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1.4 Health (CIS-STAT)

Public Health Care

Ongoing work:

• Collection, processing, analysis and dissemination of data provided by national statistical services of the Commonwealth countries illustrating public health care.
• Preparation and publication of analytic materials, in particular, a review "On morbidity, disablement and mortality of population in the Commonwealth countries".


1.4 Health (WHO Europe)


Environment and Health

Purpose:

The purpose is to provide data, information and analytical synthesis on the interrelationships between environment and public health issues (EH). This process allows monitoring of EH trends. Progress is quantified with regards to implementations of EH policies. It generates the evidence-base to support EH decision-making in countries of the WHO European Region.

Ongoing methodological work:

  • Standardization of indicator methodologies and validation of data collection and linkage analyses to produce evidence-based EH assessments.
  • Developing presentation methods for supplying information for decision-making.
  • Development of health indicators related to climate change and incorporation into the environmental health information system (contract between WHO/Europe and European Commission/DG Sanco).
  • Implementation of new international data-flows e.g. from EUROSTAT surveys.
  • Development of methods for health impact assessment and burden of disease of environmental risk factors, using hierarchical models for uncertainty estimation;
  • Development of tools for the assessment of the burden of disease of climate change.
  • Development of harmonized evaluation methodology for the effectiveness of heat health action plans;
  • Development of assessment tool for health security and climate change;
  • Application of small area techniques for the analysis of high-resolution data on mortality, morbidity and hospital admission;
  • Support to the Ministry of Health of Portugal in the development of standard tools and methods to identify housing and health priorities for local action, e.g. roll-out of an PC-based interview support program and analysis tool.

Priority objectives over the next two years:

  • Preparation of national implementation of core environment and health (EH) indicators.
  • Updating the pan-European database of the core EH indicators, assessments, reporting and addressing challenges related to sustainability and consistency of data sources.
  • Framework for system scalability to accommodate further applications of information in support to EH policy making.
  • Preparation of indicator-based assessment report on EH progress in the WHO European Region in the context of the policies implemented for the 5th Ministerial Conference on Environment and Health (Italy, March 2010).
  • Update previous estimates of health impact of air pollution in selected Member States using enhanced, model-based methods.
  • Assessment of burden of disease of selected environmental risk factors related to indoor air quality, noise and housing.
  • Economic evaluation of health impacts due to environmental exposure through application of a set of reliable estimates and characterization of their uncertainty.
  • Assessment of the burden of disease and of health security in relation to climate change and EH inequities.
  • Building capacity on integrated environment and health assessments in European Member States.

New activities to be undertaken in the next two years:

  • Collection of evidence and data on social inequities of environmental health risks.
  • Developing a data base as part of the European Environmental Health Information System (ENHIS), integrated into the IT infrastructure of the WHO Regional Office for Europe.

Meetings planned to be organized in the next two years:
  • Periodic technical meetings on methodological issues in environment and health assessments as well as the statistical data which serve as input for the EH indicators system. The meetings gather invited national professionals, professionals dealing with evaluation of national action programs on public health and/or environment, statisticians and external experts. Parallel to these, agreement on a common approach will be created in collaboration with the relevant international agencies to avoid duplication of efforts, minimize the burden of reporting by the countries and to use the same indicators where there are similar needs.


Health Statistics

Purpose:

WHO/EURO provides twice yearly updated information for the assessment and monitoring of the health situation and of trends in health and health care in countries of the European Region in order to provide support for decision-making and for the formulation of public health policies and programs including the assessment of their effectiveness. In this regards, EURO collects, reviews the quality and maintains over 600 indicators from various health dimensions in different databases.

Ongoing methodological work:

  • Annual collection and processing of national basic health statistics (e.g. demographics, health status, health determinants and health care) from 53 European WHO Member States and dissemination via the WHO/EURO website http://www.euro.who.int/InformationSources/Data/20010827_1 or from http://www.euro.who.int/HFADB;
  • Annual collection and processing of national and sub-national mortality from European WHO Member States and dissemination via the WHO/EURO website. It supplements the European health for all database (HFA-DB) providing data for a predefined set of aggregated indicators for 67 causes of death by age and sex (HFA-MDB);
  • Annual collection and dissemination of the European detailed mortality database (DMDB). This source was developed in 2007 to provide user-friendly access to detailed data by any combination of three-digit codes used in the International Classification of Diseases, ninth or tenth revisions (ICD-9 or ICD-10) and five-year age groups;
  • Collection and dissemination of the national hospital discharge data in a form of a European Hospital Morbidity database (HDMB), including detailed diagnoses by age and sex. It may be accessed at:
  • Maintenance of the WHO Health Evidence Network (HEN) as an information service for public health and health care decision makers in the European Region, as well as mapping of existing health information and data sources in the region.
  • Preparation of the 2009 European Health Report. In addition to the basic analyses of situation and trends, this report emphasizes the importance of the health system as a means to achieving better population health in the countries of the region; this report contributed to scrutinizing the validity and analytical power of the WHO/Europe databases currently maintained. It also serves as a prime instrument for dissemination of statistical findings from the Region.

