COMISIÓN EUROPEA DIRECCIÓN GENERAL DE SANIDAD Y PROTECCIÓN DE LOS CONSUMIDORES Dirección C. - Salud Pública y Evaluación de Riesgos Unidad C2 - Información sobre la salud

Acta Red de autoridades competentes en el ámbito de la información y los conocimientos

sanitarios

Luxemburgo, 15-16 de diciembre de 2003

Presidente: J.F. Ryan (Jefe de Unidad, DG Sanco C/2, Información sobre la salud). Se dispone de servicio de interpretación para las siguientes lenguas: DE, FR, ES, IT, EN. Lista de participantes/ausentes: véase el archivo adjunto a continuación. Elaborada por la Secretaría (NIVEL).

1. APROBACIÓN DEL ORDEN DEL DÍA

Se aprueba el orden del día sin modificaciones.

2. APROBACIÓN DEL ACTA DE LA ÚLTIMA REUNIÓN

Se aprueba el acta con todas las modificaciones propuestas. En el acta se incluirán copias de todas las ponencias, que se adjuntarán electrónicamente. Todas las actas de las reuniones estarán disponibles en Internet a fin de garantizar la transparencia.

3. PRESENTACIÓN DEL NUEVO ORGANIGRAMA DE SANCO C

Se presenta el nuevo organigrama de SANCO C. La nueva dirección de Salud Pública y Evaluación de Riesgos está compuesta por siete unidades (C1 a C7). La mayoría de los comités científicos se han trasladado a la «Autoridad Alimentaria».

Está prevista la creación en Luxemburgo de una Agencia Ejecutiva que contará con una plantilla de treinta y cinco personas y cuyo director se nombrará en 2004. La Agencia Ejecutiva se encargará de la preparación del Centro Europeo de Enfermedades Transmisibles (ECDC), respaldará la gestión del proyecto con evaluaciones y apoyo presupuestario, y (por lo que respecta a C2) contribuirá al Portal de Salud Pública y al funcionamiento de la red EUPHIN.

4. PRESENTACIÓN DE LA SECRETARÍA DE LA RED

El Dr. François Schellevis del Instituto NIVEL (Instituto de investigación de los servicios de salud de los Países Bajos) presenta la composición y las futuras tareas de la secretaría (véase el archivo ppt adjunto).

-- 1

Se hace hincapié en el hecho de que las principales tareas de la secretaría se centrarán en el apoyo a los servicios de la Comisión mediante la preparación de documentos de posición e

informes sobre los progresos realizados destinados a la Red de Autoridades Competentes. La secretaría se financiará de acuerdo con la norma 60/40 durante un año.

Estas tareas se vincularán estrechamente a la creación y la puesta en marcha de la lista restringida de los indicadores de salud europeos, y en ellas se ha de tener en cuenta la situación en los distintos Estados miembros y, en particular, la necesidad de integrar a los nuevos Estados miembros.

5. DEBATE Y APROBACIÓN DEL PROYECTO DE MANDATO DE LA RED DE AUTORIDADES COMPETENTES

Papel de la Red de Autoridades Competentes

Se destaca que la Red de Autoridades Competentes no es un organismo ejecutivo sino consultivo. No habrá procedimientos de votación; todas las fases de desarrollo se basan en el consenso. Constituye, además, una plataforma para el intercambio de información entre los Estados miembros sobre sus actividades en el ámbito de la información y los conocimientos sanitarios.

Composición

No se menciona al Observatorio europeo de la droga y las toxicomanías (OEDT) ni a otras agencias europeas como miembros de la Red de Autoridades Competentes. Sin embargo, se puede mencionar específicamente al OEDT dado el trabajo que realiza de recogida de datos en su ámbito de actividad.

Relación con los grupos de trabajo

La Red de las Autoridades Competentes está formada por representantes de los ministerios de sanidad de los Estados miembros. Los grupos de trabajo deberían suministrar a la Red de Autoridades Competentes las novedades y temas tratados desde distintas perspectivas en sus ámbitos de actividad. La Red de Autoridades Competentes debería tomar decisiones y establecer prioridades a través del consenso.

• Miembros de los grupos de trabajo

Los miembros de los grupos de trabajo son jefes de proyectos anteriores, en curso o futuros. Hasta ahora sólo se invitaba a los miembros de los proyectos que ya se financiaban, puesto que todavía no se había llegado a un acuerdo sobre los nuevos grupos de trabajo y proyectos. Se hizo un esfuerzo por complementar los grupos de trabajo con expertos de países que no estuviesen representados todavía en el grupo de jefes de proyecto. A los nuevos Estados miembros se les prestará una atención especial. En principio, no se practica una «política de puertas cerradas». Sin embargo, existen limitaciones de carácter físico y presupuestario.

• Vinculación de los miembros de distintos grupos de trabajo a escala de Estados miembros

Se sugiere la elaboración de una lista de los miembros nacionales que participen en los distintos grupos de trabajo con el fin de garantizar el debate bilateral.

Cooperación por lo que respecta a las tareas

-- 2

Algunos delegados expresan sus dudas acerca las tareas de la Red de Autoridades Competentes, la relación con la Agencia Ejecutiva, con la Red de responsables de los grupos de trabajo y el Portal de la Salud. La Comisión hace hincapié en que la Agencia Ejecutiva formará parte de los servicios de la Comisión y estará estrechamente vinculada a la DG SANCO/C. La Agencia Ejecutiva apoyará el trabajo diario de aplicación del Programa de Salud Pública.

Cooperación con Eurostat

Algunos representantes expresan sus dudas acerca de las tareas y la financiación de las actividades de Eurostat en el marco de los proyectos. Se aclara que, en el futuro, Eurostat se centrará en un número menor de actividades (las estadísticas sobre discapacidades dejarán de ser, por ejemplo, un ámbito prioritario). El programa de Salud Pública podría complementar el trabajo de Eurostat, en particular mediante el desarrollo de indicadores y los trabajos sobre metodología. En el Plan de trabajo de 2004 se han previsto posibilidades de actividades conjuntas sobre estadísticas sanitarias complementarias en el contexto de licitaciones.

6. PERSPECTIVA GENERAL DE ACTIVIDADES DESDE LA ÚLTIMA REUNIÓN

Proyectos aceptados de 2003

El Presidente explica el motivo por el que se ha retrasado la aprobación final de los proyectos e informa de que los contratos no se firmarán antes del 1 de febrero de 2004.

Grupos de trabajo

Mandatos de los grupos de trabajo

Los servicios de la Comisión presentan los grupos de trabajo y sus mandatos. Los delegados expresan sus dudas acerca del formato de los mandatos y los métodos de trabajo de los distintos grupos.

La Comisión tratará de utilizar un modelo común para los mandatos de los siete grupos de trabajo con el fin de armonizar el formato de los distintos mandatos.

Cada grupo desarrollará su propio método de trabajo. Dependiendo del tema y las prioridades, la subdivisión de los grupos o la creación de grupos ad hoc podría resultar una medida eficaz.

De las tareas de gestión de los grupos de trabajo se harán cargo las secretarías, que se crearán sobre la base de propuestas de proyectos. Se han recibido propuestas de creación de una secretaría de los Grupos de trabajo sobre salud mental, estilo de vida y accidentes y lesiones. Por lo que respecta al resto de los grupos de trabajo, por el momento seguirán ocupándose de su gestión los servicios de la Comisión.

Grupo de trabajo sobre mortalidad y morbilidad

Este grupo de trabajo no competirá con el Grupo de trabajo sobre mortalidad de Eurostat. Ambos grupos trabajarán estrechamente y de manera complementaria. En el futuro, podría solaparse con el Grupo de trabajo sobre salud mental por lo que respecta a las enfermedades neurodegenerativas.

Grupo de trabajo sobre estilo de vida

-- 3

Los servicios de la Comisión señalan que este Grupo de trabajo aborda las cuestiones relacionadas con el estilo de vida en la totalidad del programa. Todos los grupos de trabajo deberían recoger las «mejores prácticas». Debe volver a formularse el apartado sobre «mejores prácticas». Las líneas I y III se superponen en este ámbito. Las actividades del Grupo de trabajo deberían integrarse con las actividades de la línea III. Los grupos de trabajo pueden proporcionar asesoramiento acerca de las prioridades de los proyectos. Debería incluirse en el mandato una referencia a la inclusión de los factores determinantes.

Grupo de trabajo sobre sistemas de salud

La Comisión presenta el Grupo de trabajo y su mandato. El hecho de alcanzar el equilibrio adecuado entre la prevención y la promoción sigue siendo motivo de preocupación. Se dispone de información sobre la mayoría de los indicadores (a excepción de los indicadores sobre la movilidad de los pacientes, aspecto que se abordará en la próxima reunión).

Las observaciones de IRL sobre el carácter horizontal de este Grupo de trabajo se incorporarán como nota. La aportación de los sistemas de salud a la salud pública está incluida en el mandato. Por otra parte, el Presidente señala que el Consejo de Sanidad solicitó la recogida de información sobre «asistencia sanitaria transfronteriza» y menciona nuevos temas para el Programa de salud pública. La DG SANCO se ocupará de ello. Habrá que incluir las prioridades políticas.

Grupo de trabajo sobre salud mental/lesiones

Se presentan brevemente ambos grupos y sus mandatos relativos a la salud mental y las lesiones. SANCO C2 es responsable de los aspectos relativos a la información sobre la salud y de la promoción y la prevención en estos dos ámbitos.

El Presidente informa a los delegados de que se distribuirán las actas del Grupo de trabajo sobre salud mental. Ya dispone de una secretaría.

Plan de trabajo de 2004

El Presidente indica que el plan de trabajo de 2004 se publicará en enero de 2004 junto con la convocatoria de propuestas y que la publicación de la licitación se hará en el transcurso del año. El plazo para la presentación de de propuestas se cerrará en marzo de 2004. En marzo de 2004 se publicará un adelanto de los temas que serán objeto de la licitación.

7. INDICADORES DE SALUD EUROPEOS

La Comisión presenta el tema, tras lo cual el Sr. Pieter Kramers expone la lista actual de indicadores (véase el archivo adjunto a continuación). Éste señala que a la hora de incluir los indicadores en la lista restringida no se ha considerado su disponibilidad como criterio previo.

