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Compte rendu de la réunion du Réseau d autorités compétentes

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									                   COMMISSION EUROPÉENNE
                   DG SANTÉ ET PROTECTION DES CONSOMMATEURS

                   Direction C: Santé publique et évaluation des risques
                   Unité C2 – Information en matière de santé




                                              Compte rendu

de la réunion du Réseau d’autorités compétentes dans le domaine de l’information et de
                         la connaissance en matière de santé

                            Luxembourg, les 15 et 16 décembre 2003


Président : J.F. Ryan (Chef d’unité, DG Sanco C/2, Information en matière de santé).
Interprétation disponible en DE, FR, ES, IT, EN.
Liste des participants/excusés: voir le fichier inséré ci-dessous.
Rapport du secrétariat (NIVEL).



1.   ADOPTION DE L’ORDRE DU JOUR

Le projet d’ordre du jour est adopté sans modification.


2.   APPROBATION DU COMPTE RENDU DE LA DERNIERE REUNION

Le compte rendu est accepté avec toutes les modifications reçues. Des copies des
présentations seront intégrées de façon électronique dans le compte rendu. Tous les comptes
rendus de toutes les réunions seront mis sur Internet pour assurer la transparence.

3.   PRESENTATION DU NOUVEL ORGANIGRAMME DE SANCO C

Le nouvel organigramme de SANCO C est présenté. La nouvelle direction « Santé publique
et évaluation des risques » comprend sept unités (C1 à C7). La plupart des comités
scientifiques ont été transférés à « l’Autorité alimentaire ».

Une Agence exécutive sera créée à Luxembourg avec un effectif de 35 personnes et un
directeur qui sera nommé en 2004. Leur Agence se chargera de la préparation du Centre
européen pour la prévention et le contrôle des maladies transmissibles (ECDC), elle
soutiendra la gestion des projets avec des évaluations et un soutien budgétaire et (pour la C2)
contribuera au portail sur la santé publique et au fonctionnement du réseau EUPHIN.


4.   PRÉSENTATION DU SECRÉTARIAT DU RÉSEAU

Le Dr François Schellevis de l’institut NIVEL (Institut néerlandais de recherche des services
de santé) présente la composition et les futures tâches du secrétariat (voir le fichier ppt
inséré).



                                                     --                                       1
Il est souligné que les principales tâches du secrétariat seront concentrées sur le soutien des
services de la Commission pour l’élaboration de documents de synthèse et de rapports
d’avancement pour le Réseau d’autorités compétentes. Le secrétariat sera financé selon la
règle 60/40 pour une année.

Ces tâches seront étroitement liées à l’établissement et à la mise en œuvre de la liste
restreinte d’indicateurs de santé européens. Elles doivent tenir compte de la situation dans les
différents États membres et, notamment, du besoin d’intégrer les nouveaux États membres.


5.   DISCUSSION     ET ADOPTION DU PROJET DE MANDAT DU RESEAU D’AUTORITES
COMPETENTES

Rôle du Réseau d’autorités compétentes

Il est souligné que le Réseau d’autorités compétentes n’est pas un organe de prise de
décisions mais un organe consultatif. Il n’y aura pas de procédure de vote. Toutes les phases
de développement sont basées sur le consensus. En outre, il fournit une plate-forme pour
l'échange d'informations entre les États membres sur leurs activités en matière d’information
et de connaissance sur la santé.

Composition

Ni l’Observatoire européen des drogues et des toxicomanies (OEDT) ni d’autres agences ne
sont mentionnées comme membres du Réseau d’autorités compétentes. Toutefois l'OEDT
peut être mentionné à cause de ses travaux de collecte de données dans ce domaine d'activité.

Relations avec les groupes de travail

Le Réseau d’autorités compétentes est composé de représentants des ministères de la santé
des États membres. Les groupes de travail alimenteront le Réseau d’autorités compétentes
avec des réalisations et des thèmes considérés à partir de différents angles dans leur domaine
d’activité. Le Réseau d’autorités compétentes prendra les décisions et fixera des priorités en
consensus.