Priority objective of methodological work:

 • Design of an integrated system of statistical databases maintained by specific WHO/Europe technical programs available to external users via uniform interfaces;
  • Review and improvement of data quality of WHO/EURO data sources at different levels, including the establishment of mechanisms and tools to facilitate the process;
  • Design of a data quality assessment and improvement strategy of WHO health data collections;
  • Improvement of the international data collection co-ordination and comparability in collaboration with other international agencies (primarily with OECD and EC/EUROSTAT). Work towards establishing a joint WHO/OECD/EUROSTAT data collection for the coordination of health data collection efforts and the harmonization of health indicators in the European region. Following the national health accounts example, a joint collection on non-expenditure health indicators has been proposed, to start in 2010. Definition of scope, indicators definition, timetable and operational organization of the process have been decided by end of 2009.
  • WHO/Europe developed as joint action with the European Commission, DG-Sanco, an integrated health information system for the display and analysis of indicators on socio-economic situation, health, and health care resources on regional level (so-called NUTS2-level). This web-based information tool brings together regional data from a broad range of EUROSTAT databases. As part of this joint action, regional inequalities across Europe and their implications for differences in health have been studied. The results will be published in the first half of 2010.

New activities:

  • The implementation of an integrated health information platform that brings together data from different WHO/Europe services and thematic areas will be stepped up during 2010-2011. This will be done in coordination and close cooperation with similar projects that have started in other WHO regions on so-called "Regional Health Observatories", and in the form of the "Global Health Observatory" at WHO Headquarters in Geneva.
  • This will include the development of new tools for improving user-friendly on-line access to health data and integrated display of WHO/EURO data in various ways, including in the form of maps and improved charts.
Meetings planned to be organized in the next two years:
  • Sixth European Meeting of WHO national counterparts on health statistics and information, to be held during spring 2011. The aim will be to review demands for data and information, identify and agree on new indicators for the HFA database, suggest mechanisms for improving data collection and harmonization processes and proposes improvements to HFA data dissemination, user-interfaces and communication. In addition, the meeting will allow the sharing of country experiences in the development and use of core health information systems.


Prison and Health

Purpose:

The Prison Health database (http://www.euro.who.int/prisons) is used to develop evidence-based guidance on cost-effective disease control and health promotion in prisons as part of national strategies for public health. The information in the database is updated annually by national counterparts of the WHO Network on Prison and Health or of a representative for the Ministry of Health. The prison health database was developed in order to increase the knowledge of prison health, trends in prison health and their importance for public health. The development of the database is done jointly by WHO and the European Monitoring Centre for Drugs and Drug Addiction. It is supported by a grant from the Public Health program of the European Commission. In September 2009 it was decided to close the database until resources are available to up-data and maintain the information in the future.
Ongoing methodological work:
  • Decreasing the number of indicators and improve standardization and validation for data collection;
  • Increase the number of participating countries;
  • Develop a system for data reporting.
Priority objectives over the next two years:
  • Seek funding opportunities to re-open the database;
  • Streamline the database;
  • Increase collaboration with EMCDDA and European Commission in order to be able to continue the database.
Meetings planned to be organized in the next two years:
  • National counterpart meeting to be organized during October 2010 where the future of the prison health database will be discussed.


Alcohol

Purpose:

WHO/EURO started in 2008 to collect data on alcohol consumption, alcohol related harm and responses together with European Commission and the WHO HQ. Data will be used for a global/regional database and available for the public during spring 2010. The data will further be used for a Status report for the WHO European region, for a report for the European Commission and a Global Status report from WHO HQ.

Ongoing methodological work:

  • Data collection from 53 European Member States;
  • A system for on-line data entry;
  • Entering data in to a SPSS file.
Priority objective of methodological work:
  • A shared database will be developed at WHO HQ with a platform for each European region and also for the EU Member States only;
  • Review and improvement of data quality especially with focus on alcohol consumption by reconciling a range of different sources of data;
  • Improvement of the international co-ordination of the data collection in order to secure that data for a country are the same in different international sources;
  • Improvement of data collection, so a Member States will only have to answer one survey every second year and not different surveys from WHO Geneva, WHO/Europe and the European Commission.

New activities:

• Preparation of a European Alcohol report to be ready by May 2010.
Meetings planned to be organized in the next two years:
• Data meeting with HQ and the European Commission at regular basis;
• Alcohol counterpart meeting summer 2010.