Los comentarios emitidos por los delegados con respecto a la lista restringida de indicadores son los siguientes:

• Los criterios de selección aplicados en la lista restringida deberían ser más transparentes. • Se ha de seguir de cerca el impacto del sistema en la salud pública. • Es necesario clarificar los procedimientos y procesos ulteriores una vez que se haya acordado la lista restringida. • Disponibilidad:

-- 4

< Es necesario disponer de una perspectiva general de los datos/indicadores disponibles (p. ej. de Eurostat, la OMS y la OCDE).

< Es preciso evaluar continuamente la información sobre la disponibilidad en función del desarrollo de los acontecimientos.

< Eurostat hizo hincapié en la importancia de contar con definiciones claras. Se debería hallar el equilibrio entre la mejor definición posible y los datos disponibles. Un grupo de trabajo de Eurostat examinará las definiciones de conjunto mínimo de datos. Ya se ha proporcionado a Eurostat alguna información; es necesaria la coordinación para evitar la duplicación. Se organizarán nuevas reuniones sobre la organización de la recogida de datos con los nuevos países adherentes. Son necesarias las ventanas de usuarios y la estratificación para facilitar el acceso del público en general.

• Responsabilidades a escala nacional:

< Se precisa una estrecha colaboración entre los niveles nacional e internacional. < Es necesario un enfoque de trabajo en equipo (Red de Autoridades Competentes

/grupos de trabajo) en el marco del programa. < La lista restringida no impone limitaciones sobre las actividades nacionales. < Se ha desarrollado un diccionario de datos para la lista esencial de los indicadores

noruegos.

• Los indicadores de los «sistemas sanitarios»:

< Deberían centrarse en el «rendimiento» y los «resultados». < Para estos indicadores deberían utilizarse los datos brutos agregados. < OCDE: la estructura utilizada para los «Sistemas sanitarios» corresponde a la

estructura utilizada por la OCDE y Eurostat y tiene una perspectiva económica (de los recursos a los resultados). El hecho de cambiar de modelo llevará consigo un aumento de indicadores; en cuanto a las «necesidades», la corrección es difícil y no siempre posible de manera rutinaria. Se encuentra disponible información sobre el «análisis de eficiencia». La OCDE ha tratado la cuestión de los «tiempos de espera» y de la «calidad» («la intervención adecuada en el momento adecuado»), la siguiente frontera en términos de estadísticas sanitarias.

< Una vez iniciados los trabajos puede considerarse la necesidad de desarrollos posteriores.

< El hecho de resaltar la importancia de los datos administrativos podría ayudar a los nuevos países de Europa del Este. Precisan asesoramiento con respecto a la recogida de datos.

• «Enfermedades transmisibles»: se pueden considerar sus propios indicadores (línea II). • OMS: la OMS y Eurostat han iniciado recientemente la armonización de las estadísticas

relativas a la mortalidad hospitalaria.

Con respecto a los ECHI (indicadores de salud de la Comunidad Europea), proseguirán los trabajos relativos a los «Sistemas sanitarios» y se utilizarán datos de Eurostat. Se tendrán en cuenta los comentarios de la Red de Autoridades Competentes.

El Presidente indica que habrá que debatir las observaciones en la siguiente reunión ECHI (febrero de 2004). Se organizarán reuniones aparte con los países adherentes.

-- 5

-- 6

8. DESARROLLO DE UN PORTAL DE LA SALUD DE LA UE

La Comisión precisa que el portal facilitará la comunicación entre los grupos de trabajo. Dispondrá de enlaces con los Institutos nacionales de salud pública y las bases de datos de organismos internacionales. Además, el futuro portal de la salud aprovechará al máximo el sitio web sobre la salud pública del sitio EUROPA, reorganizado recientemente.

9. PROGRAMA DE TRABAJO DE 2004 DE LA RED DE AUTORIDADES COMPETENTES

Se pospone debido a las limitaciones de tiempo.

10. ASUNTOS VARIOS

Próxima reunión

La próxima reunión de la Red de Autoridades Competentes tendrá lugar probablemente en junio de 2004 (Nota: se ha aplazado a 5/6 de julio de 2004). Se informará a los participantes por adelantado por correo electrónico y posteriormente recibirán una carta de invitación oficial.

Evaluación de futuros proyectos

La Comisión clarifica su política recientemente establecida sobre la evaluación de proyectos en el futuro. Cada proyecto presentado en el marco de la próxima convocatoria de propuestas será evaluado por un miembro del personal de la Comisión y por un experto externo. Ambos evaluadores deberán llegar a un consenso con respecto a la calificación del proyecto. Posteriormente el comité de evaluación formado por altos cargos de la Comisión decidirá el orden de clasificación de los distintos proyectos. La lista de proyectos clasificados se trasladará entonces al Comité del programa para que emita su dictamen. Tras una consulta interservicios sobre la lista de proyectos aprobada, la Comisión celebrará acuerdos individuales de concesión de subvenciones o informará a los solicitantes sobre la decisión de rechazar el proyecto.

EUROPEAN COMMISSION HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL Directorate C - Public Health and Risk Assessment C2 - Health information

Second Meeting of the Network of Competent Authorities in Health

Information and Knowledge

FINAL LIST OF PARTICIPANTS

Luxembourg, 15-16 December 2003 Room JMO M2

MEMBER STATES

AUSTRIA:

Dr. Peter BROSCH Federal Ministry of Health and Women Unit IV/A/2 – E-Government and New Media Radetzkystrasse 2 A – 1030 VIENNA Tel.: (+43) 1 711 00 41 43 Fax: (+43) 1 715 58 30 E-mail: peter.brosch@bmgf.gv.at

BELGIUM:

Dr. Daniel REYNDERS replaced by Dr. Monique COPPENS Health Warning Unit E-mail: Monique.Coppens@health.f.gov.be Federal Public Service Health Tel.: (+32) 472 95 85 42 Food Chain Safety and Environment CAE Quartier Vésale 211 B – 1010 BRUXELLES Tel.: (+32) 2 210 42 07 Fax: (+32) 2 210 47 45 Mobile phone: (+32) 478/88 22 61 E-mail: daniel.reynders@health.fgov.be

Commission européenne, L-2920 Luxembourg. Telephone: (352) 43 01-1.

DENMARK:

Dr. Morten HJULSAGER (unable to attend) Head of Division The National Board of Health Islands Brygge 67 PO Box 1881 DK-2300 COPENHAGEN S Tel.: (+45) 72 22 74 00 Fax: (+45) 72 22 74 11 E-mail: Mhj@sst.dk

FINLAND:

Mr. Arpo AROMAA Research Professor National Public Health Institute Department of Health and Functional Capacity Mannerheimintie 166 FI – 00300 HELSINKI Tel.: (+358) 9 4744 8770 Fax: (+358) 9 4744 8760 E-mail: arpo.aromaa@ktl.fi

Dr. Mika GISSLER Development Manager National Research and Development Centre for Welfare and Health STAKES Information PO BOX 220 FI – 00531 HELSINKI Tel.: (+358) 9 3967 2279 / 40 503 3805 Fax: (+358) 9 3967 2324 E-mail: mika.gissler@stakes.fi

FRANCE:

Ms. Evelyne HOUDOIN Ministère de la Santé, de la Famille et des Personnes Handicapées Direction générale de la Santé Bureau Systèmes d’information 8, avenue de Ségur F – 75350 PARIS 07 SP Tel.: (+33) 1 40 56 76 46 Fax: (+33) 1 40 56 57 74 E-mail: evelyne.houdoin@sante.gouv.fr

2

Mr. Gérard BADEYAN Ministère de la Santé, de la Famille et des Personnes Handicapées Haut Comité de la Santé publique 8, avenue de Ségur F – 75350 PARIS 07 SP Tel.: (+33) 1 40 56 72 34 Fax: (+33) 1 40 56 79 49 E-mail: gerard.badeyan@sante.gouv.fr

GERMANY:

Frau Dr. Bärbel-Maria KURTH (unable to attend) Robert-Koch Institut Abteilung für Epidemiologie und Gesundheitsberichterstattung Nordufer 20 D – 13353 BERLIN Tel.: (+49) 30 754 3103 E-mail: B.Kurth@rki.de

GREECE:

Dr. Susan GREGORY replaced by Dr. Elpida PAVI Dept. of Health Economics E-mail: e-pavi@ath.forthnet.gr National School of Public Health 196 Alexandras Ave. GR – 115 21 ATHENS Tel.: (+30) 210 642 63 80 / 643 53 28 Fax: (+30) 210 644 95 71 E-mail: gregorys@otenet.gr

IRELAND:

Mr. Hugh MAGEE Senior Statistician Head of Information Management Unit Department of Health and Children Hawkins House DUBLIN 2 Ireland Tel.: (+353) 1 635 43 00 Fax: (+353) 1 635 43 78 E-mail: hugh_magee@health.irlgov.ie

3

ITALY:

Dr. Walter BERGAMASCHI (unable to attend) Direzione Generale Sistema Informativo Ministero della Salute Piazzale dell’Industria, 20 I – 00144 ROMA Tel.: (+39) 6 599 42 448 Fax: (+39) 6 599 42 873 E-mail: w.bergamaschi@sanita.it

LUXEMBOURG:

Ms. Yolande WAGENER Direction de la Santé Villa Louvigny Allée Marconi L – 2120 LUXEMBOURG E-mail: Yolande.wagener@ms.etat.lu

NETHERLANDS:

Mr. Peter ACHTERBERG RIVM (National Institute for Public Health and the Environment) PO Box 1 NL – 3720 BA BILTHOVEN Tel.: (+31) 30 274 91 11 E-mail: peter.achterberg@rivm.nl

PORTUGAL:

Prof. Doutor Paulo FERRINHO replaced by Dr. Mário CARREIRA Head of the Department of Information E-mail: mflc@netcabo.pt and Analysis Direccao Geral da Saude Alameda D. Afonso Henriques, 45 P – 1049-005 LISBOA Tel.: Fax: E-mail: pferrinho@dgsaude.min-saude.pt

SPAIN:

Dra. Mercedes ALFARO LATORRE (unable to attend) Subdirectora General de Sistemas de Informacion Sanitaria Direccion General de Planificacion Sanitaria, Sistemas de Informacion y Prestaciones Ministerio de Sanidad y Consumo Paseo del Prado 18-20 ES – 28073 MADRID Tel.: (+34) 91 5961 495/531 Fax: E-mail: malfaro@msc.es

4

SWEDEN:

Dr. Magnus STENBECK Chef för Analysenheten Epidemiologiskt Centrum Socialstyrelsen SE - 10333 STOCKHOLM Tel.: (+46) 8555 531 17 E-mail: Magnus.Stenbeck@sos.se

