Monitoring health in Europe: opportunities, challenges, and progress

The EUROREVES project team describe how, even for a widely used concept such as self-perceived health, existing surveys vary widely in whether the respondent is asked about health in general, or in comparison to others of the same age, whether there is a reference to the time over which health is assessed, or the number of response categories.

Abstract

The modern world has, at its heart, a strange paradox. In surveys, individuals invariably place good health at the top of their list of priorities; however, as societies we expend remarkably little effort in assessing whether we are achieving this goal or not. Instead, as is apparent from even a superficial glance at the financial pages of any leading newspaper, we devote enormous efforts to tracking economic progress (or at least some elements of it). When it comes to measuring the progress of nations, wealth wins out over health nearly every time.1 This deficit is especially important in Europe. The European idea is much more than an economic concept.2 Unlike other regional trading blocs such as the North American Free Trade Association, the development of a social Europe is just as important. Furthermore, the diversity that exists within Europe, a diversity that will increase dramatically as fifteen become twenty-five, provides a uniquely rich setting in which to understand the determinants of health and disease and to learn what policies enhance health, and in what circumstances. Examples abound.3 The observation that deaths from heart disease are so much higher in northern than in southern Europe led to identification of the benefits of what is now described as the “Mediterranean diet”. Those working in as the fields of HIV/AIDS, tobacco control, and injury prevention have developed effective networks to exchange experience and promote mutual learning. The benefits of such mutual learning are recognised in the endorsement of the Open Method of Co-ordination, a structure that encourages Member States to share experiences and learn from best practice in Europe in policy areas where legal harmonisation is either precluded or undesirable.4 This approach is currently used in the areas of social exclusion, pensions and health care. So can we chart the social progress of Europe in the same way that we follow its economic progress? At the most superficial level, clearly we can. Life expectancy at birth, for both sexes combined, improved from 74.2 years in 1980 to 78.3 years in 1999.5 The countries of Europe have long had effective systems of vital registrations allowing them to monitor births and deaths, and so to track changes in population (although we should not overlook the fact that the imperative for monitoring these data is as much about providing economic information as about monitoring health). There is also high quality information about causes of death, although there are large gaps in our understanding of how those deaths are distributed within populations, and in particular how a person’s risk of dying prematurely is influenced by their position in society, their education or employment, or their ethnicity. When one goes beyond basic measures, coverage is rather more patchy. In particular, there is still very little information on morbidity or on health status. Yet health is much more than a function of births and deaths, increasingly so as ageing populations confront a rising tide of chronic diseases that lead to long-term disability but not death. At present, the health needs of millions of European citizens are effectively invisible. It was to remedy this situation that the Community Action Programme on Health Monitoring was established in 1997. It has three strands: improving health information; development of a community-wide network for sharing health data; and strengthening analyses and reporting. In its short existence it has achieved a great deal and this supplement seeks to bring a small selection of its many outputs to a wider audience. The papers brought together here range from methodological development to cataloguing of existing data sources. Some look at particular health challenges, others at particular populations, and yet others at the many settings in which it is possible to capture information on health. They encompass information on health determinants, on health status, and on health care utilisation. One of the major obstacles to better understanding of patterns and determinants of health status has been the absence of standardised survey instruments. The EUROREVES project team describe how, even for a widely used concept such as self-perceived health, existing surveys vary widely in whether the respondent is asked about health in general, or in comparison to others of the same age, whether there is a reference to the time over which health is assessed, or the number of response categories.6 This project has proposed a set of instruments covering functional limitations, activity restriction, global activity EUROPEAN JOURNAL OF PUBLIC HEALTH 2003; 13 (3 SUPPLEMENT): 1–4