Sub-committee on Policy relevance: the first Euro-REVES meeting
The sub-committee Policy Relevance and Conceptual Harmonization has successfully met its 1995 goals: a first common understanding of the policy relevance of health expectancy indi-cators has been achieved.
Number of questions were to be examined: what developments in po-pulation's health explain the increa-sing importance of health expectan-cies as an integral health measure? Who may use these indicators and to what purposes? To which questions do that indicators provide an answer? How are health expectancies already used in European countries? Which examples of present use throw light on (future) policy relevance?
The most important task of the sub-committee was the identification of relevant persons in the different countries. After a year, Euro-Reves brought together policy makers, health data collectors and researchers interested in health expectancies for its first meeting in Leiden, the Netherlands, on 7-9 June 1995.
Representatives of 14 out of the 15 member-states and representatives from some other European countries and international organizations atten-ded this meeting. The organizing team in Leiden carried out an inven-tory among the representatives of the member-states in order to have a more substantial insight into the present use of these indicators. Country reports, discussing the ad-vancement of research on health expectancies were presented by al-most all countries.
Based upon the discussions during this meeting, the future work for the sub-committee can be described in the following targets, which should be seen as the direction in which the work needs to proceed.
Target 1: Clarify the policy rele-vance of the indicator: The sub-com-mittee should work on the understan-ding of the concepts and their trans-lation into policy questions. Health expectancies are summary measures that may be used as tools to start dis-cussion. However, it is not only ne-cessary to explain why and when health expectancies can be used by policy makers and under what kind of conditions, but to check the availabi-lity of other health information. It should be clarified which policy prob-lems may be solved by reference to health expectancies -the answer cer-tainly goes beyond health policy alone- and how far it is politically ne-cessary to have comparable cal-culations in European countries. The sub-committee should think about how it can convey its ideas about policy relevance to policy makers.
Target 2: Decide what types of health expectancies should be cho-sen for use in the European coun-tries. The different types of health expectancies can be seen as different 'view-points' on population health. Therefore different types can be used next to each other, and the confusing question on the relation between the calculations based on 'disability ques-tions' and 'perceived health' should be properly solved. High quality validation studies should be used to achieve an answer to these questions. Health expectancy based on perceived health seems the most comprehensive measure and therefore the demand for a hierarchy of health expectancy types arises. Such a hierarchy is already included in a provisional classifi-cation system of health expectancies elaborated by TNO and REVES.
Target 3: Decide which precise items are to be covered in the re-commended indicators. Recommen-dations should address the formu-lation of questions, their context (general health survey versus disabi-lity survey, for instance), etc. It is ad-vocated to use questions already re-commended by other groups. This im-plies an inventory of other initiatives and (where possible) cooperation bet-ween groups. Another idea is to base comparison between European coun-tries on a minimum set of comparable questions. Clarification is needed about the meaning of cultural diffe-rences in European countries and their implications on the way questions are answered. Also, the recommenda-tions, necessary for the achievement of this target, may be formulated to a limited number of countries based on the experience they already have. These draft recommendations conse-quently could be discussed in a future sub-committee meeting.
Target 4: Distribute the knowledge of the sub-committee and streng-then cross-links with the other Euro-Reves sub-committees. For some countries clearer recommenda-tions are awaited in order to initiate health expectancy calculations. Others already involved, have requested a simple 'cook book' as soon as possible. It should include clarification of the concepts, policy relevance, useful questionnaires, con-ditions for use etc. It would give a description of the preferred methodo-logy and of the methodological problems already solved by others. The political demand for mental health indicators is a good reason for linking the actions of the sub-committees: therefore each of them should attend the meetings of the two other sub-committees. In general, the sub-committees may try to learn from already developed initiatives for in-ternational harmonization in other fields than that of health expectancies. A study to identify factors of success or failure for such cross-national har-monization effort could be very use-ful. A problem is, however, that such special studies are not inherent parts of the Euro-Reves action. Separate funding shall have to be found and the sub-committee shall have to think about how its work may profit from parallel actions.
The next meeting of the sub-commit-tee Policy Relevance and Conceptual Harmonization will take place in the summer of 1996. It is envisaged that, in between, some smaller meetings will be necessary, for instance to en-hance the writing of a hand-book, to strengthen the cross-links with the other sub-committees and to see whe-ther it is useful to start a 'consensus' process with some countries which are already involved in health expec-tancy research.