Tobacco

Purpose:

The EURO tobacco control database was developed in 2002 and revised and updated in late 2005. It contains data on various aspects of tobacco control policies in WHO European Member States and provides standardized information to track and assess tobacco-control measures within and across countries in the EURO region. It also includes a unique feature of providing tobacco control legislation with English translation of legislative texts.

Priority objectives:

 •  Increase the available data and pursuing additional sources for information.
  •  Improve the current status of the WHO/EuropeO tobacco control database by providing the most up-to-date information, making it more interactive, allowing for more analysis and being innovative in services to offer to the Member States.
  •  Work closely with Health Information Team (Health for All) and Headquarters (Global Health Observatory) to collaborate in the data collection and consistent presentation of information.
  •  Collaborate with other NCE units (alcohol, nutrition and physical activity) to engage in an integrated approach to surveillance.

New activities to be undertaken in the next year:
  •  Expansion of Global Adult Tobacco Survey (GATS), as well as Global Youth Tobacco Survey (GYTS) and Global Health Professions Student Survey (GHPSS) to new countries in the region
  •  Development and deployment of a comprehensive and integrated tobacco control database, with links to WHO/Europe non-communicable diseases risk factors database.
  •  Introduction of new data collection tool through online data entry with validation and document uploading capabilities.
  •  Establishment of a group of tobacco control consultants/experts who could be engaged in surveillance/analysis activities and capacity building work at country level.
Meetings:
  •  National counterpart meeting once per biennium
  • Regional Workshop on the implementation of the WHO Framework Convention on Tobacco Control, with discussions on surveillance and data collection


Nutrition and physical activity

Purpose:

WHO/Europe started in 2005 to collect data on the prevalence of overweight and obesity in all population groups as preparation for the European Ministerial Conference on Counteracting Obesity (15-17 November 2006, Istanbul). To follow up and ensure implementation of the Charter that was endorsed at this Conference, prevalence data have been included in the WHO European Database on Nutrition Policy and regularly updated (http://data.euro.who.int/nutrition/). Diet and physical activity are main determinants of overweight and obesity and thus WHO/Europe started late 2008 to collect data on dietary intake patterns and physical activity levels and patterns. All the information collected will be included in a European regional database on Nutrition, Obesity and Physical Activity (NOPA), which will be accessible to policy-makers and will assist Member States in monitoring their nutrition and physical activity policy implementation and making comparisons between countries.

Ongoing methodological work:

 • Annual collection and processing of national and sub-national data on the prevalence and trends of overweight and obesity, physical inactivity, food consumption and nutrient intake in all population groups (children, adolescents and adults) from the 53 Member States of the WHO European Region;
  • As part of the WHO European Childhood Obesity Surveillance Initiative that aims to monitor routinely the policy response to the emerging obesity epidemic, a first data collection round took place during the school year 2007/2008 by 14 countries. Body weight and body height as well as dietary and physical activity patterns have been measured among primary school-children aged 6-9 years. A second round is taking place during the school year 2009/2010.
Priority objectives beyond 2009:
  • Calculation of inter-country comparable estimates of the prevalence of overweight/obesity, nutrient intake and physical inactivity, based on a standardized methodology.
  • New activities to be undertaken in the next year:
  • Finalization and launch of the comprehensive and integrated NOPA database. The two currently existing databases (http://data.euro.who.int/nutrition/ and http://data.euro.who.int/physicalactivity) will then be merged. This database will include the following components:
     o Surveillance data: nutritional status, dietary habits and physical activity.
     o Policies: nutrition, physical activity promotion, obesity.
     o Actions to implement the policies: government programmes and initiatives, public-private partnerships, legislation in the different areas of action.
     o Good practices: programmes, initiatives and preventive interventions in different settings improving diet, physical activity and/or preventing obesity;
     o Status of implementation of key commitments: contained in the European Charter on Counteracting Obesity, the European Commission's White paper on "A Strategy for Europe on Nutrition, Overweight and Obesity related health issues" and the Second European Action Plan for Food and Nutrition Policy 2007-2012.
  • First progress report on the implementation of the European Charter on Counteracting Obesity, which will include the abovementioned information so far in all 53 Member States in the WHO European Region.
Meetings:
  • Fourth meeting of the principal investigators of the participating countries in the WHO European Childhood Obesity Surveillance Initiative (Rome, Italy; 8-10 February 2010);
  • Joint meeting of the 27EU national information focal points for a joint WHO/EC monitoring project on improving nutrition and physical activity and prevention obesity with the 53 WHO nutrition counterparts (Geneva, Switzerland; 24-26 March 2010). At this meeting Member States will be asked to validate and confirm the information WHO/EURO has identified by then, which will then be fed into the progress report and the official release of the WHO European NOPA database.


