The main objectives of EHES Pilot Joint Action were to plan and prepare for full-size surveys in the European countries actively planning or already carrying out national HESs. These objectives were met well in the twelve countries which completed the Joint Action. The Joint Action revealed the power of collaboration in the planning and preparation for surveys and of learning from the experiences of others. This was appreciated both by the countries which were planning their first national HES and those with existing periodic or annual HESs. The same is true regarding the training programme and external quality assessment. Support in sampling design was important to ensure that representative health indicators and their precision can be estimated accurately.
Germany, Italy, Netherlands and UK/England started their full-size HESs before or early during the Joint Action period. Slovakia conducted a full-size HES after the pilot survey at the end of year 2011, and Finland conducted one in the beginning of 2012. The other six piloting countries are expected to start in 2012–2014, depending on funding. In addition, Luxembourg is planning to start a national HES in 2012 and France in 2013. Although these did not participate in the Joint Action, they have collaborated with EHES for the standardization.
The pilot surveys are too small to provide precise estimates of health indicators, and represent only small areas of the countries. Therefore they cannot be used to infer information about health in these countries or across Europe, but they are important for testing and further developing the survey methods and their national adaptations. This paper was written soon after the end of the Joint Action. The assessment of the data from the pilot surveys is ongoing, and will provide more information on the quality of the pilot surveys.
The piloting countries have used the pilot survey data to test local reporting. DG Health and Consumers of the European Commission has prepared the HEIDI data tool for the European level reporting of health indicators
. The suitability of HEIDI for reporting the EHES data will be tested.
The EHES Pilot Project has set up a structure for EHES to provide high quality comparable health indicators on major public health issues which cannot be monitored in other ways. The structure consists of nationally conducted HESs and the EHES Reference Centre, to provide information to the HEIDI reporting system. Each country is responsible for conducting and primarily funding the national surveys. However, partial financial support from the EU would lower significantly the threshold for countries joining EHES. An EHES Reference Centre is needed to maintain the European standards; provide support to the countries, to ensure the comparability of the national data; and to facilitate joint European level reporting of the forthcoming full-size HESs. Hence it should be funded at the EU level. This funding is not currently available, but a recent conclusion adopted by the Council of the EU recognizes the importance of the sustainability of health monitoring
Obtaining high participation rates is a major challenge in all population surveys. The EHES Joint Action tested various approaches in different cultures; further development of innovative approaches is needed. It is also likely that more resources will be required for participant recruitment in the future.
It is a prerequisite for EHES that the national and European regulations and principles on ethics and data protection recognize the role of HESs for the benefit of public health. In one piloting country, the national principles for limited contacts with the selected persons seriously restricted the efforts to obtain a high participation rate and therefore the ability to obtain representative information. The EU Data Protection Directive has now been opened for revision: we hope it will facilitate future public health monitoring and research in all countries
In addition to data demands expressed in the EU’s policy statements when the pilot phase of EHES started, EHES can provide much of the key data called for in the Political Declaration of the United Nations High-level Meeting on Non-communicable Diseases in 2011 and in the WHO/Euro Action plan for the Strategy for the Prevention and Control of Non-communicable Diseases for 2012–2016
[11, 14, 19, 20].
EHES will also be a unique data source for epidemiologic and public health research, with high potential to contribute to the objectives of the Europe 2020 Flagship Initiative Innovation Union
. The EHES Pilot Project is creating data sharing principles which will facilitate wide research use of the data while respecting the legitimate interests of the survey participants and organizers.