Harry PA van de Water
Harry P.A. van de Water, TNO Prevention and Health, P.O.Box 2215, 2301 CE Leiden, The Netherlands
Phone: +31 71 181 778, Fax: +31 71 176 382
From the 10th of October
Phone: +31 71 5181 778, Fax: +31 71 5176 382
Sub-committee on Mental Health
The aims of the Mental Health Sub-Committee may be generally stated as follows: (1) Develop and promote cal-culations of Mental Health ex-pectancies; (2) Standardise methodolo-gy through consensus; (3) Recommend instruments for assessment; (4) pro-vide cross-cultural comparisons; (5) Transmit results to other colleagues.
At the first meeting of the Euro-Reves sub-committee in Montpellier, June 1994 it was decided that studies, already conducted in Europe, inclu-ding mental health indicators, should be examined in order to determine to what extent mental health expectancy calculations might be undertaken from existing data sets rather than initiating costly new studies. In order to locate existing data sets, the com-mittee coordinators designed a postal survey of contact persons in mental health in each of the European countries. 65 questionnaires were thus sent to mental health organizations, asking for details of studies with a mental health component carried out in their respective country and for information concerning current mental health priorities.
Thirty replies have so far been received, describing 50 separate studies in the United Kingdom, the Netherlands, Sweden, Belgium, Eire, Switzerland, Denmark, France, Germany and Spain. To date, no information has been received from Portugal, Italy, Greece, Finland or Austria. The earliest date for a survey commencing was in 1947, with 40 commencing since 1980. Many were currently ongoing with no determined end date, although the furthest date into the future set for completion was in 2002. Of these surveys, 20 were locally based, with 13 regionally based and 11 national surveys. Twenty-six were longitudinal, with 11 cross-sectional and 5 containing elements of both.
The second sub-committee meeting was held on June 6 in Leiden. 11 persons took part in this meeting, including persons directly involved in mental health surveys in the U.K., the Netherlands and Germany. The meeting discussed the results of the survey of mental health data bases which had been identified in Europe and it was generally agreed that a great deal of data had already been collected which could be used for mental health expectancy calcula-tions. A large number of longitudinal studies were found which will permit the development of multi-state calcu-lations using incidence data in this area.
National priorities were discussed and it was generally agreed that the problems of senile dementia, depres-sion and schizophrenia were the most important problems presently facing mental health care professionals in Europe. The group discussed the rising importance of research into homelessness and current, possibly politically motivated, encouragement towards drug abuse research. The surprising result of relative disinterest in suicide might be due to the fact that the survey covered almost enti-rely academic centres, which were less likely to cover the subject. The extent to which priority areas reflect true need, or simply political interests and the availability of research funding, is difficult to establish although clinicians felt that the areas described reflected reasonably well the distribution of the cases which they saw.
The meeting agreed that the sub-committee should work increasingly in conjunction with the Mental Health Divisions of WHO and WHO-Europe towards developing a consensus on which indicators and scales were most appropriate with different types of survey. The motivations for choice of different instruments were discussed, deciding that the instrument used depended upon which diagnosis and measurements were required. An im-portant conclusion drawn from the experience of the U.K. Mental Health Survey was that in the long term studies which focused on obtaining a good description of presenting symptoms were more fruitful than studies which aimed to classify the individual immediately into a dia-gnostic category according to a given diagnostic algorithm. It was pointed out that diagnostic criteria change over time but that if detailed symptom lists were obtained varying diagnostic criteria could be applied and reapplied to this basis data. The meeting also discussed possible problems in amalgamating methods and informa-tion, focusing on cross-cultural diffe-rences, problems of measurement, self-report vs. proxy, fluctuating per-formance, and the representation of institutionalised populations.
With regard to the work of the sub-committee over the next year, the co-ordinators agreed to continue to up-date the inventory of European data sets and to this end representatives of the countries for whom no reply had so far been received were contacted at the main Euro-Reves meeting which took place over the next three days. It was also decided to go one step further and develop an "instrument bibliography library" as part of the committee's efforts to become a re-source centre for research in this area. This "library" would provide details of all known health studies throu-ghout Europe which have included mental health indicators, and a copy of the study protocol scanned onto diskette with a bibliography of publi-cations relating to the study. This in-formation would be made available free of charge to researchers on re-quest. It is hoped that this information may then be used by workers in the field of Mental Health for not only mental health expectancy calculations but also for meta-analysis, cross-cultural comparisons or as a basis for the construction of new research protocols.
Centres with existing data bases suit-able for the calculation of mental health expectancies will also be con-tacted over the coming year with a view to producing new calculations. The sub-committee will act as a re-source centre in this respect, assisting centres in both the calculations and the interpretation of results.
The next meeting of the Euro-Reves network will be organized in June 1996 in London by the Mental Health sub-committee so that mental health will be its dominant theme.