Communicable Disease Surveillance, Prevention and Control

Purpose:

This database contains data gathered through surveillance, prevention and control activities on communicable diseases - such as tuberculosis, HIV/AIDS and sexually transmitted infections, and malaria - and data on immunization coverage in countries and recent outbreaks in Europe. It offers information on recent outbreaks in Europe and some other textual information. The database allows detailed review and assessment of the situation on the main infectious diseases in the WHO European Region. It also offers some data at the sub-national level.

Ongoing methodological work:

  • Collection and dissemination of data on vaccine preventable diseases, including monthly incidence of measles, rubella, acute flaccid paralysis (polio), and diphtheria, and annual summaries of immunization program indicators (vaccination coverage, immunization schedules), through the Centralized Information System for Infectious Diseases (CISID) database http://data.euro.who.int/cisid/. Monthly surveillance statistics for measles jointly collected and reported with EUVAC.NET;
  • Annual collection and dissemination of data on non-vaccine preventable infectious diseases, including zoonotic, vector-borne, blood-borne and water related, through the centralized information system for infectious diseases (CISID);
  • Annual collection and dissemination of epidemiological data on the following sexually transmitted infections (STIs): Syphilis (total, early, late and congenital), Gonorrhoea, Chlamydia, Herpes simplex and HPV as well as viral hepatitis and HIV/ hepatitis co-infection. Data are collected through the WHO Communicable Disease Annual Reporting Form and disseminated through the Centralized Information System for Infectious Diseases (CISID) database;
  • Enhanced surveillance of HIV/AIDS conducted jointly by WHO EURO and the European Centre for Disease Prevention and Control (ECDC) in the 53 WHO EURO Member States since January 2008. Dissemination of data in an annual WHO/ECDC HIV/AIDS surveillance in Europe report (available at http://www.euro.who.int/aids) and through the centralized information system for infectious diseases (CISID): http://data.euro.who.int/cisid/;
  • Annual collection, through an annual WHO/UNAIDS/UNICEF reporting tool, on the health sector response to HIV/AIDS, including information on access to prevention, treatment and care for people living with HIV/AIDS. Data dissemination via the annual "Towards universal access" progress report (http://www.who.int/hiv/pub/2009progressreport/en/);
  • Annual collection and dissemination of tuberculosis notification and treatment outcomes, including drug-resistant TB data in collaboration with ECDC. Annual collection and dissemination of tuberculosis control program data maintained through CISID.
New activities:
  • Development of an online data entry tool for rubella and Congenital Rubella Syndrome through CISID;
  • Development of an electronic data transfer protocols between ECDC and WHO databases;
  • Improvement of automated uploading capabilities in countries that are reporting surveillance data to CISID.
     o Update TB data entry form, considering i) Regional challenges for TB control (prisons, migrants) and ii) new global TB data production circle (switch to earlier data collection);
     o Develop a TB case base data collection tool for the countries that maintain their TB case data management in a case-based format. Data extraction script for aggregating the data according to CISID2/TUB3
  • Migrate historical TB database according to CISID2/TUB3 database specification;
  • Develop a TB case based data management application to be recommended to the countries that manage own data on paper and in aggregated format.


Health Accounts

Purpose:

WHO/Europe's work on health systems financing includes efforts to produce reliable, internationally comparable and transparent estimates of health expenditures for each country in the Region, using a common international standard (the International Classification for Health Accounts). Estimates are produced in a consultative process with technical specialists in all Member States and partner agencies. The work results in aggregate health expenditure estimates available on-line in the WHO/Europe Health for All database.

Ongoing methodological work:

The System of Health Accounts (SHA), a global standard for defining and classifying financial resources for health, is going through a major revision. The work is led jointly by WHO, OECD and Eurostat. WHO/Europe continues to contribute to this revision to ensure the new standard is aligned with the functional framework for health financing that we use in our country and normative/analytic work, with the aim to increase the usefulness of health expenditure data and National Health Accounts in health financing policy work and monitoring. WHO/Europe contributions are made through input papers to the revision process, and participation in revision meetings. Such engagement is ongoing and will continue in 2010, when a first full draft of the second edition of the System of Health Accounts is expected to be drafted by the International Health Accounting Team (lead by experts from OECD, WHO, and Eurostat).

Priority objective of methodological work:

WHO/Europe has established a validation process of all health expenditure data published in the Health For All Database, the WHO World Health Statistics and the WHO WHOSIS database. The validation consists of an informal network of experts in health accounting and/or health financing in the region, with whom is shared preliminary estimates from WHO and who are invited to provide comments and alternative estimates.
In the area of pharmaceuticals, WHO collaborates with the EU funded PHIS and PPRI network; this will produce in 2010:
  • updated national pharmaceutical profiles of EU countries;
  • indicators for national pharmaceutical systems;
  • data on medicines in hospitals.
Some statistical data referred to on pharmaceuticals are included in the European Health for All database (mostly types of expenditure data on medicines) and is coordinated with the National Health Accounts as well.


