Ei dian otsikkoa

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Pieter Kramers Antti Tuomi-Nikula WP
contributions to ECHIM Working Party on
Information on Lifestyle Specific
Subgroups Luxemburg 9 November, 2007
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• ECHIM actions
• Modifications/additions to the shortlist based
  on suggestions by the Working Parties/projects,
  over the past year
• Improving existing indicators
• Suggesting additions (deletions)
• In February listed in document Update of the
  ECHIM indicator shortlist, draft 7 February
  2007 now placed in tables Improvement of
  existing indicators.. and recommended
  additions, and updated with new information.

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Input from WP Lifestyles SG

• Fall 2006 input from Dafne project for addition
• Spring 2007 extensive input from WP Lifestyles
  for improvements and additions of indicators
• Related to alcohol consumption
• Health of the elderly
• Child health
• Gender-specific health
• Extensive e-mail discussion for clarification
• October 2007 input from 2 projects on prisoners
  health
• All suggestions included in overview tables (next
  slides)

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Improving existing indicators

• For each ECHI shortlist indicator a
  Documentation sheet is built, with the
  following items
• Indicator definition
• Calculation
• Underlying concepts
• Relevant dimensions (age, sex, etc)
• Preferred data source(s) (HIS, registries, etc)
• Rationale
• Data availability (also in MS)
• References
• Work to do

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Improving existing indicators

• Many suggestions can be technically accommodated
  in preparing the documentation sheets
• Some issues need discussion in the ECHIM Core
  Group, with expert groups and with WP LIS
• Required documentation often not complete
• ECHIM response restricted to input for the
  shortlist ECHI long list will not be updated as
  such but supplemented by records on projects
  dealing with indicators
• Next slides give WP LIS input

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Improving existing indicators

• Alcohol-related mortality Mindful ICD codes
  proposal does not cover all causes like e.g.
  injuries
• ECHIM proposal investigate approach by
  attributable fractions the HEM Closing the gap
  project has done good work on this (final
  conference 23 October in Brussels)
• Injuries home/leisure violence specify for
  children and elderly. WP accidents/injuries will
  give suggestions for data sources and will
  comment on the documentation sheets split
  home/leisure and violence
• ECHIM follow directions of WPs

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Improving existing indicators

• Body mass index specify for children
• ECHIM include proper age bands and proper survey
  instruments
• Physical activity specify for children
• ECHIM include proper age bands the proposed
  instrument and strategy for EHIS is perhaps not
  fit for children use proper survey instrument
• Smoking specify for children
• ECHIM include proper age bands the proposed
  instrument and strategy for EHIS is perhaps not
  fit for children use proper survey instrument

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Improving existing indicators

• Pregnant women smoking include all trimesters of
  pregnancy
• ECHIM agree, but data collection is a problem
  anyway
• Total alcohol consumption and hazardous alcohol
  use add specification wine-beer-spirits include
  'frequency of heavy drinking occasions' and
  'regular drinkers. Earlier ECHI choice total
  consumption from trade/production, hazardous use
  from (E)HIS.
• ECHIM keep to these two follow WP input
  develop best indicator(s) from EHIS leave
  unrecorded production for development.

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Improving existing indicators

• Regulations (legislation, enforcement,
  adjudication Alcohol report (2006) p283) of the
  alcohol market price and tax measures
  Restrictions on availability Regulations on
  advertising, promotion and sponsorship (p258
  Alcohol report (2006)) e.g. alcohol
  advertisement restrictions (equivalent to smoking
  advertisement restrictions (4.1.3)). Alternative
  Regulations aiming at the reduction of alcohol
  consumption and its consequences (p240ff, p251
  Alcohol report (2006)) including labeling of
  warning on containers of alcoholic products
  (p253, p357/8, p414 Alcohol report (2006))(see
  chapters 7-9 Alcohol report (2006)) In the
  long list there are also regulations on alcohol
  and driving. EU co-financed projects have
  collected or are collecting these data.
• ECHIM collect material regular information
  gathering possible?

