European Community Health Indicators (ECHI) : ECHI shortlist as a basis for international comparisons

Improving comparability among EU countries

ECHI shortlist has been developed for data harmonization among EU countries

The European Community Health Indicators (ECHI) shortlist, which includes over 80 indicators, has been developed within the EU Public Health Programme (2003-2008) as a priority list for data harmonization among EU countries. ‘Harmonization’ refers to uniformity of indicator definition as well as of underlying data collection. The shortlist indicators were selected by expert panels to represent a core set of ‘the most important public health items, from a general policy maker’s point of view’. The selection was also driven by national public health priorities (Kramers, 2005). The list was adopted by DG Sanco as a central guide for the further implementation of health monitoring and reporting at the EU level, and mentioned as such in the recent EU Health Strategy (EC, 2007d). One of the main tools for collecting the ECHI shortlist data will be Regulation No 1338/2008 on Community statistics on public health and health and safety at work, which was developed for harmonized collection of data for different EU indicator sets, among which the ECHI shortlist (EC, 2008b).

Stepwise approach towards comparable data

A number of steps are necessary to reach the goal of regular availability of comparable data and indicators from all EU Member States.:

Selecting the topics on which we need information, from the policy maker’s perspective (example: smoking behaviour in the population). This has resulted in the ECHI indicator shortlist.
Defining the indicator(s) to be calculated (example: percentage of regular cigarette smokers, by 5-year age band, by sex, by educational level). This step was implemented in the so-called ‘documentation sheets’, i.e. guidelines for indicator operationalisation.
Arranging for an appropriate and harmonized data collection system in each country (example: implementing the same survey questionnaire asking the precise question from which the indicator can be calculated, using an adequate sampling frame).
Dissemination of indicator data and meta-data.

ECHI background and concepts

Comparable health information is a major priority for the European Commission

The ECHI shortlist has resulted from a series of activities under three subsequent EU programmes, i.e. the Health Monitoring Programme (1998-2003), and the ‘Health Information strands’ within the first (2003-2008) and second (2008-2013) Programme of Community Action in the Field of Health.

The Health Monitoring Programme has aimed at ‘the establishment of a Community health monitoring system’, in order to:

Measure health status, its determinants, and trends therein throughout the Community.
Facilitate the planning, monitoring and evaluation of Community Programmes and actions.
Provide Member States with appropriate health information to make comparisons and support their national health policies.

ECHI long list of indicators

As a first step towards the implementation of these aims, a comprehensive set of over 200 indicators was proposed by the ECHI-1 project (i.e., ECHI long list). These indicators originated from a large number of indicator projects under the coordination of EU Health Monitoring Programme. The following criteria guided the selection of these indicators:

Cover the entire public health field. See also Conceptual model of the basic principles governing public health (De Hollander et al., 2007).
Meet user needs: serve policy actions for MS, EU
Where possible use earlier work of international organizations (Eurostat, OECD and WHO-Europe) in defining indicators, but also allow for innovations

The formation of ECHI shortlist

As ECHI long list expanded too much to be practical, the ECHI-2 project selected the so-called ECHI shortlist, in order to prioritize and focus the European Commission’s work for harmonization of data collection by EU Member States.

The indicators on the shortlist were selected from the long list by a panel of public health generalists, discussed and amended in all Working Parties operated under the Public Health Programme (2003-2008) and finally adopted by DG Sanco as a central basis for further work.

The shortlist selection was guided by two additional criteria:

The indicator should be relevant from the point of view of the ‘general public health official’.
The indicator should be oriented towards the ‘large public health problems’, the ‘large health inequalities’ and the ‘large possibilities for improvement’, in terms of health impact and options of (cost-)effective intervention.

Preparing for implementation of the shortlist

During 2005-2008, the ECHIM project has continued the work on the ECHI shortlist by:

Improving and expanding the definitions, data source description and documentation of each indicator, laid down in ‘documentation sheets’.
Mapping the availability of the indicators and underlying data at national level, by analyzing the existing international databases (WHO-HFA, Eurostat, OECD), and by a survey among the Member States.
Setting up a network of national health information specialists

Starting the implementation process

In 2009 the work is continued in a so-called ‘Joint Action’, in which DG Sanco works together with the Member States and Eurostat, to further improve the implementation of the ECHI shortlist and other indicators throughout the EU. Main areas of work within the Joint Action for ECHIM will be:

Finalisation of indicator development and documentation
Implementation of shortlist indicators in the Member States (i.e., introducing the indicators to national (and possibly regional/local) administrators and decision makers and modifying existing data sources and creating new data sources in order to improve national data availability and quality).
Description of data flow & pilot for data collection and reporting for those ECHI shortlist indicators for which no regular and adequate data are available in the international databases.

Click here for more information on the products of ECHI(M) projects and the Joint Action for ECHIM. In addition, the website of the current Joint Action of ECHIM is accessible here.

Utilizing ECHI shortlist

The use and dissemination of the ECHI shortlist is increasing

The ECHI shortlist is an important cornerstone in building the envisaged ‘European health information and knowledge system’. It has already adopted as a basis for several activities:

The European Commission (DG Sanco as well as Eurostat) have started to use the ECHI shortlist as a basis for activities connected to the harmonization of data collection by Member States. DG Sanco is publishing data according to the shortlist on its website. More comprehensive and interactive ECHI data presentations are currently being developed by the European Commission and the ECHIM experts for publication on the Sanco site. Hyperlinks have been established between the EU Public Health Portal and the EUPHIX website .
Several European countries (e.g. Ireland, Latvia and Cyprus) use the ECHI shortlist to guide data collection in their country.
The importance of the shortlist is also underlined by the European regulation on community statistics on public health and health and safety at work that takes the ECHI shortlist as one of the starting points (EC, 2008b).
The Council of the European Union has welcomed the new European Health Strategy 2008, which emphasizes the importance of a ‘System of European Community Health Indicators with common mechanisms for collection of comparable health data at all levels’ (EC, 2007; Council, 2007).
The Council ‘calls upon the Member States and the Commission to build upon existing work on health indicators and select and measure the relevant ones for monitoring and evaluation of the Health Strategy’ (Council, 2007).