1.4 Health (Eurostat)

Theme 1.05 Health and safety

1. Description

Based on Regulation (EC) 1338/2008 of 16 December 2008 concerning Community statistics on public health and health and safety at work, activities will be continued to develop, collect, analyse and disseminate a consistent set of statistics on (info) public health as the statistical element of health information required by the second programme of Community action in the field of health 2008-2013 and the further Health Strategy, and (ii) health and safety at work in order to meet the needs of the Community strategy on health and safety at work 2007-2012. The main focus will be on quality improvement for the different sets of indicators, on preparatory work for implementing measures for the framework regulation and on providing data for health and safety indicators as part of the structural, sustainable development social inclusion, and the European Community Health Indicators (ECHI). This refers in particular to the core set (ECHI short list) and progressively their regional elements, to the streamlined indicators portfolios of the Open Method of Coordination (OMC) for the area of health care and long-term care, as well as to other indicator sets such as the contextual indicators on disability and social integration. Cooperation with Member States in the area of public health will enter into a new dimension by strengthening the partnership on public health as an ESS network.

2. Work Programme for 2010

2.1 ONGOING WORK

  • Cooperation with Member States on public health statistics via ESSnet Public Health in order to improve data quality and arrive at more complete dissemination of data and indicators in the area of public health.
  • Collecting experience from the first implementation to prepare an implementing regulation on the EHIS (European Health Interview Survey). Processing and analysis of the first EHIS data to be submitted to Eurostat in 2009- 2010 and cooperation in the Budapest Initiative.
  • Continuation of the System of Health Accounts (SHA) joint questionnaire and methodological revision of SHA together with the OECD and the WHO.
  • Continuation of a data collection on non-expenditure health care data and development of a Joint Questionnaire together with the OECD and the WHO.
  • Preparation for the implementation of the special survey module on disability and social integration of disabled people.
  • Continuation of pilot data collections and developments of the methodology for data collection on morbidity.
  • Implementing measures on causes of death (COD) and preparation of implementing measures on accidents at work statistics.
  • Dissemination of the data of the LFS ad hoc module 2007 on accidents at work and work-related health problems.
  • Improvement of the coverage (target population as well as phase 3 variables on causes and circumstances) for ESAW (European Statistics on Accidents at Work) and the consolidation of EODS (European Occupational Diseases Statistics) in new Member States and candidate countries.
  • Methodological improvement on automated coding — COD.

2.2 NEW WORK

  • Analysis of MORB (morbidity) pilot data.
  • Revision of EHIS with a view to the second round.
  • Implementation of the NACE Rev 2 classification and preparation for the ISCO 2008 revision in the ESAW and EODS data collections and dissemination.
  • Improving the quality of ESAW data by defining and implementing the corrections for under-reporting.
  • Follow-up of the IDB (Injury Database) and INTEGRIS (Integration of European Injury Statistics) projects.
  • Preparation of the implementation of the 2011 LFS ad hoc module on employment of disabled people.

 2.3 SIMPLIFICATION AND BURDEN REDUCTION

  • Joint data collection on health care data together with the OECD and the WHO.

3. Work to be carried out by other DGs involving data collection from Member States

For some areas in the field of public health, data such as injuries and regional health statistics are collected directly by DG Health and Consumer Protection (DG SANCO), through actions which are not directly steered by Eurostat, under the Programme of Community action in the field of health 2008-2013. Eurostat will, where relevant and possible, provide technical support on the follow up these projects, such as by examining the possibility to launch an ESSnet.
The European Foundation for the Improvement of Living and Working Conditions (Eurofound) will continue the development of an observatory of working conditions in Europe. Eurofound will also launch its 5th European Survey on Working Conditions.
The European Agency for Safety and Health at Work (EU-OSHA) will continue to develop its Risk Observatory on new and emerging risks.
The European Centre for Disease Prevention and Control (ECDC) coordinates collections of data on communicable diseases at Community level.
Data on key indicators on drugs are collected by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), and work is coordinated with Eurostat.

5. Planned new legislation

Adoption of two implementing measures (COD and ESAW) for Regulation 1388/2008.


1.4 Health (OECD)

Health Accounts

Purpose

To provide policy relevant, comparative data and analysis on health expenditure and financing, and to facilitate harmonisation across national health accounting practices. To provide data sources for research and to make country-specific health accounts data and analysis more widely available.

Objectives and outputs

The fourth Joint OECD, Eurostat and WHO System Health Accounts (SHA) data collection was successfully implemented in 2009. It has improved the availability and comparability of health expenditure data and also contributed to the improvement in health expenditure data published in OECD Health Data. A System of Health Accounts database has been developed as a component of the OECD Statistical Information System. National Health Accounts Experts and others interested in accessing health accounts data can now do so using OECD.Stat and SourceOECD.
Methodological developmental work has continued on a number of projects: Improving the Comparability and Availability of Private Health Expenditure; Development of Output based Health-Specific Purchasing Power Parities; Estimating Expenditure by Disease, Age and Gender; and Improving Estimates of Imports and Exports of Health services and Goods. The consultation process for the revision of the SHA manual has continued. The revision is a collaborative activity of the OECD, Eurostat and WHO.