•    Les membres des groupes de travail

     Les membres des groupes de travail sont les chefs des projets antérieurs, actuels et
     futurs. Jusqu’à présent, seuls les membres de projets financés ont été invités, dans la
     mesure où les nouveaux groupes de travail et les nouveaux projets n’ont pas encore été
     décidés. Un effort a été fait pour compléter les groupes de travail avec des experts venant
     de pays non représentés dans le groupe de chefs de projet jusqu'à présent. Une attention
     spéciale sera accordée aux nouveaux membres. En principe, il n'y a pas de "politique de
     la porte fermée ». Il existe néanmoins des contraintes physiques et budgétaires.

•    Relation entre les membres des différents groupes de travail au niveau de l’État
     membre

     Il a été suggéré de faire une liste des membres nationaux participant aux différents
     groupes de travail pour assurer des discussions bilatérales.

Coopération en ce qui concerne le niveau des tâches


                                             --                                                2
Certains délégués s’interrogent sur les tâches du Réseau d’autorités compétentes, sa relation
avec l’Agence exécutive, le réseau de chefs de groupes de travail et le portail « santé ». La
Commission souligne que l’Agence exécutive fera partie des services de la Commission et
sera étroitement liée à la DG SANCO/C. Elle aidera au travail quotidien de mise en œuvre du
programme en matière de santé publique.

Coopération avec EUROSTAT

Certains représentants s’interrogent sur les tâches et le financement des activités
d’EUROSTAT dans le cadre des projets. Il est expliqué qu’à l’avenir EUROSTAT se
concentrera sur un nombre restreint d’activités (par ex. les statistiques sur le handicap ne
seront plus un domaine prioritaire). Le programme en matière de santé publique pourra
compléter le travail d’EUROSTAT, notamment par l’élaboration d’indicateurs et le travail
sur la méthodologie. Des possibilités d’activités conjointes sur des statistiques
complémentaires en matière de santé sont prévues dans le programme de travail de 2004 sous
la forme d'appels d'offres.


6.   PANORAMA DES ACTIVITES DEPUIS LA DERNIERE REUNION

Projets acceptés pour 2003

Le Président explique pourquoi il y a eu un retard dans l’approbation finale des projets et
annonce que les contrats ne seront pas signés avant le 1er février 2004.

Groupes de travail
Mandats des groupes de travail
Les services de la Commission présentent les groupes de travail et leurs mandats. Les
délégués s’interrogent sur le format des mandats et les méthodes de travail des différents
groupes de travail.

La Commission s’efforcera d’utiliser un modèle commun pour les mandats des sept groupes
de travail afin que le format des différents mandats soit harmonisé.

Les méthodes de travail doivent être mises au point par chaque groupe de travail. Selon le
thème et les priorités, la subdivision ou l’établissement de task forces sur une base ad hoc
pourrait s’avérer efficace.

Les tâches de gestion des groupes de travail seront assurées par les secrétariats qui seront
établis sur la base des propositions de projets. Des propositions d’établissement d’un
secrétariat ont été reçues pour les groupes de travail sur la santé mentale, le mode de vie, les
accidents et les lésions. Les autres groupes de travail continueront à être gérés, pour le
moment, par les services de la Commission.

Groupe de travail sur la mortalité et la morbidité

Ce groupe de travail ne sera pas en concurrence avec la Task force sur la mortalité
d’EUROSTAT. Ces deux groupes collaboreront étroitement et de façon complémentaire. À
l'avenir, il pourrait y avoir un chevauchement avec le groupe de travail sur la santé mentale
en ce qui concerne les maladies neurodégénératives.

Groupe de travail sur les modes de vie

                                             --                                                3
Les services de la Commission soulignent que ce groupe de travail traite des questions de
modes de vie pour l’ensemble du programme. Des « meilleures pratiques » doivent être
incluses dans tous les groupes de travail. Le paragraphe sur les meilleures pratiques doit être
reformulé. Il y a un chevauchement entre les volets I et II dans ce domaine. Les activités du
groupe de travail doivent être intégrées dans les activités du volet III. Les groupes de travail
peuvent donner des conseils sur les priorités des projets. Une phrase sur l’inclusion des
déterminants doit être incluse dans le mandat.

Groupe de travail sur les systèmes de santé
La Commission présente le groupe de travail et son mandat. Le juste équilibre entre
prévention et promotion est encore une source de préoccupation. Des informations sont
disponibles sur la plupart des indicateurs (sauf en ce qui concerne la mobilité des patients ; ce
sujet sera traité lors de la prochaine réunion).