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Suggesting additions

• For areas
• Nutrition
• Alcohol use
• Elderly health
• Child health
• Gender issues
• Prisoners health
• Only top and strong indicators included
  fitted into ECHIM structure
• Not always documentation or rationale present
• WP Lis 36 out of a total of 71 suggested
  additions
• Limited number of additions will be allowed

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Suggesting additions

• Demographic socio-economic factors
• Children below poverty line (child)
• Children by household net income (child)
• Prison population rate (prison)
• Health status
• Mortality all childhood cancers (also suggested
  by Eurochip child)
• Mortality endometrium cancer (gender, elderly)
• Suicides in prison/detention (prison)
• PYLL (potential years of life lost) Eurostat 65
  causes (gender)
• Mortality of intentional and unintentional
  injuries related to alcohol consumption (alcohol)
• Homicides and suicides due to alcohol consumption
  (alcohol)

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Suggesting additions

• Health status, cont.
• Incidence of all cancers (elderly, also suggested
  by Eurochip)
• Sexually transmitted diseases (gender)
• Prevalence of liver cirrhosis (alcohol)
• Incidence of intentional and unintentional
  injuries related to alcohol consumption (alcohol)
• Prevalence of neuropsychiatric conditions related
  to alcohol consumption / in alcohol drinkers
  (alcohol)
• Prevalence of fetal alcohol syndrome AND/OR
  Intellectual deficits in childhood related to
  prenatal exposure to alcohol (alcohol)
• DALYs (disability adjusted life years) lost due
  to hazardous and harmful alcohol consumption
  (alcohol)

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Suggesting additions

• Health status, cont.
• Euroqol score (elderly gender)
• Measure of children's quality of life (child)
• Absenteeism from work/sickness absence (gender)
• Percentage of infertile couples (gender)
• Sexual abuse and violence (elderly gender,
  child)
• Limitations in household activities (elderly)
• Limitations in personal care (elderly)
• Limitations in school, work, leisure activities
  (elderly, child)

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Suggesting additions

• Determinants of health
• Consumption/availability of meat and meat
  products (nutrition)
• Age at first exposure to active smoking (child)
• Physical punishment in children (child)
• Age at first alcohol intoxaction or drunkenness
  (child, alcohol)
• Household expenditure on alcohol
  beer-wine-spirits (alcohol)
• Total unrecorded consumption (alcohol)
• Pregnant women drinking alcohol (alcohol)
• Prevalence of childhood adversities (abuse,
  neglect, violence) among children of heavy
  drinkers (alcohol)

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Suggesting additions

• Health interventions health systems and health
  promotion
• Pregnant women attending regular prenatal visist
  (child)
• General preventive examination (child)
• Deliveries after fertility treatment (gender)
• Regulations on alcohol (alcohol)
• Regulations on alcohol and driving (alcohol)

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Suggesting additions

• ECHIM core group 18-19 October on additions
• Continue with proposed procedure for additions to
  shortlist
• But keep extension very limited shortlist should
  be kept short i.e. no more than some 10
  additions
• Expand on criteria for selection

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Suggesting additions

• Procedures, basic idea as outlined earlier
• Present selection list (now 71) to WP indicators,
  December 2007
• First selection of individual top-10 (or top-5)
• Presenting rank order from this, discuss
  cut-point
• Discuss outcome in plenary, if needed repeat
  selection
• Present final rank order, decide on cut-point
• Final approval ECHIM Core group spring 2008
• More formal approvals later in WP indicators,
  NCA, etc.

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• Procedures, selection criteria
• in the first shortlist selection these were
• Relevance from the point of view of the general
  public health official
• Connection with large public health problems,
  large health inequalities and large
  possibilities for improvement
• Data availability was not included to allow for
  development

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• Now will be added as criteria
• Proper rationale (as linked to the criteria used
  earlier)
• Proper definition
• Good validity (does it measure what it intends to
  measure)
• Good reliability (accurate, consistent)
• Good discriminative power
• Reasonable data availability

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• What for WP Lis?
• A shortlist should cover many areas of public
  health, and additions will be more limited than
  foreseen earlier.
• Proposals from WP on children, elderly and gender
  are like user-windows, mostly covering items
  already in the shortlist especially items on
  children need careful consideration.
• Proposals on alcohol make for a good set by
  itself, but look like unbalanced in the frame of
  an overal PH shortlist.
• ECHIM advice try to select a smaller set really
  directed to the shortlist, and prepare a complete
  Documentation sheet for each indicator. Link