UNITED KINGDOM:

Dr. Hugh MARKOWE Department of Health Skipton House London Road LONDON SE1 6LH United Kingdom E-mail: Hugh.Markowe@doh.gsi.gov.uk

5

EEA countries

LIECHTENSTEIN:

Dr. Eva-Maria HIEBL (unable to attend) Legal Advisor Office of Social and Preventive Medicine PO Box 722 FL – 9494 SCHAAN Tel.: (+423) 236 73 30 Fax: (+423) 236 73 39 E-mail: eva-maria.hiebl@spmd.llv.li

NORWAY:

Dr. Liv GROTVEDT Senior Adviser Norwegian Institute of Public Health Department for Health Statistics P.O. BOX 4404 Nydalen N - 0403 OSLO Norway Tel.: (+47) 23 40 81 49 / 92 09 72 04 Fax: (+47) 23 40 81 46 E-mail: liv.grotvedt@fhi.no

ICELAND:

Mr. Sveinn MAGNUSSON (unable to attend) Head of Department Ministry of Health and Social Security Laugavegur 116 150 REYKJAVIK Iceland Tel.: (+354) 5458 700 E-mail: sveinn.magnusson@htr.stjr.is

6

Candidate countries

SLOVENIA:

Mr. Andrej MARUSIC replaced by Dr. Dasa MORAVEC BERGER Institute of Public Health E-mail: dasa.moravec@ivz-rs.si Trubarjeva 2 Tel.: (+386) 1 2441 456 1000 LJUBLJANA Slovenia Tel.: (+386) 1 2441 400/401 Fax: (+386) 1 2441 447 E-mail: andrej.marusic@ivz-rs.si

SLOVAK REPUBLIC:

Mr. Jan KRALIK (unable to attend) Acting Director for Economics and Informatics Ministry of Health of the Slovak Republic Limbova 2 837 52 BRATISLAVA Slovak Republic Tel.: (+4212) 5937 3121 Fax: (+4212) 5477 7949 E-mail: jan.kralik@health.gov.sk

ROMANIA:

Dr. Catrinel PERIANU Phare and Communitary Programmes Unit General Directorate of International Co-operation European Integration and Development Policies Ministry of Health and Family Cristian Popisteanu Street, no. 1-3 RO – 70109 BUCHAREST Tel.: (+40) 21 3072620 Fax: (+40) 21 312 14 33 E-mail: phare_minsan@yahoo.com / catrinel_per@yahoo.co.uk

LITHUANIA

Dr. Aldona GAIZAUSKIENE Lithuanian Health Information Centre Kalvariju 153 LT – 2042 VILNIUS Tel.: (+370) 5 277 3301 Fax: (+370) 5 277 3302 E-mail: aldona@lsic.lt

7

POLAND

Mr. Konrad ROGALEWSKI Center for Health Care Information Systems Al. Jerozolimskie 155 PL – 00-238 WARZAW Tel.: (+48) 22 824 27 21 Fax: (+48) 22 824 27 37 E-mail: k.rogalewski@csioz.gov.pl

LATVIA

Dr. Jautrite KARASKEVICA Deputy Chief of the Board, Director of Health Statistics Questions Health Statistics and Medical Technology Agency 12/22 Duntes Street LV – 1005 RIGA Tel.: (+371) 7501 582 Fax: (+371) 7501 591 E-mail: jautrite@vsmta.lv

TURKEY

Dr. Nihat YURT (unable to attend) Ministry of Health Department of Information Processing Mithatpasa Cad. No: 3D, Blok Kat: 1 06434 SIHHIYE ANKARA Turkey Tel.: (+90) 312 4300142 E-mail: nihat@saglik.gov.tr

MALTA

Dr. Renzo PACE ASCIAK (unable to attend) Consultant Health Information 95 G’Mangia Hill G’Mangia MSD 08 Malta E-mail: renzo.pace-asciak@gov.mt

8

ESTONIA

Dr. Luule SAKKEUS replaced by: Mr. Madis ABEN Analyst Analycist Department of Health Information and Analysis Health Information and Analysis Ministry of Social Affairs Gonsiori 29 Gonsiori 29 EE – 15027 TALLINN EE – 15027 TALLINN Estonia Estonia Tel.: (+372) 62 69 977 Tel.: (+372) 6269 166 Fax: (+372) 6269 714 Fax: (+372) 6269 124 E-mail: Luule.Sakkeus@sm.ee E-mail: madis.aben@sm.ee

HUNGARY

Dr. Jozsef VITRAI ’Johan Bela’ National Centre of Epidemiology 2-6, Gyali H – 1097 BUDAPEST Hungary Tel.: (+36) 1 476 6416 E-mail: vitraij@oek.antsz.hu

CYPRUS

Dr. Pavlos PAVLOU IT co-ordinator Ministry of Health 10 Marcou Drakou 1448 NICOSIA Cyprus Tel.: (+357) 22 400220 Fax: (+357) 22 305346 E-mail: pavlospavlou@cytanet.com.cy

BULGARIA

Mr. Jordan P. ARNAUDOV Head of IT Department National Centre for Health Informatics Ministry of Health N.15 bul. ‘Ivan Geshov’ BG – 1431 SOFIA Tel.: (+359) 2 954 94 83 Fax: E-mail: arnaudov@nchi.government.bg

9

CZECH REPUBLIC

Mr. Michael VIT, MD (unable to attend) Chief Public Health Officer Ministry of Health Department of the International Relations Palackeho Nam. 4 CZ – 128 01 PRAHA 2 Tel.: Fax: E-mail: jana.lanzova@mzcr.cz

10

SPEAKERS

Mr. Pieter KRAMERS Dept. of Public Health Forecasting National Institute of Public Health and Environment Antonie van Leeuwenhoeklaan 9 Postbus 1 NL – 3720 BILTHOVEN Tel.: (+31) 30 27 42 163 Fax: (+31) 30 27 44 450 E-mail: pgn.kramers@rivm.nl

INTERESTED PARTIES

Dr. Francois G. SCHELLEVIS NIVEL Netherlands Institute for Health Services Research PO Box 1568 NL – 3500 BN UTRECHT Tel.: (+31) 30 2729 724/700 Fax: (+31) 30 2729 729 E-mail: f.schellevis@nivel.nl

Mr. Walter DEVILLE NIVEL Netherlands Institute for Health Services Research PO Box 1568 NL – 3500 BN UTRECHT Tel.: (+31) 30 2729 647/700 Fax: (+31) 30 2729 729

11

INTERNATIONAL ORGANISATION

Dr. Anca DUMITRESCU Director Division of Information, Evidence & Communication World Health Organisation Regional Office for Europe 8 Scherfigsvej DK – 2100 COPENHAGEN Tel.: (+45) 3917 1518 Fax: (+45) 3917 1868 E-mail: eln@who.dk

Replaced by:

Dr. Remigijus PROCHORSKAS Health Information and Evidence Unit (HIE-IDB) World Health Organization Regional Office for Europe Scherfigsvej 8 DK – 2100 COPENHAGEN Tel.: (+45) 3917 1482 Fax: (+45) 3917 1895 E-mail: rpr@euro.who.int

Mr. Manfred HÜBER replaced by: Mr. Gaëtan LAFORTUNE OECD E-mail: gaetan.lafortune@oecd.org Health Policy Unit 2, rue André Pascal F - 75775 Paris Cedex 16 Tel.: (+33) 1 45 24 76 33 Fax: (+33) 1 44 30 63 61 E-mail: manfred.huber@oecd.org

12

13

EUROPEAN COMMISSION

• Mr. John F. RYAN, Head of Unit SANCO C/2

• Mr. Horst KLOPPENBURG, DG SANCO C/2

• Mr. Antonio DORONZO, DG SANCO C/2

• Dr. Frédéric SICARD, DG SANCO C/2

• Mr. Ole HENRIKSEN, DG SANCO C/2

• Ms. Tone HARENGEN, Stagiaire DG SANCO C/2

• Ms. Sylvie MANGUIN, DG SANCO C/2

• Mr. Didier DUPRE, DG ESTAT E/3

• Mr. Roland BLADH, DG EMPL E/2

EUROPEAN MONITORING CENTRE FOR DRUGS AND

DRUG ADDICTION

• Mr. P. ROUX EMCDDA Rua da Cruz de Santa Apolónia 23-25 PT – 1149-045 LISBOA E-mail:

• Mr. Norbert FROST, Project Manager EMCDDA Rua da Cruz de Santa Apolónia 23-25 PT – 1149-045 LISBOA E-mail: Norbert.Frost@emccda.eu.int

Secretariat of the Network of Competent Authorities (NCA)

• Objectives• Context• Embedding• Activities• Institution and team

Objectives

Following the mandate of the NCA:To support the activities of the NCA

aimed at developing and implementing activities under strand I (Health Information) of the 2003-2008 EC Public Health programme

Context of the secretariat

• Funding as project (to be confirmed) starting January, 2004 (?)

• Project includes secretarial support for Network of Working Party Leaders (NWPL)

Embedding

Network Working Party Leaders

WP7

Network of Competent Authorities

Commission services Secretariat

WP 4

WP1

WP2

WP3

WP5

WP6

Eurostat Core Groups

Activities I

• Surveillance of progress of activities in the Health Information Strand

• Preparation of discussions within the NCA on EU health (information) issues (background documents, analytical and progress reports)

• Provide guidance to the contents structure of the electronic information systems

• Identification of needs and obstacles for health information systems in acceding countries

Activities II

• Implementation of the shortlist of health indicators:– Liaison between NCA and NWPL– Liaison with Eurostat Core Groups and external

organisations (a.o. WHO, OECD)– Liaison with developers of electronic systems– Promoting and supporting (improvement of) data

collection and harmonisation in MS and acceding countries

Institution

Netherlands Institute for Health Services Research (NIVEL)

• Non-governmental, non-profit research institute (private foundation)

• Founded in 1965, based in Utrecht• 90 fte scientific personnel (2002)• 12 m€ annual turn-over (2002); appr.