Les remarques de l’Irlande sur la nature horizontale de ce groupe de travail seront incluses
sous la forme d’une note. La contribution des systèmes de santé à la santé publique fait partie
du mandat. En outre, le président déclare que le Conseil Santé a demandé de collecter des
informations sur les « soins de santé transfrontaliers » et propose plusieurs nouveaux thèmes
pour le programme sur la santé publique. La DG SANCO s’en chargera. Des priorités
politiques doivent être incluses.

Groupe de travail sur la santé et les lésions psychiques
Présentation de ces deux groupes de travail et de leur mandat portant sur la santé et les
lésions psychiques. SANCO C2 est responsable des aspects d’information sur la santé ainsi
que de la promotion et de la prévention dans ces deux domaines.

Le président informe les délégués que le compte rendu du groupe de travail sur la santé
mentale sera distribué. Leur secrétariat a été mis en place.

Programme de travail pour 2004
Le président déclare que le programme de travail pour 2004 sera publié en janvier 2004 avec
l’appel à propositions et que l’appel d’offres sera publié dans le courant de l’année. Le délai
pour les soumissions sera mars 2004. Une annonce préalable concernant les sujets de l’offre
sera publiée en mars 2004.


7.       INDICATEURS DE LA SANTÉ EUROPÉENS

La Commission introduit ce sujet, suivi par une présentation de M. Pieter Kramers
concernant la liste actuelle d'indicateurs (voir le fichier inséré ci-dessous). Il souligne que la
disponibilité n’a pas été un critère prioritaire pour les indicateurs à ajouter sur la liste
restreinte.

Les commentaires des délégués sur la liste restreinte d’indicateurs sont les suivants:
• les critères de sélection pour la liste restreinte doivent être plus transparents,
• il convient de rester concentré sur l’impact du système sur la santé publique,
• Il convient de clarifier davantage les procédures et les processus ultérieurs lorsque la liste
restreinte est approuvée,
• disponibilité:
     <      un panorama des données/indicateurs disponibles est requis (notamment à
            EUROSTAT, l’OMS, l’OCDE);
                                              --                                                 4
  <     les développements en cours nécessitent une réévaluation de l’information sur la
        disponibilité;
  <     EUROSTAT souligne l’importance de disposer de définitions claires. Un équilibre
        doit être trouvé entre la meilleure définition et les données disponibles. Une Task
        force au sein d’EUROSTAT examinera les définitions de la série de données
        minimale. EUROSTAT a déjà obtenu certaines informations ; une coordination est
        requise pour empêcher les chevauchements. Des réunions séparées sur
        l’organisation de la collecte des données avec les nouveaux pays adhérents seront
        organisées. Des guichets utilisateurs et la méthode de stratification sont nécessaires
        pour accroître l’accessibilité d’un large public.

• responsabilités au niveau national:
  <     une étroite collaboration est requise entre les niveaux national et international,
  <     une approche de travail d’équipe (Réseau d’autorités compétentes/groupes de
        travail) par pays est requise dans le cadre du programme,
  <     la liste restreinte n’impose pas de limitations aux activités nationales,
  <     un dictionnaire des données a été mis au point pour la liste restreinte des indicateurs
        norvégiens;

• les indicateurs des « systèmes de santé »:
  <     doivent se concentrer sur la « performance » et les « résultats »,
  <     doivent utiliser les données brutes agrégées,
  <     OCDE : la structure utilisée pour les « systèmes de santé » correspond à la structure
        utilisée par l’OCDE et EUROSTAT et elle a une perspective économique (des
        ressources aux résultats). Passer à un autre modèle impliquerait une augmentation
        du nombre des indicateurs ; en ce qui concerne les « besoins » la correction est
        difficile et n’est pas toujours disponible de façon routinière. L’information sur
        « l’analyse d’efficacité » est disponible. L’OCDE s'est penchée sur la question des
        « délais d'attente » et de la « qualité » (« l’intervention juste au moment juste »), la
        prochaine frontière en matière de statistiques de santé,
  <     les besoins de développement ultérieur peuvent être énoncés lorsque les travaux ont
        commencé,
  <     il convient de mettre davantage l’accent sur les données administratives qui aideront
        les nouveaux pays de l’Europe de l’Est ; ils ont besoin de conseils sur la collecte des
        données.

