Health interview surveys. Towards international harmonization of methods and instruments.

With the strategy for health for all and its 38 targets, the WHO Regional Office for Europe has created a common health policy for Europe, and has developed internationally agreed indicators for measuring progress towards the attainment of the targets. Some of these indicators are "classical" health indicators, such as mortality rates and the incidence of notifiable diseases, while others reflect more recent public health concerns such as health-related behaviour and quality of life. For the latter group, gathering the information necessary for monitoring and evaluating progress is somewhat haphazard. Health interview surveys provide the best -- in some cases the only -- means of collecting data on many of these indicators, since they mirror the information that only properly approached individuals may be able to provide and ensure that all subgroups of the population are covered. Yet such surveys have enjoyed a long tradition only in a few countries. Moreover, when these indicators are covered, the results are often not comparable. The methods and instruments used to collect data have often been developed without international coordination or adapted from those used in other countries, usually with substantial modification to suit what are perceived to be local requirements. There has also tended to be considerable uncertainty among those countries lacking a tradition of health interviewing as to the best way of conducting surveys. Against this background, the WHO Regional Office and Statistics Netherlands organized a series of consultations, which have resulted in the internationally agreed methods and instruments for health interview surveys set out in this book. These methods and instruments are likely in the longer term to become standards, thus improving comparability of information. This book provides practical guidance on methods for health interview surveys. It is thus essential reading for all concerned in the planning and carrying out of such surveys, whether in national statistical offices or in public or private interviewing agencies. It will also be useful to all in the public health community, including students and academics.

Health interview surveys: towards international harmonization of methods and instruments

Monitoring health is an essential task of country systems for health information and of measuring the European Region’s progress towards health for all, the policy which includes internationally agreed indicators for countries to use. Health interview surveys provide the best means to collect data on some of the indicators that reflect more recent public health concerns such as health-related behaviour and quality of life. The surveys mirror the information that only properly approached individuals may be able to provide and ensure the coverage of all population subgroups. Yet they enjoy a long tradition in only a few countries. Moreover, information on indicators is sometimes not comparable. The methods and instruments of data collection have often been developed without international coordination or adapted from those in use in other countries, usually with substantial changes to meet local requirements. Also, countries lacking a tradition of health interviewing are often uncertain about the best way to conduct surveys. The WHO Regional Office for Europe and Statistics Netherlands organized meetings to tackle these problems, resulting in the internationally agreed methods and instruments for health interview surveys that are set out in this book. These are likely to become standards and thus improve the information comparability. The book provides practical guidance on health interview surveys, describes their role in health for all monitoring, the development and use of methods and instruments, and the prospects for harmonizing the surveys across the European Region.

Health in the central and eastern countries of the WHO European Region: an overview.

The enormous social, political and economic changes that began in the CCEE/NIS in the late 1980s included the revelation and public discussion of a widening health gap between these countries and the other Member States of the European Region. The continuing economic problems and their effects on health increase the urgency of the need for assistance from the international community. Diverging trends in life expectancy became evident in the mid-1970s, and the gap continued to widen in the 1980s for all major causes of death, particularly cardiovascular diseases. The situation is worse in the NIS than in the CCEE, and worst in the central Asian countries. In 1990, the worst infant mortality rate in these countries was eight times the best rate elsewhere in the Region. Non-mortality data, while patchy, confirm the indications given by mortality data. There is no single reason for the health gap, but contributory factors include the increasing prevalence of major risk factors in lifestyles and the environment, and the low efficiency and effectiveness of health care systems. The current situation and short-term prospects are mixed, but the negative trends in mortality and morbidity patterns are likely to continue for some time. While the worst health problems of the transition period in the CCEE/NIS could largely have been avoided, there is no doubt that economizing on health today will exact large costs tomorrow.

PIP: The socioeconomic conditions in eastern European countries are declining. Deterioration began during the mid-1960s. The mortality gap has continued to widen during the 1980s. The Central Asian Republics show mortality patterns similar to ones in developing countries; infant mortality is about 8 times higher than in western Europe. Infant mortality rates in eastern and central Europe are 2-3 times higher than in western Europe. Cardiovascular diseases are the leading cause of death. Another increasing mortality group is lung cancer, and the gap is widening in the West. The NIS (formerly republics of the Soviet Union) have high rates of communicable diseases preventable through immunization. The logistics of vaccine distribution and storage are inadequate. Abortion is the primary means of family planning. 70% of the population of the Russian Federation reported their health as less than good, and only 20% of Russian military personnel are fit based on international standards. Tobacco consumption and high alcohol consumption are the primary health risks. Poor nutrition, stress, and drug abuse add to the risks. The health gap is wide also due to poor housing conditions and environmental pollution. Health care systems, unhealthy lifestyles, and unhealthy environments all contribute to the widening gap in health. The rigid administrative health structures are not conducive to change. The quality of care is low. Decentralization and private sector involvement may produce needed changes in the quality of health services. CCEE countries spend 4.5-7.1% of gross national product on health, compared to 7.3% in the West. In the Czech Republic, Poland, Hungary, and Slovakia, health expenditures per person are 3-4 times less than in OECD countries. Prices are very high for drugs, food, and energy. Although the medical staff-patient ratio is high, there are shortages in particular specialties. Nurses are poorly trained and in low supply. Hospital equipment is very old and poorly maintained. There is overuse of secondary and tertiary hospitals and underuse of general hospitals.

Using regional indicators: the experience of Europe.

The 1987-1988 health-for-all (HFA) monitoring exercise produced a considerable amount of quantitative and non-quantitative data which were used for the assessment of the progress towards HFA in the European Region. At the same time it demonstrated many shortcomings and problems with regard to the availability and quality of data. Relevance of replies to non-quantitative indicators leaves considerable room for improvements. Good or satisfactory relevance can only be found in about one-third of the country replies. Data on most morbidity indicators, except infectious diseases, were provided on average by one-third of the countries. Nearly two-thirds of the countries provided data on cervical and breast cancer and some occupational diseases. At least half of the data seem not to be comparable; some data are potentially comparable, depending on additional information to be collected. Perceived health estimates are collected by a few countries, but data are not directly comparable. Many countries conduct surveys at different times on one or more aspects of lifestyle. However, comparable data are restricted mainly to educational levels, smoking, alcohol and nutrients. Data on health services and resources are more promising, as they are provided by about two-thirds of the countries.