25% structural grant from MoH

Team

François Schellevis MD PhD, project leaderOverall supervision and responsibility, embedding in

NIVEL, coordination with DG SanCoWalter Devillé MD MPH PhD, project

coordinatorDaily manager, supervision of activities, work plan,

planning, budget, quality control, etcNN senior researcherEsmée Kolthof, junior researcherSupportive staff

EUROPEAN COMMISSION HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL Directorate C - Public Health and Risk Assessment C2 - Health information

Minutes of the Meeting of the Working Party on Accidents and Injuries1,

11th and 12th December 2003, Euroforum Building, Luxembourg, Room 0001

Present: see annex “List of participants”

1. Introduction The Commission Services presented the three strands of the Public Health Programme: 1. Health Threats, 2. Health Determinants, 3. Health Information. The main goal of the Health Information strand and its seven Working Parties is to build a sustainable health monitoring and health information system on community level and involve the new Member States as quickly as possible. Following Working Parties were established to achieve the goals of the Public Health Programme: 1. Lifestyle, 2. Mortality, Morbidity, including Rare Diseases, 3. Environment and Health, 4. Mental Health, 5. Accidents and Injuries, 6. Health Systems, 7. European Health Indicators (starting 2004). The meetings of the seven Working Parties are defined as expert meetings and the participants will be reimbursed as private experts.

2. Adoption of the draft agenda The agenda was adopted without any alterations.

3. Adoption of the minutes of the last meeting The minutes were adopted.

1 Due to search problems on the web site of the Commission the outgoing and incoming Secretariat together with the Commission Services agreed to rename the Working Party from “Working Party on Injury Prevention” to “Working Party on Accidents and Injuries”.

Commission européenne, L-2920 Luxembourg. Telephone: (352) 43 01-1. Office: EUFO/3182. Telephone: direct line (352) 43 01-33282. Fax: (352) 43 01-32059. Internet: horst.kloppenburg@cec.eu.int

4. Discussion and adoption of the revised draft Mandate Concept, structure and work procedure The Working Party on Accidents and Injuries has two major differences compared to the other six Working Parties: 1. In addition to the implementation of the Health Information and Knowledge it is

as the Mental Health Working Party responsible for prevention and promotion activities.

2. The singularity of the Working Party on Accidents and Injuries is data collection. The data collection is carried out by the National Data Administrators.

The discussion on the mandate was reopened because of new experience since the last meeting of the Working Party. The Commission Services summarised the concept of the mandate as follows: • No hierarchical system but trust should be the basis for co-operation of the

private experts within the Working Parties. The different standpoints of the experts are necessary and consensus building is foreseen. As the EU commitology does not apply to the Working Parties no voting procedures are required within the mandate.

The experts of the Working Parties are defined as the leaders of current, old and new projects. All other nominations were done by the members of the Network of Competent Authorities (NCA), e.g. for new Member States, when there were no project leaders (see guidelines of the WP).

The individual Working Party members should keep close contacts with colleagues from their territory represented in the Network of Competent Authorities, the Network of Working Party Leaders and other Working Parties.

On the proposal of the Commission Services the Working Party approved Ms. Eleni Petridou (GR) as Working Party leader and Mr. Rupert Kisser (AT) as deputy. Task forces The Commission Services explained the purpose and role of the task forces within the Working Parties: In order to be more operational it is necessary to form smaller groups of experts for specific issues. Task forces will be set up on an ad hoc basis. The experts within these task forces will not be reimbursed by the EC but the EC will try to invite them to meetings. The support of the EC to exchange ideas on super-national and international level will be the incentive for this work. Prepared documents shall inform other colleagues and the Commission about the state of the art in respective areas of the task force. Three task forces were set up and the following participants volunteered: • Road accidents: Rupert Kisser (AT, Co-ordinator), Costas Antoniades (CY), Veronika Benesova (CZ), Eleni Petridou (GR), Maria Benyi (HU), Claudio Detogni (IT), Yolande Wagener (LU), Renzo Pace Asciak (MT), Jerzy Karski (PL), Baltazar Nunes (PT), Lothar Shelp (SE), Mateja Rok-Simon (SI) • Burden of injuries: Eleni Petridou (GR, Co-ordinator), Robert Bauer (AT), Joanne Vincenten (European Child Safety Alliance, ECOSA), Claudio Detogni (IT), to be checked (LU), Jautrite Karaskevica (LV), Saakje Mulder (NL), Baltazar Nunes (PT) • Indicators: Five relevant indicators commonly agreed and operational in sense of

data should be available Birthe Frimodt-Møller (DK, Co-ordinator), Eleni Petridou (GR), Anne Lounamaa (FI), Bertrand Thelot (FR), Claudio Detogni (IT), Jautrite Karaskevica (LV), Renzo Pace Asciak (MT), Marta Malinowska-Cieslik (PL)

2

Adoption The revised draft mandate was adopted.

5. Short list of European Health Indicators Mr. Pieter Kramers presented the existing short list of European Health Indicators. He conceded that injury indicators are not very abundant even in the full ECHI list and that an adequate relation with updated work in injury projects should be established (see annex). Ms. Maria Seguí-Gómez gave a presentation about the indicator concept in the injury field and presented examples of injury indicators. She stressed the importance to exactly define the purpose of the indicators and the respective operationalisation (choice of numerator and denominator) (see annex). The Commission Services stressed that it is important to focus on a first set of well defined injury indicators which might be integrated into the short list. The following examples were emphasised: - Road traffic mortality, - Home and leisure accident mortality, - Long bone fractures, - Hip fractures, - Falls of the elderly, - Seat belt use in Europe. It was agreed that Ms. Birthe Frimodt-Møller, the co-ordinator of the task force on injury indicators, will attend the next meeting on 19th and 20th of February 2004 of the ECHI-group. For the development of injury indicators it is essential to get an overview on the availability of injury data. ESTAT will be asked to deliver this overview.

6. Report of the National Data Administrator Group Mr. Robert Bauer, the leader of the National Data Administrators group, reported the general objectives, deliverables, problems and challenges of the Injury Database (IDB; former „Injury Surveillance System ISS“) and their future perspectives (see annex). It was highlighted that some Member States have withdrawn from the data collection for the Injury Database. Thus an appropriate response with a view to turning this trend shall be developed. In order to amplify the importance of the Injury Database an example of the use of the IDB data in regards to „Burns in children“ was given by Ms. Anne Mette Tranberg Kejs. The presentation demonstrated the unique character of the IDB data, as a number of injury details and a description of each case is available. In future also estimates about absolute number of injuries in Member States will be possible (at the moment absolute numbers are available only at national level from the Hospital Discharge Registers).

7. Ongoing and finalised projects: what can we learn? Ms. Athena Kakavouli (GR) presented the results of the project “Cost-benefit of the Injury Prevention Programme”. Under this project the former Injury Prevention Programme was evaluated with a view to recommending specific actions in the future. The recommendations put emphasis on reaching a wider audience through more effective dissemination channels. Furthermore the objectives of projects should be clearly defined well in advance (see annex).

3

8. New projects under Work Plan 2003: what do we expect? Mr. Robert Bauer (AT) presented the project “Maintenance, Development and Promotion of the ISS Hospital Survey”. The project on data administration and management will be managed by the Austrian project leader. It will be performed together with the National Data Administrators. In the past for the fifteen Member States a National Data Administrator has been nominated, now under this project National Data Administrators are to be nominated also for the Accession Countries, EEA Countries and Candidate Countries (see annex). Ms. Joanne Vincenten (European Consumer Safety Association - ECOSA) presented the project “Strategic and Action Planning for Child Safety”. The aims of the project are to develop a standardised set of collection of benchmark tools, a report of the magnitude of the burden of child injuries in Europe and national child safety action plans in eighteen European Countries. These project deliverables are directly linked to the declaration and action plan that will be approved by the Ministers of Health and Environment of 52 European Countries at the Ministerial Conference in Budapest in June 2004 (see annex). Mr. Constantin Frangakis (GR) presented the project “European Network for Safety among Elderly (EUNESE)”. The aims of the project are the development of an EU-wide network of experts in injury prevention, gerontology and mental health, the development of a best-practice policy manual as well as the implementation of pilot projects to reduce injuries of senior citizens (see annex).

9. Future outputs Project development

On request of the group the Commission Services gave some explanations about projects to be funded:

- A project should be Europe wide.

- Build up own networks, combine forces and agree on one project leader.

- Due to budgetary constrains try to restrict applications for one year only but earmark future steps.

- Distribution key of 60:40 will probably not increase.

- Try to draft messages and results of your projects in a way that they are impressing and convincing and understandable to lay people.

Determining of aims The participants of the Working Party meeting agreed to focus on specific priorities and to develop policy related recommendations in the area with a view to initiating prevention measures and contributing to the future Health Portal. The incoming Secretariat of the Working Party gave an overview on future activities in this area (see annex).

4

5

10. Any other business News from DG SANCO In regard to Consumer Protection (DG SANCO Directorate B in Brussels) Mr. Knut Kroepelien referred to the recently adopted resolution on the Safety of Consumer Services. Furthermore he stressed that for Consumer Protection it is of utmost importance to take account of the potentials of these aspects in the Injury Database. Concerning DG SANCO Directorate C on Public Health in Luxembourg the Working Party was informed that: - an “executive agency” shall be established to facilitate the administrative part of

the work. - The units of Health Legislation and Policy will move to Brussels. - In addition to Information on Accidents and Injuries, Injury Prevention and

Safety Promotion Activities were allocated to unit C2. - DG SANCO C will move to the Jean Monet building end of January, beginning of

February 2004. World Conference on Injury Prevention and Safety Promotion Mr. Rupert Kisser gave an overview on the preparations done in regard to the Seventh World Conference on Injury Prevention and Safety Promotion on 6th to 9th of June 2004 in Vienna (further detailed information is available on the web site: www.safety2004.info). Next meeting of the Working Party The next meeting of the Working Party on Accidents and Injuries will take place on 28th and 29th of April in the Jean Monet Building, room M5. The members of the Working Party were invited to send proposals for the agenda of the next meeting to the Secretariat.