Non-member countries involved in the activity:

Chile, Croatia, Cyprus, Estonia, Israel, Latvia, Lithuania, Malta, Romania, Russian Federation, Slovenia

Databases

OECD Health Data (Expenditure and Financing)
System of Health Accounts Database.

Main Developments for 2010

General aspects:

In 2010, the fifth Joint OECD-Eurostat-WHO health accounts (SHA) data collection will take place. Previous improvements to the validation tools used both by the national compilers and the international organisations will continue to provide efficiency gains in the validation exercise and ultimately feed through to improved timeliness in dissemination of the data.
The 2010 questionnaire remains unchanged from previous years and it is envisaged that the questionnaire will continue to be based on the current version for at least the next few years with any changes kept to a minimum. As much as it is possible it is the aim to collect SHA Tables for preceding years (that is, from 2000 onwards).
In addition, an increasing number of OECD and non-OECD countries are expected to submit data to the 2010 collection which will improve overall coverage and data comparability. Combined with improved linkages to the OECD Health Data database, this will also lead to an increase in the quality of the expenditure and financing data in OECD Health Data 2010.
The main developments in the OECD Health Data collection in relation to expenditure and financing (Parts 5 & 6) are continuing improvements in the consistency between the 3 tables for total, public and private health expenditure and increased harmonisation with the Joint SHA data collection so that data are fully comparable.
The consultation process for the revision of the SHA manual will continue in 2010. A draft of the revised SHA Manual will be produced by the end of the year, as a collaborative project of the OECD, Eurostat and WHO.
The methodological projects such as Improving the Comparability and Availability of Private Health Expenditure; Development of Output based Health-Specific Purchasing Power Parities; Estimating Expenditure by Disease, Age and Gender; and Measurement of Health Volume Output have or will be completed. These projects as well as methodological work undertaken in the past such as Refinement of the SHA framework for health financing; Definitions and estimation of long-term care expenditure; and Incorporating Input, Output and Productivity Measurement into the SHA Framework will continue to feed into the revision of the SHA manual. The project on Improving Estimates of Imports and Exports of Health Care Goods and Services under the SHA will be completed in 2010.

Health Care Quality Indicators

Purpose

The purpose of the Health Care Quality Indicators (HCQI) Project is to develop a set of indicators that can be used to raise questions regarding quality of care across countries. They are reported as a regular chapter in Health at a Glance since 2007.

Objectives and outputs

The HCQI Project goals in 2010 are: to review and refine existing quality of care indicators in preparation for the 2010-11 HCQI Data Collection to commence in November 2010; and to undertake data analysis to support research work in relation to the Health Ministerial Meeting in October 2010 and the ongoing priorities of the HCQI Project.

Non-member countries involved in the activity:

Cyprus, Latvia, Singapore

Databases

HCQI Data Collection

Main Developments for 2010

Data management:

Ongoing consideration of StatWorks during 2010.


Health Data

Purpose

To provide policy makers and health researchers with a wide range of statistics on health and health systems to allow comparative analysis of different aspects of the performance of health systems. The central parts of the database include data on health care resources, their utilisation, expenditure and financing. This is complemented by a broader range of data on health status, lifestyle, and other data on the socio-economic environment of health systems in OECD countries, in order to provide data on the context of health systems for policy analysis. Developmental work is also under way to obtain comparable data on disparities in health status and health care access and use, as well as on the quality of health care. Some of these data will be gradually included in OECD Health Data to fill important gaps in measuring the performance of health systems.

Objectives and outputs

Progress was achieved in 2009 in improving the availability and comparability of key indicators of health status and health systems that are reported in the publication Health at a Glance 2009.
The activity is co-ordinated with Eurostat, WHO Geneva and WHO Europe to reduce the duplication of work and promote the harmonisation of international data collection and reporting. Developmental work carried out in 2009 will lead to a new joint data collection between the OECD, Eurostat and WHO Europe on non-monetary health care statistics in 2010.

Databases

OECD Health Data 2010

Main Developments for 2010

General aspects:

Improving the availability and comparability of data on non-medical determinants of health, in particular on nutrition and overweight/obesity problems. Introducing a new joint OECD/Eurostat/WHO Europe data collection on non-monetary health care statistics (including both human resources in health and physical/technical resources). Assessing the feasibility of filling data gaps on the occurrence of selected chronic diseases, working in collaboration with other international organisations (the focus will be to try to gather incidence and prevalence data on ischaemic heart disease, stroke and asthma, to complement the data currently reported on cancer incidence, diabetes prevalence and HIV/AIDS incidence).


