Measuring health and disability at European and world level

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Measuring health and disability at European and
world level

• Marijke de Kleijn and Huib ten Napel
• WHO-FIC Collaborating Centre
• in The Netherlands

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For your information

• WHO-FIC Collaborating Centre in The Netherlands
• Head Dr Marijke W. de Kleijn de Vrankrijker
• e-mail marijke.de.kleijn_at_rivm.nl
• Deputy head Huib ten Napel
• huib.ten.napel_at_rivm.nl
• Website (Dutch and English)
• www.rivm.nl/who-fic
• Newsletter 2/year for free

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Content of presentation

• Why measurement of functioning and disability in
  the context of health at population level
  (surveys/censuses)?
• Why international interest?
• Why ICF relationship?
• World level UN (WG),WHO, UNECE
• European level Eurostat and MHADIE
• Conclusions, recommendation

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Why?
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Why?

• Why measurement of functioning and disability in
  the context of health at population level
  (surveys, censuses)?
• Need for information on health and functioning of
  whole population, not only mortality and
  morbidity

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Why?

• Why international interest?
• Cross national comparability of data
• Serves policy goals (government, disability
  organizations) and planning
• Need for agreed reference instruments guidelines

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Why?

• Why ICF as framework?
• Attention to full spectrum of functioning/disabili
  ty (all components of ICF) incl. environmental
  factors (not limited to diseases and impairments)
• Data collection relating to all persons in the
  population (not limited to those with disability)
• Common language and contribution to comparability
  of data
• WHO-FIC Implementation Committee priority area

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World level
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UN

• Washington Group on Disability Statistics (WG),
  UN City Group
• WG tasks
• short set(s) for censuses
• extended set(s) for surveys
• methodology disability issues
• ICF as framework

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WG short set

• Current proposed short set 6 questions mainly
  body function and (basic) activity
• Seeing
• Hearing
• Walking/stairs
• Remembering/concentrating
• Self care
• Communicating
• Addition of a few questions on participation and
  environment under development

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WG short set

• Pilots
• Africa
• South America
• Working group for evaluation of results
• UN census program 2010
• Disability included based on ICF
• WG questions

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WG extended sets

• Focus on all components of ICF
• One proposal includes
• existing instruments
• WHS-17 (mainly body function)
• WHO-DAS-12 (mainly activity, bit of P)
• advantage in line with UNESCAP
• Other proposal in preparation
• Participation
• Environment

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WHO

• WHO/UNESCAP project on health and disability
  statistics
• Pilots in Asia Pacific region including ICF based
  disability question sets for censuses and
  surveys
• WG short set (body function and activity),
• WHS-17 (mainly body function),
• WHO-DAS-36 (mainly activity, bit of P),
• Need for assistance (Australian census,
  environment)

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WHO

• Results of pilot in Asia Pacific to be included
  in WG analysis of pilot results
• WHO/UNESCWA
• to follow UNESCAP work
• taking into account WG work

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European level
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Eurostat

• Eurostat statistical office of EU
• European Health Survey System
• Modular approach
• Modules to be implemented in countries HIS by 2007

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European modules

• Health Status available for pilots
• Determinants under development
• Health care under development
• Basic charact. under development
• Functioning
• and disability to be developed

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European modules (2)

• European Health Status Module (EHSM)
• general health, chronic diseases
• physical and sensory problems
• personal care, household activities
• school and work activities
• psychological distress and wellbeing
• Mixture of body function/activity/participation
• European Functioning and Disability Module
• ICF based, main focus participation and
  environmental factors
• WG work to be taken into account

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MHADIE project

• EU project Measuring Health and Disability in
  Europe
• Aim is to demonstrate feasibility and utility of
  ICF
• as crosscutting, universal framework and
  international standard to influence and support
  new European policy guidelines on health and
  disability
• by means of statistical, clinical and
  experimental research.
• ICF-DIN developed basic advanced ICF course

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World and European level
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UNECE/WHO/Eurostat

• Started 2004, continued 2005
• Measurement of health status/state
• Selection of domains for inclusion
• mobility, dexterity,
• vitality/fatigue,
• affect, anxiety,
• pain,
• hearing, vision,
• social relationships (incl. communication)
• cognition (memory/concentrating, thinking/problem
  solving)
• Mixture of body function and activity

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UNECE/WHO/Eurostat (2)

• website http//www.unece.org/stats/documents/2005
  .11.health.htm
• Meeting report and papers regarding question sets
  for each domain
• Planning to finalize selection of domains, draft
  set of questions and testing plan for
  implementation in countries by March/April 2006

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Conclusions
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ICF relationship
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ICF relationship

• ICF annex 9 no E!
• All instruments no S
• All instruments F and A/P
• Some instruments focus F and A
• Some instruments focus P
• Some instruments include E
• See for full matrix at detailed level addendum
  to paper B.5-8 www.who.int/classification/network/
  meeting2005

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ICF relationship

• Areas of overlap e.g.
• Hearing, seeing/vision, communication
• Dexterity, mobility
• Household, self care
• Recommended solution in case of overlap
• If same component/concept complementary or
  identical question
• If different component different questions
  possible

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ICF relationship

• WHO-FIC network rules for use of ICF in censuses
  and surveys
• Correct use of concepts, terms, definitions
• Correct use of scheme of ICF
• Use of full spectrum of ICF (all components)

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World coverage

• Coverage of regions by initiatives e.g.
• WG Africa, South America
• Eurostat Europe
• WHO Asia Pacific
• UNECE N.America, Asia Pacific, Europe
• If different initiatives mean different reference
  question sets without clear relations different
  regions will collect different data and
  comparability of functioning and disability data
  shall not be possible!!!

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Recommendation

• Responsible organizations should
• coordinate their initiatives and recommended
  reference instruments
• using the ICF as the ruler for comparison of
  instruments and data

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Dank voor uw aandacht