Minutes of the First Meeting of the Mental Health Working Party EUROFORUM, Luxembourg, 25–26 November 2003 Tuesday, 25 November 2003 1. Welcome and adoption of the agenda Adoption of the Agenda The chairperson, Horst Kloppenburg, welcomed all participants to the meeting. The agenda was adopted. Mr. Kloppenburg introduced the recent organisational changes which have taken place in the Directorate General of Health and Consumer Protection. The new structure in the Directorate General of Health and Consumer Protection (DG SANCO) with regard to public health is as follows: Directorate Public Health and Risk Assessment consists of the following Units (Head of Unit): C1 Programme management (L. Briol) C2 Health information (J.F. Ryan) C3 Rapid reaction to health threats (G. Gouvras) C4 Health determinants (M. Rajala) C5 Health strategy (B. Merkel) C6 Health measures (R. Haigh) C7 Risk assessment (P. Wagstaffe) Units C1-C4, which are in charge of implementing the Public Health Programme (PHP) will stay in Luxembourg and units C5-C7, which are responsible for overall issues and policy issues are (will be) located in Brussels. From 2004 onwards, an Executive Agency to implement the public health programme with about 35 employees will be set up. This Agency will take care of administrative tasks, and also perform advisory duties. In the future, the logistical arrangements for the secretariats of the Working Parties (see below) may be taken over by the Executive Agency. What is the Working Party on Mental Health? Working Parties (WP) are established for the duration of the Programme of Community Action in the field of public health (2003–2008) in seven areas, one of which is Mental Health. The overall task of the newly inaugurated WPs is to implement Strand 1 (Health information and knowledge) of the Public Health Programme. The WP meets twice per year to look horizontally at information, data collection and diffusion especially with regard to the indicators. Each WP reports to the Network of Competent Authorities, where the Member States are represented. In this context, it was mentioned that the Working Party on Injuries and the Mental Health Working Party are structured differently from the other WPs in that mental health promotion and injury prevention are also covered by the Working Parties in question. These two WPs will, in addition to developing indicators and aiming at making them operational, also contribute to exchange of best

1

practice, development of policy and prevention initiatives, matters covered by the ‘determinants’ strand of the public health programme. The respective tasks of the Programme Committee, the Network of the Competent Authorities, the Working Party on Community health indicators/Network of Working Party Leaders, which form the other structures of Strand 1 of the Public Health Programme, were explained by Mr. Kloppenburg. On 1 January 2003, the implementation of the new Public Health Programme began. The programme committee consists of representatives of the Member States, the Accession countries - to become Members of the EU in May 2004 – the enlargement countries and EEA countries. There are altogether 31 countries involved, when Romania, Bulgaria, and Turkey will be taken into account. About the roles of the Programme Committee and the Network of the Competent Authorities, the participants were told that - the Programme Committee has a legal base in the decision establishing the EU Public Health Programme, while all other layers are tools to assist the Commission services to implement the Public Health Programme - the Network of competent authorities has a same role as the working parties and provides an overview of the situation in the countries (members of this network are/have been nominated by the members of the Programme Committee, and they are mostly heads of public health institutes in charge of development of policy in their own countries on health information). The following structure is the Working Party of Community health indicators/Network of Working Party Leaders, which consists of the leaders of the WPs, and has, therefore, an inherently horizontal character. As to the Working Party on mental health it was suggested that Prof. Kristian Wahlbeck (of STAKES) would be the Working Party Leader and Dr. John Henderson (of MHE) would act as its Deputy. This suggestion was unanimously agreed. The mandate Mr. Kloppenburg explained that with regard to the WP, the Commission does not aim at building a hierarchical structure: all members of the WP have the same rights and same position. In principle, the WPs are set up for consensus building - no-one can be obliged by majority or voting - and to convince the members to compromise and to reach common agreements on the specific issues that are dealt with. Some points that were raised in this context were: - The Mental Health Working Party tries to cover the geographical situation in Europe - as to the membership (1) it convenes the leaders of the past, present and future projects supported by Community public health funding and (2) if some country has not been involved in these projects previously, it will be the task of the representative of the network of competent authorities to nominate an expert for the working party; (3) representatives of international organisations (e.g. WHO, OECD, ILO) can join in and be members as the others; (4) outside experts not involved, but will be invited if needed - The Working Party is an instrument of the Commission to implement the public health programme; the Commission Services will be assisted by a secretariat (located in STAKES, which has submitted a funding application for a secretariat and for the co-ordination of various projects under strand 1 - others coming from strand 3 handled from the side of the secretariat)

2

- For the individual projects, the steering structure stays as planned, but issues can be discussed - task forces can be established on an ad hoc basis, if needed, and discussed in the plenaries of the WP. - Co-operation of the Working parties (outlined in a document distributed at the meeting) will be called for and organised by the Commission Services, in the framework of a horizontal group network of working parties leaders, described above. The mandate was then adopted and Mr. Kloppenburg thanked the participants for their trust and confidence in the Commission Services. 2. Overview of projects on mental health promotion The past and present EC-funded projects in the field of mental health promotion were introduced. The list of projects and presenters is as follows: - Putting mental health on the European Agenda (V. Lehtinen; presentation annexed to the minutes) - Combating stress and depression related problems (J. Henderson on behalf of L. Meulenbergs) - Mental illness and stigma in Europe (A. Constantopoulos) - An outline of projects on children and adolescents (J. Henderson) - Mental health economics (D. McDaid; presentation annexed to the minutes) - Mental health promotion and prevention strategies for coping with anxiety, depression and stress-related disorders in Europe (J. Henderson) - Integrating mental health promotion interventions into countries' policies, practice and the health care system (E. Jané-Llopis; presentation annexed to the minutes). In addition to the above, two other projects - Unemployment and Mental Health, and Mental Health in Europe - have been carried out in the past. Subsequently, two future projects, expected to receive funding from the first call for proposals in the 2003 funding round were presented. These were: - Implementation of mental health promotion and prevention policies and strategies in EU member states and applicant countries (J. Henderson) - Nüremberg Alliance Against Depression, (U. Hegerl; presentation annexed to the minutes) A draft report tentatively entitled "Strategies for implementation of mental health promotion and prevention actions against depression and depression-related problems" was presented (J. Lavikainen). In this context it was mentioned by the chairperson that this is a crucial report that has been listed in the Commission management Plan 2004. Therefore, the report is already politically sensitive and will certainly attract substantial attention. Finally, critical and constructive comments from the members of the Working Party were welcomed at a later stage of finalizing the report. 3. Discussion on future perspectives on mental health promotion Following the presentations, the participants of the meeting were asked to consider related issues and problems in regard to Mental Health Promotion as the preparation of the Work Plan for 2005 starts already in spring 2004. In this context, tools for mental health impact assessment as well as the interactions between mental health and information technology were brought up. It was noted that it would be worthwhile to build on what has already been recommended in the previous projects and what can be learnt from the problems of the past projects. With regard to this, some key issues were sustainability, training programs and capacity building. The concept of evidence was discussed and it was agreed that a

3

background paper is needed. In addition, it was mentioned that transition periods also play a role during working life; Internet needs to have a more interactive role - tools are already offered in many countries for self assessment etc. Trust building is relevant here together with focusing on comprehensive strategies on the organisational level. Additional suggestions focused on qualitative evidence, migration, liaisons between research and implementation institutes and exploring cross-cutting mental health components in the other existing programmes. The need for embedding mental health in general health promotion programs has to be considered. It was also emphasized that some issues need to be seriously considered if projects are to be applied - such as cross-border (across working party boundaries) initiatives (e.g. cross-border idea of burden). Next, it was decided that a task force will be established to consider the topic of evidence in the context of mental health promotion and to produce a short document (2 pages) which would perhaps be distributed to the other Working Parties as well. This task force will be led by Kristian Wahlbeck and Eva Jane-Llopis and the members are Angelo Barbato, Ricardo Gusmao, David McDaid, Heinz Katschnig, Karl Kuhn and Eleni Petridou (of the Working Party on Injury Prevention). It was decided that this group will prepare the document which will be distributed for discussion before the next meeting of the Mental Health Working Party (which will be held in the summer of 2004). Another task force on future perspectives of mental health promotion was established to contemplate issues to be taken up in the future workplans. The members are John Henderson, Patricia Noonan Walsh, David McDaid, Viviane Kovess, Dainius Puras, Athanassios Constantopoulos, Charles Pull, Iveta Bluka, Mojca Dernovsek and Juha Lavikainen. 4. Overview of past, present and future projects on mental health indicators - Mental health indicators (V. Lehtinen; presentation annexed to the minutes) - Report on the state of mental health in Europe (V. Kovess) - Specific points as to the project on disabilities were presented (P.N. Walsh): (1) people with handicaps live longer (a family issue) (2). confusion between mental health and intellectual disabilities (3) some people with intellectual disabilities live in large institutions (4) many people fall between systems (5) existing indicators do not fit with people with intellectual disabilities (6) vulnerability and depression in older people (e.g. bereavement). - The new project on mental health indicators (presented by J. Lavikainen, T. Brugha, A. Ozamiz, E. Jane-Llopis, H. Katschnig, V. Kovess). This presentation highlighted the proposal of STAKES submitted to the Call for Proposals 2003, by introducing the overall contents of the applied project and the specific partnership projects (due to a lack of time, this presentation was moved to be held on Wednesday).

4

Wednesday, 26 November 2003 5. Presentation of the short list of European Community Health Indicators - ECHI (P. Kramers; presentation annexed to the minutes) 6. Inclusion of mental health indicators The discussion on inclusion of mental health indicators tackled both generic and technical questions in a detailed way. As a result of this discussion, it was considered that to the short list of the Community health indicators, an indicator on positive mental health, the MHI5 (5-item Mental Health Inventory), and an indicator on social environment should be added. All in all, the work on this list is still in progress and it is likely that a number of additions will be included. Therefore, the Working Party should reach a common agreement towards development of further indicators or improving or replacing the current mental health indicators included in this list. It needs to be borne in mind that this work should contribute to the development of the health information and knowledge system. To this end, the secretariat of the Working Party will prepare a background paper for the next meeting containing a proposal for the indicators to be included. 7. Availability of data and further networking (K. Wahlbeck; presentation annexed to the minutes) 8. Discussion on future perspectives on mental health information With regard to future communication between the members of the Mental Health Working Party, it was agreed that an interactive web-based virtual office - a Webboard - will be established and maintained in the STAKES website. It was pointed out that National focal points may not necessarily represent their Member States authorities. As to the terminology, it was decided to use the expression Member State instead of the term National. It was mentioned that the implementation of the whole Strand 1 of the Public Health Programme has begun and progressed very rapidly. Respecting the idea of transparency, all relevant information - lists of participants, agendas, minutes - of the Network of Competent Authorities and the pertinent networks and working parties together with the name list of the members of the Programme Committee, will be published on the Commission's webpage. The work to be conducted in the area of mental health indicators is of prime importance here. Mr. Kloppenburg thanked all participants for their contributions and closed the meeting at 13:20. Annexes 1. Agenda 2. Draft mandate 3. List of participants 4. The members of the ad hoc task forces 5. Powerpoint presentations (attached separately) 6. Relevant websites

5

ANNEX 1 DRAFT AGENDA

Tuesday, 25 November 2003

1. Welcome and Introduction

- Adoption of Agenda

- What is the Working Party on Mental Health?