• maladies transmissibles : ils peuvent considérer leurs propres indicateurs (volet II) ;
• OMS : l’OMS et EUROSTAT ont récemment commencé à harmoniser leurs statistiques
  de mortalité hospitalière.

Le projet ECHI poursuivra ses travaux concernant les « systèmes de santé », les données
d’EUROSTAT seront utilisées. Les commentaires du Réseau d’autorités compétentes seront
pris en considération.

Le président déclare que les commentaires devront être discutés lors de la prochaine réunion
ECHI (en février 2004). Des réunions séparées seront organisées avec les pays adhérents.




                                               --                                              5
8.   MISE AU POINT D'UN PORTAIL DE LA SANTÉ DANS L'UE

La Commission explique que ce portail facilitera la communication entre les groupes de
travail. Il aura des liens avec les instituts nationaux de santé publique et les bases de données
d’organisations internationales. En outre, ce futur portail de la santé sera la meilleure
utilisation du site Web récemment réorganisé sur la santé publique du site EUROPA.


9.   PROGRAMME DE TRAVAIL DU RÉSEAU D’AUTORITÉS COMPÉTENTES POUR 2004

Ce point est reporté en raison de contraintes de temps.


10. DIVERS

Prochaine réunion

La prochaine réunion du Réseau d’autorités compétentes aura probablement lieu en juin 2004
(note : reportée aux 5 et 6 juillet 2004). Les participants seront informés à l’avance par
courrier électronique suivi d’une lettre d’invitation officielle.

Évaluation des futurs projets

La Commission explique sa politique récemment déterminée relative à l’évaluation des
projets à l’avenir. Chaque projet soumis dans le cadre du prochain appel d’offres sera évalué
par un membre du personnel de la Commission et un expert externe. Les deux évaluateurs
devront se mettre d’accord sur une notation. Ensuite, le comité d’évaluation, composé de
hauts fonctionnaires de la Commission, se mettra d’accord sur le classement des différents
projets. La liste des projets avec leur classement sera alors soumise au comité du programme
pour avis. Après une consultation interservices sur la liste des projets approuvés, la
Commission conclura les différents accords de subvention ou informera les candidats de la
décision de rejet de leur projet.




                                             --                                                 6
                       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
                                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




                                          13
      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 of
                     Competent
                     Authorities

Commission                                Eurostat
  services           Secretariat         Core Groups


                  Network Working
                  Party Leaders
                         WP7



      WP     WP      WP        WP   WP    WP
      1      2       3         4    5     6
               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 leader
  Overall supervision and responsibility, embedding in
   NIVEL, coordination with DG SanCo
Walter Devillé MD MPH PhD, project
 coordinator
  Daily manager, supervision of activities, work plan,
   planning, budget, quality control, etc
NN senior researcher
Esmée Kolthof, junior researcher
Supportive 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
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.




                                             5
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
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/




                                             22
Network of Competent Authorities
         Luxembourg,
    15-16 December 2003

   ECHI: European Community Health
 Indicators and the selection of a set of
  first 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, comparing
countries, 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-            •   Determinants of health
    economic factors                       – personal and biological factors
     – population                          – health behaviours
     – socio-economic factors              – living and working conditions
•   Health status                     •   Health services and health
     –   mortality                        promotion
     –   morbidity disease-specific        – prevention, health protection,
     –   generic health status               health promotion
     –   composite health status           – health care resources
         measures                          – 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 ‘generic
  indicators’ (topics);
• Concept of ‘User-Windows’: interest-oriented subsets
  of indicators;
• ECHI increasingly used as focus for co-ordination
  between HMP projects, more recently within the new
  Public Health Programme’s Working Parties.
    Areas in which recommendations from
    HMP 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 the
  perspective (‘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 data
     harmonisation 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 by
                       ECHI
•   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) gave
    their 50 first and 50 second choices from approx. 400
    items/indicators.
•   ECHI team (June) and NCA (July) gave general approvement
    plus some amendments.
•   Eurostat gave preliminary assessment of availability.
•   Fall 2003: additional comments, a.o. from Working Parties
    Core list selection process, guided by
               ECHI (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 health
  systems); 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 (EMCDDA
  definition); 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.

								
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