
2. 
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. 

Details  of  these  indicators  are  given  in 
Annex  II to this programme. 

of 

to 

the  collection  of 
4.  Contributing 
the 
supporting 
comparable  data  by 
elaboration 
including 
Community-wide  surveys  in  support  of 
Community policies,  or modules or agreed 
forms  of  words  for  questions  in  existing 
surveys. 

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. 

17 

and 

cost-effectiveness 

6.  Support  for  the  assessment  of  the 
of 
feasibility 
developing  standardised  health  resource 
statistics with the aim of including them in 
a  future  Community  health  monitoring 
system. 

B. 

D E V E L O P M E NT  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 
the  access,  retrieval, 
regard 
confidentiality and security for the different 
types  of  information  to be  included  in the 
system. 

the 

to 

assessment  of  the  feasibility  and  cost-
effectiveness  of  developing  standardised 
health  resource  statistics  with  the  aim  of 
including  them  in  the  Community  health 
monitoring  system. 

Encouragement  of  and  support  for 
7. 
the  development  of  a  network 
for 
transferring and 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  to  the  access, 
retrieval,  confidentiality  and  security  for 
the  different  types  of  information  to  be 
included  in the system. 

C. 

ANALYSES  AND  REPORTING 

Objective: 

To  develop  methods  and 
tools  necessary  for  analysis 
and  reporting,  and  support 
analyses  and  reporting  on 
health 
trends, 
status, 
determinants,  and the  effect 
of policies  on health. 

18 

8. Encourage the development of a capacity 
for  analyses,  including  comparative  and 
predictive  methodologies  and  tools,  the 
testing  of  hypotheses  and  models  and the 
and 
evaluation 
outcomes. 

of  health 

scenarios 

8. 
Encouragement  of  and  support  for 
the development of a capacity for  analyses, 
enhancing  existing  capabilities,  and  for 
feasibility 
for  possible  new 
structures,  comparative  and  predictive 
methodologies  and  tools,  the  testing  of 
hypotheses  and  models  and  the  evaluation 
of  health  scenarios  and  outcomes. 

studies 

9.  Support  for  the  analysis  and  evaluation 
of  the  impact  of  Community  actions  and 
programmes  in  public  health. 

for 
of 

the  production  and 
10.  Support 
dissemination 
other 
and 
reports 
information  material  on  health  status  and 
trends,  health  determinants  and  the  impact 
on  health  of  other  policies. 

the 

Support 

9. 
analysis,. 
for 
preparation,  and  dissemination  of  reports 
evaluating the impact of Community  action 
and  programmes  in  the  field  of  public 
health. 

for 

the 

Support 

preparation. 
10. 
production  and  dissemination  of  reports 
and  other  information  material  on  health 
status  and  trends,  health  determinants  and 
the  impact  on  health  of  other  policies. 

ANNEX  II 

Non-Exhaustive  list  of  domains  in  which 
health  indicators  may  be  established  under 
the  Community  health  monitoring  system 

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 

19 

-  mental  health 

5.  Anthropometric  characteristics 

B. 

Life  Style  and  Health  Habits 

Illicit  drug  consumption 

1.  Tobacco  consumption 
2.  Alcohol  consumption 
3. 
4.  Physical  activities 
5.  Diet 
6.  Sexual  behaviour 
7.  Other health  promotion-related 

activities 

C. 

Living  and  working  conditions 

1.  Employment/unemployment: 

-  occupation 
2.  Work  environment: 
-  accidents 
-  exposure 
and 
substances 

other 

to  carcinogenic 
dangerous 

-  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 
to  carcinogenic 
-  exposure 
and 
dangerous 
substances outside the work 
environment 

other 

D. 

Health  Protection 

1.  Sources  of  financing 
2.  Facilities  /  Manpower 

20 

-  Health resource utilisation 
-  Health care personnel 
Cost / Expenditure 
- 
In patient care 
-  Out patient care 
-  Pharmaceutical  products 
Consumption / uses 
- 
In patient care 
-  Out patient care 
-  Pharmaceutical  products 
Health  promotion  and  disease 
prevention 

£. 

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 

21 

ISSN 0254-1475 

COM(96) 222 final 

DOCUMENTS 

EN 

05 

Catalogue number  : CB-CO-96-232-EN-C 

ISBN 92-78-04220-X 

Office for Officiai Publications of the European Communities 

L-2985 Luxembourg 

2<L