- The Mandate

2. Overview of projects on mental health promotion

- Putting mental health on the European Agenda (by V. Lehtinen)

- Combating stress and depression related problems (by L. Meulenbergs)

- Mental illness and stigma in Europe (by A. Constantopoulos)

- An outline of projects on children and adolescents (by J. Henderson)

- Mental health economics (by D. McDaid)

- Mental health promotion and prevention strategies for coping with anxiety, depression and stress-related disorders in Europe (by J. Henderson)

- Integrating mental health promotion interventions into countries' policies, practice and the health care system (by E. Jané-Llopis)

- Implementation of mental health promotion and prevention policies and strategies in EU member states and applicant countries (by J. Henderson)

- Presentation of the report on "Strategies for implementation of mental health promotion and prevention actions against depression and depression-related problems" (by J. Lavikainen)

3. Discussion on future perspectives on mental health promotion

4. Overview of past, present and future projects on mental health indicators

- Mental health indicators (by V. Lehtinen)

- Report on the state of mental health in Europe (by V. Kovess)

- The new project on mental health indicators (by J. Lavikainen)

Wednesday, 26 November 2003

5. Presentation of the short list of European Community Health Indicators – ECHI (by P. Kramers)

6. Inclusion of mental health indicators

7. Availability of data and further networking (by K. Wahlbeck)

8. Discussion on future perspectives on mental health information

9. Any other business

6

ANNEX 2 Draft mandate

Mental Health Working Party (MHWP)

1. Purpose of the Mental Health Working Party In implementing the health information and knowledge strand of the Public Health Programme and in particular the Work Plan 2003 thereof, the Mental Health Working Party shall be established.

The Mental Health Working Party shall contribute to the improvement of the information and knowledge and to the promotion of a positive mental health and wellbeing and prevention of mental ill-health.

The purpose of the Mental Health Working Party is to provide a forum for discussion and exchange of views and experience on mental health information and to contribute to the improvement and promotion of a positive mental health and wellbeing.

The Mental Health Working Party shall contribute to the compilation and development of a sustainable health monitoring system in the field of mental health, to the collection, the sharing and diffusion of mental health data. It shall participate in making the mental health indicators based on the above mentioned mental health data and on other databases operational. It shall contribute mental health indicators to the short list of European health indicators. It shall co-ordinate in this respect with other priority areas of the information and knowledge system. It shall advise on the creation of a EU strategy to address a positive mental health. It shall also contribute to the preparation of the annual work plans of the Public Health Programme 2003-2008. It shall assist in the diffusion of ‘good and best practice’ by means of presentation and comparison of national health information and knowledge in the fields of mental health. It shall also examine mental health related issues in other Community policies and co-ordinate its own activities with those of related European and International Institutions and Organisations, such as the WHO, the Council of Europe, OECD, etc. 2. Duration and members of the Mental Health Working Party The Mental Health Working Party is established for the duration of the Public Health Programme 2003-2008. Members of the Mental Health Working Party are contract holders in the area of mental health information and mental health promotion, and competent stakeholders in the field of mental health such as International Organisations, NGOs and patient representatives. The Network of Competent Authorities shall be informed of the participants of this working party. 3. Organisation of the work of the Mental Health Working Party The Mental Health Working Party shall be linked to a Secretariat, which shall contribute to the organisation of meetings and preparation of documents.

7

The Secretariat shall be a central focus point for better co-ordination on the Mental Health Working Party members and external stakeholders such as International Organisations, etc. If necessary, the Mental Health Working Party might establish ad hoc Task Forces in order to carry out or guide any development work in specific areas with a view to preparing consensus documents to be discussed and agreed in plenary afterwards. 4. Tasks • To contribute to the compilation and development of a sustainable health monitoring system in

the field of mental health, to the collection, sharing and diffusion of mental health data;

• To participate in making the mental health indicators operational and to develop them further;

• To co-ordinate with other priority areas of the information and knowledge system;

• To give advice on the preparation of a European strategy in mental health;

• To identify elements with a view to contributing to the preparation of the annual work plans in its fields of competence;

• To evaluate, benchmark and diffuse national ‘good and best practices’;

• To examine the possibilities of common evidence-based actions;

• To examine mental health related issues in other Community policies and their impact;

• To contribute to the co-ordination of mental health activities in the yearly public health forum and other relevant events.

The Mental Health Working Party shall meet twice per year. The meetings will be organised by the Commission Services in Luxembourg.

8

ANNEX 3 The list of participants

EUROPEAN COMMISSION HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL Directorate C - Public Health and Risk Assessment C2 - Health information

First Meeting of the Mental Health Working Party

DRAFT LIST OF PARTICIPANTS Luxembourg, 25-26 November 2003

Room EUFO 001

MEMBER STATES AUSTRIA: Prof. Heinz KATSCHNIG Ludwig-Boltzmann Institute for Social Psychiatry Spitalgasse 11 A-1090 VIENNA Austria Tel.: (+ 43) 1 406 00 75 Fax: (+ 43) 1 406 00 75 BELGIUM: Ms. Leen MEULENBERGS (Unable to attend) Advisor FPS Health, Food Chain Safety and Environment Department of International Relations Esplanade Building, room 303 Boulevard Pacheco 19/5 B - 1010 BRUSSELS Belgium Tel.: (+ 32) 2 210 44 62 Fax: (+ 32) 2 218 67 46 E-mail: leen.meulenbergs@health.fgov.be DENMARK: Dr. Marianne JESPERSEN (Unable to attend) National Board of Health The Danish Ministry of the Interior and Health Islands Brygge 67, p.G. 1881 DK – 2300 COPENHAGEN S Denmark Tel.: (+ 45) 72 22 75 80 Fax: (+ 45) 72 22 74 19 E-mail: mj@sst.dk

9

FINLAND: Dr. Juha LAVIKAINEN STAKES Mental Health Group P.O. Box 220 FIN-00531 HELSINKI Finland Tel. (+358) 9 3967 2184 Fax. (+358) 9 3967 2155 E-mail: juha.lavikainen@stakes.fi Prof. Ville LEHTINEN Kanervatie 18 FIN-20540 TURKU Finland Tel. (+358) 2 2373 253 E-mail: ville.lehtinen@stakes.fi Prof. Kristian WAHLBECK STAKES Mental Health Group P.O. Box 220 FIN-00531 HELSINKI Finland Tel. (+358) 9 3967 2300 Fax. (+358) 9 3967 2155 E-mail: kristian.wahlbeck@stakes.fi FRANCE: Prof. Viviane KOVESS MGEN, DRESP 3, Square Max Hymans F – 75748 PARIS Cedex 15 E-Mail: vkovess@mgen.fr GERMANY: Prof. Ulrich HEGERL Klinik der Ludwig-Maximilians-Universität München (LMU) Nußbaumstraße 7 D - 80336 MÜNCHEN Germany E-mail: uhegerl@psy.med.uni-muenchen.de

10

Prof. Armin SCHMIDTKE (Unable to attend) Dept. for Clinical Psychology Clinic for Psychiatry & Psychotherapy University of Würzburg Fuchsleinstrasse 15 D-97080 WÜRZBURG Germany Tel.: (+ 49) 931 201 7600/7668 Fax: (+ 49) 931 201 7669 E-mail: clips-psychiatry@mail.uni-wuerzburg.de Dr. Karl KUHN Federal Institute for Occupational Safety and Health Haupsitz Dortmund Friedrich-Henkel-Weg 1-25 D-44149 DORTMUND Germany Tel.: (+ 49) 231 9071 243 Fax: (+ 49) 231 9071 362 E-mail Kuhn.Karl@baua.bund.de GREECE: Dr. Athanassios CONSTANTOPOULOS Mental Health Centre Regional General Hospital of Athens Zalogou 6 GR - TK 153 43 AGIA PARASKEVI Attica Tel.: (+ 30) 210 601 6030/9212 Fax: (+ 30) 210 639 8697 E-mail: mhc@otenet.gr Dr. Eleni PETRIDOU Athens University Dept. of Hygiene and Epidemiology M. Asias 75 GR – 11527 ATHENS Greece Tel.: (+ 30 ) 210 746 2187/2105 Fax: (+ 30) 210 777 3840 E-mail: epetrid@med.uoa.gr IRELAND: Dr. Bairbre NICAONGUSA (Unable to attend) Department of Health and Children Hawkins House Dublin 2 Ireland Tel.: (+353) 1 6354137 Fax: (+353) 1 6354373 E-mail: Bairbre_NicAongusa@health.irlgov.ie

11

Dr. Patricia Noonan WALSH Pomona Project Leader University College Dublin D-002 – D-005 John Henry Newman Building Belfield Dublin 4 Ireland Tel.: (+353) 1 716 8333 Fax: (+353) 1 716 8568 E-mail: patricia.walsh@ucd.ie ITALY: Dr. Angelo BARBATO Epidemiology and Social Psychiatry Unit Department of Neuroscience Mario Negri Institute via Eritrea 62 I – 20157 MILANO Tel.: (+39) 02 39014431 Fax: (+39) 02 33200049 E-mail: barbato@marionegri.it Dr. Roberto CARDEA Senior Medical Officer Sanitary Prevention Directorate Ministry of Health via Sierra Nevada 60 I - 00144 ROMA Tel.: (+39) 06 5994 4881 Fax: (+39) 06 5994 4253 E-mail: r.cardea@sanita.it LUXEMBOURG: Prof. Charles PULL Centre Hospitalier de Luxembourg Département des Neurosciences 4, rue Barblé L – 1210 LUXEMBOURG Luxembourg Tel.: (+352) 44 11 27 06 Fax: (+352) 44 12 47 E-mail: pull.charles@chl.lu NETHERLANDS: Dr. Eva JANE-LOPIS Academic Centre of Social Sciences University of Nijmegen, Department of Clinical Psychology P.O. Box 9104 NL – 6500 HE NIJMEGEN The Netherlands Tel.: (+31) 24 36 126 67