1.4 Health (UN Statistics Division)

Disability Statistics

Ongoing methodological work:

• Development of methods to improve the collection and compilation of disability statistics through surveys and censuses. In particular, UNSD worked with the Washington Group on Disability Statistics in developing of a small set(s) of general disability measures, suitable for use in censuses. In addition, currently involved in the development of an expanded set of measures suited for use in sample-based national surveys, or other statistical formats. See http://unstats.un.org/unsd/methods/citygroup/washington.htm for more information.

Data collection:

• The questionnaire on Human Functioning and Disability statistics was sent to countries for completion as part of the regular DYB data collection system. The results have since been analysed.
• Disability statistics has been collected on ad hoc basis and stored in the Disability Statistics database version 2 (DISTAT-2). Excerpts from DISTAT-2 were posted on the internet in mid-2001. See: http://unstats.un.org/unsd/demographic/sconcerns/disability/ for more information
• Questions on disability, asked in censuses worldwide from 1995 to 2004 have been posted on the UNSD website. See http://unstats.un.org/unsd/demographic/sconcerns/disability/disabmethods.aspx


1.4 Health (UNECE STAT)

Activity 6.5: Health statistics

Description and objectives

Work towards the improvement of the comparability of health status statistics in the UNECE region, in cooperation with the Washington Group on Disability Statistics, the World Health Organization and Eurostat.

Activities and output

• Develop guidelines for statistics on measuring health status to assist UNECE member countries in designing surveys on measuring health status and to promote the utilization of common terminology and methodology. The work is done in collaboration with Eurostat and the Washington Group.
• Explore the possibility of creating a common forum on health statistics together with WHO and Eurostat.
• Finalize the survey module on measuring health status (Budapest Initiative Mark 2), in coordination with the existing groups, such as the Washington Group and the Eurostat Group on Health Interview Survey (HIS).
• Prepare a report on the outcome of the work of the Budapest Initiative.
• Provide secretariat support to the Steering Group on Health Statistics and the Task Force on Measurement of Health Status.
• Organise the Work Session on the Measurement of Health Status, in cooperation with WHO and Eurostat, on 20-22 January 2010.
• Organise the Meeting of CES Task Force on Measurement of Health Status in May 2010.

Organizations and groups involved

CES Steering Group on health statistics (TOR to be approved by the Bureau)
CES Task Force on measurement of health status (so-called Budapest Initiative)
Eurostat
WHO
Washington Group on Disability Statistics
Eurostat Group on Health Interview Survey.


1.4 Health (WHO (Headquarters))


Methods and country health information systems

WHO is continuing to work to improve methods and country health information systems for measuring population health, health system functioning, inequities in health, core health-related indicators including health-related millennium development goals, as well as key inputs into the health system such as national health expenditures.

WHO's Global Health Observatory

WHO is developing a Global Health Observatory (GHO) that aims to enhance access to ¬-- and analyses of - WHO's data and statistics on health situation and trends. The Global Health Observatory is an Organization-wide activity with strong links to the regional and country offices. The goal is to enhance the quality, efficiency and effectiveness of all of WHO's work in the area of health statistics. The main target audiences are the general public, policymakers and public health professionals (in practice, research and education) in Member States and international organizations. The Global Health Observatory will disseminate information in three ways:
• a web portal providing one entry-point to WHO's health statistics and analyses, including theme pages and data views;
• a data repository that includes easy links to all major data bases;
• analytical reports on specific and cross-cutting topics.
In 2009, as part of the GHO, WHO issued a global report on women and health bringing together and analysing data on health-issues relevant to women across the life-course and around the world.

Methodological work

WHO methodological work continues to focus on better measurement of fatal and non-fatal health outcomes in a comparable manner and on the development of improved estimation techniques for summary measures of population health and the measurement of inequality. Specific activities include:

Mortality statistics
The WHO Department of Health Statistics and Informatics is continuing to support countries strengthen their routine health information and civil registration systems. WHO has developed a strategic guidance tool to support countries to identify gaps and weaknesses in their vital statistics and find feasible ways of addressing them.
WHO continues to invest greater effort to improve the coverage and timeliness of causes of death statistics by working with countries to:
• obtain and update civil registration information for Member States with complete civil registration, with a delay of no more than two calendar years;
• establish and implement mechanisms to obtain, validate and update vital statistics for countries with partial registration data, e.g., where data are limited to cities or to sample registration areas;
• establish and implement mechanisms to obtain, validate and update data for countries with limited registration capacity, using data from small scale/sample registration and surveillance systems;
• WHO has produced, in collaboration with other international partners, a standard verbal autopsy tool to collect data on cause of death data in household surveys in settings where vital registration is non-existent or incomplete.