Carol Jagger, University of Leicester, Dept Epidemiology and Public Health, 22-28 Princess Road West, Leicester LE1 6TP, United Kingdom
Tel: +44 116 252 3211, Fax: +44 116 252 3272
Karen Ritchie, INSERM / Equipe vieillisse-ment cognitif, Centre Val d'Aurelle, Parc Euromdecine, 34298 Montpellier cedex 5, France
Tel: +33 67 61 30 26, Fax: +33 67 61 30 47
Euro-REVES Info... Euro-REVES Info... Euro-REVES Info... Euro-REVES Info... Euro-Rev
European Data-Base on Health Surveys and Health Reports
The general coordination of Euro-Reves has organised a documentary founds gathering documents dealing with the health statuts of the European populations and of some others. The data-base is mainly composed of health surveys and related documents (protocols, questionnaires, some results, users' guide...) and general health reports (analysis, statistical, prospective). The General Coordination insures the analysis of these documents. A first ad- hoc report will be available by December 1995.
Equipe INSERM, Centre Val d'Aurelle, Parc Euromédecine, 34298 Montpellier cedex 5, France
Academia Europaea: Paris, 4-5 December 1995
Meeting on life without disability
With the support of the president of the Academia Europaea, Prof. H Curien, several members of the Academia (J Dupâquier, AM Guillemard, P Karli) are organising a meeting on the theme 'Life without disability'. This meeting will take place in Paris on 4 and 5 December 1995.
This is a theme of wide interest which requires a multidisciplinary approach (for example demography, statistics, epidemiology, physiology, gerontology, psychology) and the organisers of the meeting hope that it could be developed into an Academia study group or further workshops in 1996 and 1997. Members of the Academia who are interested in the subject and who would like to participate in the proposed European study group or workshop series will be welcome in Paris meeting (which will be conducted in French). The four sessions of the meeting will focus on the following aspects: (1) concepts, methods and sources; (2) preliminary assessments and analyses; (3) evolutionary factors; (4) potential gains and costs.
Those wishing to attend the meeting in Paris in December 1995 or to participate in the organisation of the European activity on this theme within the framework of the Academia are invited to write to:
197 rue St Jacques, 60240 Delincourt, France
Second Euro-Reves meeting
The second general meeting of Euro-Reves is scheduled. It will be organized by the sub-committee on mental health and will be held in June 1996 in London.
INSERM, Centre Val d'Aurelle, Parc Euromédecine, 34298 Montpellier cedex 5, France
Univ. of Leicester, Dpt Epidemiology and Public Health, 22-28 Princess Road West, Leicester LE1 6TP, UK
Conference and workshop:
Proceedings including papers on health expectancy
Active (disability-free) life expectancy: Proceedings of the Third WHO-CC Symposium, Sendai, July 5-6 1995. (WHO-CC Monograph n¡3). Including:
van de Water HPA, Robine JM, Cambois E. International comparison of health expectancies: The European experience.
50th session of the International Statistical Institute, Beijing Aug. 21-29, 1995. (Proceedings of the) In: Bulletin of the International Institute of Statistics 1995:LVI. Including:
Robine JM, Romieu I, Cambois E. L'estimation des années de vie vécues en incapacité: une initiative universelle.
European Population Conference / Congrès Européen de Démographie, Milano, Sept. 4-8, 1995: Contribution of Italian scholars. Roma: IRP. Including:
Frova L. Longevity and quality of life: an appraisal of healty life expectancy.
Unpublished papers from the same conference (available from Euro-Reves general Coordination):
Geurts J. International comparability of disability-free life expectancy: the need for harmonized measurement instruments for impairements, disability and handicaps.
Robine JM, Mormiche P, Sermet C. Vie et santé s'allongent: un effet conjoint de meilleures conditions d'existance et des progrès médicaux.
Vallin J. Espérance de vie: quelle quantité pour quelle qualité de vie ?
Editor: Jean-Marie Robine
Editory staff: Isabelle Romieu
Three European Reports on Health expectancies
van de Water HPA, Boshuizen HC, Perenboom RJM. Public health status and forecast: Health expectancy of the Dutch population. Leiden: TNO Prevention and Health, 1995. (Report n°431501009)
Bone M, Bebbington AC, Jagger C, Morgan K, Nicoolaas G. Health expectancy and its uses. London: Department of Health, 1995
Roelands M, Van Oyen H. L'espérance de vie sans invalidité des personnes agées: une méthode de planning et de prise de décision dans le secteur des soins de santé. Bruxelles: services fédéraux des Affaires Scientifiques et Culturelles, 1995
Euro~Reves Newsletter n°2
Euro~Reves Newsletter n°2