12

Fax: (+31) 24 36 155 94 E-mail: llopis@psych.kun.nl PORTUGAL: Dr. Maria Jose HEITOR DOS SANTOS replaced by: Dr. Ricardo GUSMAO Directorate of General Health Clinica Universitaria de Ministry of Health Psiquiatria e Saude Mental Alameda Ad. Afonso Henriques 45-77 Faculdade de Ciências Medicas PT – 1049-005 LISBON Calcada da Tapada 155 Portugal PT – 1300 LISBON E-mail: mjhs@dgsaude.min-saude.pt E-mail: rgusmao@esoterica.pt SPAIN: Prof. J. Agustin OZAMIZ Facultad de CC.PP y Sociología Universidad de Deusto Aptdo 1, 48080 BILBAO Spain Tel.: (+34) 607 517 522 E-mail: eganda@soc.deusto.es SWEDEN: Prof. Lars JACOBSSON Psychiatric Clinic Univ. Hospital 901 85 UMEA Sweden E-mail: lars.jacobsson@psychiat.umu.se UNITED KINGDOM: Dr. John H. HENDERSON 36 Long Cram, Haddington East Lothian, EH41 4NS Scotland United Kingdom Tel.: (+44) 1620 829 404 Fax: (+44) 1620 829 405 E-mail: john.henderson53@btopenworld.com Mr. Gregor HENDERSON (Unable to attend) Mental Health and Well Being The Scottish Executive St Andrew's House (3EN) Regent Road EDINBURGH EH1 3DG Scotland United Kingdom E-mail: Gregor.Henderson@scotland.gsi.gov.uk

13

Prof. Terry BRUGHA Professor of Psychiatry Section of Social and Epidemiological Psychiatry University of Leicester LEICESTER United Kingdom Tel.: (+44) 0 116 225 6295 Fax: (+44) 0 116 225 6235 E-mail: tsb@le.ac.uk Mr. David McDAID London School of Economics and Political Science Health and Social Care, Houghton Street LONDON WC2A 2AE United Kingdom Tel.: (+44) 20 79 55 68 40 Fax: (+44) 20 79 55 68 03 E-mail: D.Mcdaid@lse.ac.uk

14

EEA countries LIECHTENSTEIN: Mr. Rene MEIER Synergo AG Institute for Community and Regional Development Essanestr. 616 FL – 9492 ESCHEN Liechstenstein Tel.: (+423) 371 1100 Fax: (+423) 371 1102 E-mail: rene.meier@synergo.li NORWAY: Dr. Lars MEHLUM (Unable to attend) Instituttgruppe for psykiatri Oslo University Bygning 20 Sognsvannsveien 21 N-0320 Oslo Norway Tel.: (+47) 22 92 34 73 Fax: (+47) 22 92 39 58 E-mail: lars.mehlum@psykiatri.uio.no ICELAND: Dr. Tomas ZOEGA (Unable to attend) Department of Psychiatry University Hospital 101 REYKJAVIK Iceland Tel.: (+354) 56 01 707 E-mail: tomasz@rsp.is

15

Candidate countries SLOVENIA: Dr. Andrej MARUSIC replaced by: Dr. Mojca Z. DERNOVSEK Institute of Public Health E-mail: mojca.dernovsek@ivz-rs.si Trubarjeva 2 1000 LJUBLJANA Slovenia Tel.: (+386) 1 2441 400/401 Fax: (+386) 1 2441 447 E-mail: andrej.marusic@ivz-rs.si SLOVAK REPUBLIC: Dr. Peter BREIER General Hospital Ruzinov Dept Psychiatry Ruzinovska 6 826 06 BRATISLAVA Slovak Republic Tel.: (+ 421) 243 333 247 Fax: E-mail: breier@nspr.sk ROMANIA: Dr. Bogdana TUDORACHE President Romanian League for Mental Health Sos. Mihai Bravu 90-96 BI.D 17, Sector 2, Ap. 149 RO – 70109 BUCHAREST Tel.: (+ 40) 21 252 60 11 Fax: (+ 40) 21 252 08 66 E-mail: lrsm@dnt.ro LITHUANIA Dr. Associate Prof. Dainius PURAS Clinic of Psychiatry Vilnius University Vytauto g.15 LT – 2004 VILNIUS Tel.: (+370) 612 413 90 Fax: (+370) 52 75 22 75 E-mail: dainius.puras@mf.vu.lt

16

POLAND Prof. Stanislaw PUZYNSKI (Unable to attend) Director Institute of Psychiatry and Neurology Sobieskiego 1/9 PL – 02-957 WARSAW Tel.: (+ 48) 22 842 26 50 Fax: (+48) 22 842 53 75 E-mail: puzynski@ipin.edu.pl LATVIA Dr. Iveta BLUKA Dept. Director Health Promotion Centre Skolas str. 3 LV – 1010 RIGA Tel.: (+371) 686 422 Fax: (+371) 686 421 E-mail: vvc@parks.lv TURKEY Dr. Toker ERGUDER (Unable to attend) Head, Substance Dependence Dept. General Directorate of Primary Health Care Ministry of Health Ataturk Bulvari 65/8 SIHHYE/ANKARA Turkey Tel.: (+90) 312 435 6840 Fax: (+90) 312 430 4204 E-mail: terguder@saglik.gov.tr MALTA Dr. Ray XERRI (Unable to attend) 6 Harper Lane, Floriana Malta G.C. Tel.: (+ 356) 22 99 23 20 Fax: (+ 356) 22 99 26 57 E-mail: ray.xerri@gov.mt ESTONIA Dr. Ain AAVIKSOO (Unable to attend) Ministry of Public Health Gonsiori 29 EE – 15027 TALLINN Estonia Tel.: Fax: E-mail: ain.aaviksoo@sm.ee

17

HUNGARY Dr. Laszlo LAJTAVARI Nyiro Gyula Hospital H – 1135 BUDAPEST Tel.: (+36) 30 260 2641 E-mail: lajtavari@labo.axelero.net Dr. Janos VIZI National Centre for Epidemiology (OEK) PO Box 64 H – 1966 BUDAPEST Pf. Tel.: (+ 36) 1 476 6416 E-mail: vizij@oek.antsz.hu CYPRUS Dr. Evangelos ANASTASIOU Head, Athalassa Hospital Mental Health Services Ministry of Health 1452 NICOSIA Cyprus Tel.: (+357) 22 402101/402104 Fax: (+357) 22 487941 E-mail: director.mhs@cytanet.com.cy BULGARIA Dr. Toma TOMOV (Unable to attend) Head, Department of Psychiatry Alexandrovska Hospital Sofia Medical Academy 1 Georgii Sofijski str. BG – 1431 SOFIA Tel.: (+359) 2 983 3184 Fax: (+359) 2 983 1184 E-mail: ttomov@netissat.bg CZECH REPUBLIC Dr. Cyril HÖSCHL Prague Psychiatric Centre Ustavni 91 CZ – 181 03 PRAGUE 8 Tel.: (+ 420) 2 6600 3131 Fax: (+ 420) 2 6600 3134 E-mail: hoschl@pcp.lf3.cuni.cz

18

SPEAKERS Mr. Pieter KRAMERS Dept. of Public Health Forecasting National Institute of Public Health and Environment Antonie van Leeuwenhoeklaan 9 Postbus 1 NL – 3720 BILTHOVEN Tel.: (+31) 30 27 42 163 Fax: (+31) 30 27 44 450 E-mail: pgn.kramers@rivm.nl INTERESTED PARTIES Mr. Rodney ELGIE Gamian Europe Riverside Business Centre River Lawn Road UK – TN9 1EP TONBRIDGE, Kent United Kingdom Tel. +44 (0) 1732 367926 E-mail: Rodneyelgie@supanet.com INTERNATIONAL ORGANISATION Prof. Wolfgang RUTZ WHO Euro Office Scherfigsvej 8 DK - 2100 COPENHAGEN Tel.: (+ 45) 3917 1418 E-Mail: wru@who.dk EUROPEAN COMMISSION • Mr. Horst KLOPPENBURG, DG SANCO C/2 • Ms. Sylvie MANGUIN, DG SANCO C/2 • Mr. Lucian AGAFITEI, DG ESTAT D/6

19

ANNEX 4 The Task Forces Task Force on Evidence Leaders: Eva Jane-Llopis and Kristian Wahlbeck Members: Angelo Barbato Ricardo Gusmao Heinz Katschnig Karl Kuhn David McDaid Eleni Petridou Task Force on Future Perspectives on Mental Health Promotion Leaders: John Henderson and Patricia Noonan Walsh Members: Iveta Bluka Roberto Cardea Athanassios Constantopoulos Mojca Dernovsek Viviane Kovess Juha Lavikainen David McDaid Charles Pull Dainius Puras

20

ANNEX 5 Powerpoint presentations Attached separately

21

22

ANNEX 6 Relevant websites DG SANCO - Public Health: europa.eu.int/comm/health/index_en.html WHO Regional Office for Europe - Mental Health Programme www.euro.who.int/eprise/main/WHO/Progs/MNH/Home Organisations Mental Health Europe-Santé Mentale Europe: www.mhe-sme.org STAKES: www.stakes.fi/mentalhealth Project related Implementing Mental Health Promotion Action: www.preventioncenter.net/index.html Mental Health Economics: www.mentalhealth-econ.org/

Network of Competent AuthoritiesLuxembourg,

15-16 December 2003

ECHI: European Community Health Indicators and the selection of a set offirst phase core indicators (‘shortlist’)

Pieter Kramers; on behalf of the ECHI-team

ECHI-1 project: Establishing European Community Health Indicators

Objective: To propose a set of EC health indicators for the HMP (Health Monitoring programme) and EU information system (for monitoring trends, comparingcountries, supporting policies);

Implying: The core business of HMP’s Pillar A;

ECHI-1: final report February 2001.

ECHI-1:Four criteria for indicator selection

• Be comprehensive (cf. Annex II/HMP; next slide);

• Meet user needs (MS/EU health policy priorities; based on policy documents); i.e., an ‘indicator’ always serves potential (policy) action;

• Cover existing data, but also point at development needs: innovation;

• Use earlier work, match international developments(WHO-Euro/HQ, OECD, Eurostat, included in project team; their indicators largely included).