Improving Measurement of Morbidity and Risk factors
Self reported health data on levels of health, chronic diseases and risk factors are known to be subject to a host of reporting biases. In order to provide comparable measurement of these factors, innovative methods of data collection are proposed for low- and middle-income countries with poor health information:
• Health examination survey: collection of biological and clinical data, behavioural/risk factor data and background characteristics;
• Global risks to health: 2004 update: WHO has updated its analyses of the relative contribution of major risk factors to population ill-health and produced a report detailing the burden of mortality, injuries and disease caused by 24 risk factors globally and in a range of regional groupings.

Summary measures of population health
WHO will continue to work with international partners in the updating of information on burden of disease using up-to-date epidemiological data as well as improved estimation techniques:
• Child mortality estimates are now updated annually, working on coordination with the Inter-agency Group for Child Mortality Estimation (includes Unicef, United Nations Population Division, World Bank, WHO). Estimates by country for 2008 will be published in 2010.
• Life tables estimates are also updated annually for all Member States.
• WHO is an active partner in the update to the Global Burden of Disease for 2005. WHO's contribution includes:
o Advancing methods for using multiple-cause-of-death statistics to generate correction algorithms for incorrectly certified deaths.
o Developing estimates of the total (all-cause) incidence and prevalence of selected disabilities which are sequelae of multiple diseases, including hearing loss, vision loss, infertility, low IQ, incontinence, and anemia.
o Updating disability weights using new primary data from a multi-country community study, in collaboration with Harvard University.

Monitoring health system performance
During 2008, a toolkit of indicators and measurement strategies for monitoring health systems has been developed with a wide range of collaborators, including country experts and donor agencies. During 2009, WHO will pilot test a systematic approach to country health systems monitoring and analysis. The goals is to improve the availability, quality and use of health system data to inform country health sector reviews and planning processes and strengthen assessments of health systems performance. Following the pilot test in 3-5 countries, the approach will be extended to other countries, with a focus on low- and lower- middle- income countries.
The WHO Health Statistics and Informatics department continues to work with the Health Metrics Network (HMN) partnership in strengthening country capacity to collect and report high quality health data. HMN is working closely with partners in countries to strengthen the infrastructure for a health information system that combines information from multiple sources.


Health Expenditures - Financial risk protection

Ongoing methodological work
WHO will continue to develop indicators measuring financial risk protection and poverty impact of health payments.
Priority objective on methodological work
Development of methods for countries to monitor these indicators over time.
New activities to be undertaken in the next two years
Technical briefs on key indicators and their distribution across socio-economic groups.


Health expenditure statistics: national health accounts

Ongoing methodological work
WHO is continuing to update the figures on health expenditure of its Member States each year in the World Health Statistics and online (www.who.int/nha). Estimates are based on nationally reported data publically available or sent to various international bodies, plus data from household surveys. In a joint attempt to produce more comparable health expenditure data, WHO, together with the OECD and Eurostat, is working on a revised and unique version of health accounts methodology to be published in 2011. It will replace WHO, World Bank and USAID 'Producer's Guide to National Health Accounts' for low and middle income countries, as well as OECD 'System for Health Accounts' (SHA).
Priority objective on methodological work over next two years
• Contribution to revisions of the SHA;
• Consultation of Member States by region to validate proposed revision.


Human Resources Development in Health

Ongoing methodological work
A key area of work is the collection and dissemination of data and research on health personnel to provide evidence on human resources (HR) for policy formulation and health system scale-up.
Priority objectives on methodological work in 2009
Publication of a "Handbook on monitoring and evaluation of human resources for health, with special applications in low and middle income countries", and initiate activities to build capacity in its use.
Priority objectives on methodological work over the next two years
• Consensus on a core set of HR indicators and means to their measurement to monitor and assess HR development strategies.
• Building capacity in use of HR Action Framework among countries and stakeholders to address specific HR issues.
• Contribute to the improvement of standard definitions for health occupations in the new revision to the International Classification of Occupations in collaboration with the International Labour Organization.
New activities to be undertaken in the next two years
• Support to countries and regions in the development and strengthening of HR Observatories and other cooperative mechanisms for knowledge sharing.
• Coordinate partnerships and catalyze initiatives to strengthen HR information systems at the country and sub-country levels.


1.5 Income and consumption (OECD)

Revision of the Canberra Handbook on the Measurement of Household Income

Purpose

To revise the 2005 Handbook on the Measurement of Household Income, in the light of evidence from new research and statistical conventions.

Objectives and outputs

Work started in the fall of 2009, and will continue until early 2011. A revised Table of Contents of the report has been agreed, and tasks have been assigned to various participants. the OECD took the lead in developing a survey of country practices to assess the robustness of existing surveys and definitions.

Main Developments for 2010

General aspects:
A first draft of the revised handbook should become available by late 2010