ECHI – comprehensiveness: main categories of indicators;

model: health status -> determinants -> action

• Demographic and Socio-economic factors

– population– socio-economic factors

• Health status – mortality– morbidity disease-specific– generic health status– composite health status

measures

• Determinants of health– personal and biological factors– health behaviours– living and working conditions

• Health services and health promotion

– prevention, health protection, health promotion

– health care resources– health care utilisation– expenditures/financing– health care quality

ECHI-2: 2002-2004; present state

• Indicator list expanding and innovative, by uptake of HMP project recommendations and other work;

• Still many ‘indicators’ listed in terms of ‘genericindicators’ (topics);

• Concept of ‘User-Windows’: interest-oriented subsetsof indicators;

• ECHI increasingly used as focus for co-ordination between HMP projects, more recently within the newPublic Health Programme’s Working Parties.

Areas in which recommendations fromHMP projects (and other sources) are

included in ECHI list up to now• Functional health status/health expectancies• Socio-economic differences• Mental health• Cardiovascular indicators; musculoskeletal conditions• Diabetes mellitus; cancer• Lifestyle and biological risk factors • Food consumption/nutrition• Alcohol consumption; physical activity• Perinatal health; child health; reproductive health

Topics from HMP projects (and other sources) included in ECHI list (continued)

• Environmental health indicators (WHO)• Human resources in health care• Pharmaceutical products; hospital data• Linked to Eurostat: causes of death, health interview surveys,

morbidity• other: EMCDDA: illicit drugs• other: WHO EuroHIS• other: OECD System of health accounts• other: OECD pilot on health care quality indicators• other: Injury programme (limited)

The concept of ‘User windows’:Examples

• Principle: subset of indicators selected from theperspective (‘window’) of a specific user.

• Examples:– Mental health: health status, determinants, health care

issues;

– Injuries: mortality/morbidity, environmental and behavioral determinants, prevention, health care;

– Health inequalities: inequalities in mortality, morbidity, risk factors, health promotion settings, access to services;

– Cockpit view: overview of the ‘most important issues in the whole public health field’: the ‘core set’ of today.

Spring 2003: work on ‘first phase core list’

• Rationale:– Practical means of approaching the goals of the new public

health programme.

– ECHI list is expanding by the inclusion of many HMP project recommendations.

– Practical priorities are needed to focus work on dataharmonisation and data collection: first step for implementation of an information system.

– Work this out as an example of a user window.

Criteria for core list selection

• Viewpoint of the ‘general public health official’ (‘cockpit’); – which are the large public health problems and inequalities?

– which are the large possibilities for improvement?

– all this in terms of size/impact (burden of ill-health on population level) and the options of (cost-)effective intervention.

• Availability was not taken as a primary criterion: thus we will end up with a (1) quick implementation set and (2) a development set.

Core list selection process, guided byECHI

• A procedure was formulated and discussed broadly;

• The March 2003 version of the ECHI comprehensive list was used as the basis for selection;

• The ECHI team and some HMP co-ordinators (total of 19) gavetheir 50 first and 50 second choices from approx. 400 items/indicators.

• ECHI team (June) and NCA (July) gave general approvementplus some amendments.

• Eurostat gave preliminary assessment of availability.

• Fall 2003: additional comments, a.o. from Working Parties

Core list selection process, guided byECHI (continued)

• Present number of items/indicators in the 4 ECHI classes: • demography/socio-economic factors: 4 from 40

• health status: 25 from > 150

• health determinants: 13 from 70

• health systems (including health promotion, prevention, health services): 15-20 from 150

• Some issues still under discussion (mainly in healthsystems); some comments still coming from Working Parties; availability being checked by Eurostat, HMP projects, Working Parties.

First phase core list by December 2003 see paper version of December 10, with remarks on definitions and

availability

• Demographic and socio-economic factors (full list: 40 items):– obvious population issues not included– where appropriate, stratify indicators by gender, age, SES,

subnational region• Population by 4 ISCED classes of education • Total employment rate 15-64/total unemployment • % Population with income below 60% national median

(Eurostat definition)• Suggestion Sweden: add population by ISCO occupational

groups; ECHI: OK

First phase core list by December 2003 (2);health status (full list > 150 items); mortality

• Life expectancy at various ages

• Infant mortality• Peristat project: prefers neonatal + fetal mortality, by

birthweight, gestational age; ECHI: OK

• Standardised death rates 65 causes Eurostat; 0-64; 65+

• Smoking related deaths

• Alcohol related deaths• WP injuries: Include specifically alcohol-related injury deaths;

ECHI: OK but not specified by ICD; how to do?

• Suggestion EMCDDA: Add drug-related deaths (EMCDDAdefinition); ECHI: OK

First phase core list by December 2003 (3);health status, specific conditions

• Remark: make clear whether incidence or prevalence

• HIV/AIDS; WP mental health: big public health problem?

• Lung cancer, breast cancer, prostate cancer, all cancers• ECHI: delete prostate and all cancers, too much, inconsistent

• Diabetes prevalence all types; Norway: include children; ECHI: take care of age roupings in general

• AMI, stroke (incidence); COPD (prevalence)

• Musculoskeletal condition (prevalence); follow MSD project for definition

• (Low) birth weight; follow Peristat project for definition

First phase core list by December 2003 (4);health status, specific conditions, cont.

• Dementia/Alzheimer, depression; follow WP mental health for definition

• Suicide attempt; WP mental health: base on surveys (CIDI)

• Road traffic injuries; WP injury prevention: make an item ‘injuries by intent and sector’, including road traffic, workplace, home/leisure, suicide attempt, other violence; basically on hospital discharge; other sources?; ECHI: OK, but then accept two sources for suicide attempt.

First phase core list by December 2003 (5);health status, perceived and functional health

• Self-reported health

• Prevalence of any chronic illness or condition

• Limitations of usual activities, past 6 months, health related

• Limitations in seeing, hearing, mobility etc.

• Health expectancy based on the first three above (this choice based on availability)

• Sweden: add social stress indicator; WP mental health: add general mental health indicator (preliminary: MHI-5); ECHI: OK with WP-MH suggestion, social stress covered here or in social determinants (see next slides)

First phase core list by December 2003 (6);determinants of health (full list: 70 items)

• Body mass index; Norway: include children; ECHI take care of age groupings

• (enhanced) blood pressure

• Regular smokers; pregnant women smoking

• Alcohol: heavy drinking; total alcohol consumption

• Use of illicit drug (including children)

• Intake of fruit; vegetables

• Physical activity; breastfeeding

First phase core list by December 2003 (7);determinants of health (cont.)

• Comment NCA and Sweden: why no environmental indicator? Suggestion ECHI-coord.: add an indicator on housing, following recommendations of project on environment and health (impact on physical and mental health probably substantial)

• Comment from WP mental health: indicator from social/workplace area is lacking; ECHI: OK; recommendation from WP-MH on social support indicator or related will follow.

First phase core list by December 2003 (8); Health systems (full list: 150 items); prevention, health

protection, health promotion

• Coverage of vaccination in children

• Coverage of screening breast and cervical cancer

• Policies on healthy nutrition (development area!)

• Policies and campaigns on (un)health lifestyles and injury prevention (development area!); WP mental health: add suicide prevention; ECHI: consider possibilities for development

• Integrated programmes in settings (school, workplace, etc.; development area!)

First phase core list by December 2003 (9); Health systems (continued); health care resources

• Physicians employed

• Nurses employed

• Latvia, Greece: add hospital beds; ECHI prefers beddays or related utilisation measure

• Greece: add some technologies (MRI, CT); ECHI: would be useful showing innovation in health care

• Sanco: mobility of professionals; ECHI: not in long list; development area?

First phase core list by December 2003 (10); Health systems (continued) health care utilisation

• General practitioner utilisation; Latvia: expand to outpatient visits; ECHI: take best operationalisation of generalised outpatient care use

• NCA July, Latvia: add beddays; ECHI: take combination of beddays, ALOS and discharges, on advice hospital data project

• NCA July: add certain medicine use; WP mental health: include antidepressants in primary care; ECHI: decide on basis of Euro-med-data project

• NCA July: add certain surgeries; ECHI: select on basis of innovation or accessibility criterion; work out with hospital data project

First phase core list by December 2003 (11); Health systems (continued); utilisation, expenditures

• Sanco: include ‘patient mobility’; ECHI: not in long list; what do we want to know?

• total public/private expenditures on health (OECD definition)

• Greece: % private expenditure; ECHI: check what is in OECD definition

• Greece: % population insured; ECHI: OK

First phase core list by December 2003 (12); Health systems (continued) health care quality

• Waiting lists/times; Sanco: include accessibility measure; ECHI: difficult one for comparability; WHO instrument on responsiveness?

• Cancer survival rates• Latvia: add stage at cancer diagnosis; diabetes

complications; TB mortality• Greece: add hospital infections – ECHI: make equilibrated and limited selection for this area,

also based on recent work of OECD health care quality group

First phase core list by December 2003 (13) Health systems (continued) health care performance?

• Most comments on ‘health systems’, why?

• Criteria difficult tom apply? Then perhaps:– no ‘technical’ grouping by: ‘resources’, ‘utilisation’,

‘expenditures’ but:

– ‘performance’ grouping by: ‘effectiveness’, ‘safety’, ‘accessibility/equity’, ‘efficiency’;

– keep health promotion development indicators as separate area outside the health care (and prevention) services

• In this grouping many of the same indicators will appear but criteria are more easy: relevance for enhancing health, serving the patient

First phase core list: preliminary assessement of availability of data

• Three categories:– Readily and regularly available, reasonably

comparable;

– Data available, not standard, comparability in question; recommendations by HMP projects for further development

– ‘Wish list’: interest to have information, no feasible indicator definition, no data; much development needed

First phase core list: preliminary assessement of availability of data (2)

• Group Available Partly av. Wish

• Socio-econ. 4 - -

• Mortality 4 3 -

• Morbidity 3 9 -

• Funct., HE 5 1 -

• Determinants 7 7 -

• H. prom., prevent. 1 2 3

• Health care 8 2 2

• Quality of care 1 5 -

• Total 33 27 5

Further work on the first phase core list ?

• Further discussion in, comments from Working Parties;

• Sorting out how to deal with the Health Systems part;

• Soon close the discussion on which items to include in the shortlist now (when? After last WP meeting?);

• After that:

– Finalise indicator definitions with HMP projects and WP’s;

– Establish the list, in ‘implementation’ and ‘development’ parts;

– Work this out with NCA secretariat and Eurostat.

Further work (2)

• For NCA members: feedback on implementation possibilities, create commitment in MS

• This set is a ‘first phase’, gradual expansion foreseen

• ECHI will work further on the ‘comprehensive list’ and other user-windows, with HMP projects, WP leaders; meeting on february 19-20.