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Fresher - FoResight and Modelling for European HEalth Policy and Regulation Project 

Horizon 2020

  Horizon 2020


Indices are commonly used to provide a comprehensive picture of health and wellbeing across regions countries, in multiple dimensions 1. Significant advances have been made at EU level on health inequality measurement. Yet, the need for more meaningful information on the regional health inequalities within the European Union urged for research advances in developing holistic measures, integrating relationships between the multiple dimensions of population health 2 and based on sound methods taking into account Europe`s diversity, with the potential of monitoring health and of foreseeing the impact of policies 3. A multidimensional index of population health may be used by researchers, experts and policymakers to: I) understand how population health varies across and within countries; II) comprehend how environmental, social, economic and lifestyle/behavioural variations explain different levels of population health; III) monitor current and future European regional inequalities and inequities in health; IV) comprehend the extent to which policies from different sectors can improve health and reduce inequalities at different geographical levels.

Therefore, there are critical aspects to consider when developing such multidimensional measure: from the selection of the most relevant indicators to the constraints of data availability and data treatment in order to compare and aggregate indicators. In this process, the participation of experts and stakeholders from various areas of disciplines and geographical locations is deemed as valuable not only to capture multidisciplinary point of views but also to increase their awareness on what are the main drivers of health inequalities across and within European countries.

WP5 focused on the construction and application of the Population Health Index (PHI) to all EU regions (269 NUTS2) and to ten metropolitan areas (Athens, Barcelona, Berlin, Brussels, Lisbon, London, Paris, Prague, Stockholm and Turin). The PHI aimed to provide a comprehensive picture of health inequalities in multiple dimensions and at different geographical levels. More specifically, the objectives were to:

● Provide a framework for integrating data from different dimensions. This included data management, data collection, construction of EURO-HEALTHY databases and its integration with online platforms, namely a web-based Geographic Information System (WEBGIS).
● Inform the construction of the Population Health Index. This included I) the application of participatory processes (involving stakeholders and experts) to identify the areas of concern and key dimensions and select indicators of health determinants and of health outcomesconsidered relevant to evaluate population health and II) assisting the multicriteria modelling of the index (value functions and coefficient weights).
● Analyse the geographical variations of the PHI across areas of concern and dimensions. A number of geospatial analysis methods (e.g. spatial autocorrelation, regression analysis, cluster analysis) using GIS tools, were applied to visualize and study the patterns and degree of inequalities and to infer the relationships between multiple health determinants and health outcomes.

● Data platforms The development of web platforms for data management (enabling the data upload, storage and download) facilitated the integration of a very large set of indicators from different dimensions in the different scales of analysis (Country, NUTS 2 regions and municipalities within metropolitan areas). Making these platforms open and accessible by all partners, the collaboration research between all partners was enhanced and the usage of a common framework to analyse population health across Europe was promoted.
● Participatory processes The participatory processes undertaken to structure the PHI (main areas of concern, key dimensions and indicators) were successful in adding diversity of points of view and in validating the holistic perspective of health (inter- trans- multidisciplinary) that frame this measure. As an example, 80 indicators were selected to appraise population health in multiple dimensions of health determinants and health outcomes.
● Databases The data collection of indicators pointed to significant differences in the data availability across different population health dimensions. Several indicators, namely of physical and built environment and lifestyles and health behaviours, that were selected for inclusion in the PHI, revealed constraints regarding availability and reliability of data at regional level (NUTS 2). Specific activities of data completeness were undertaken to overcome the cases of missing data, which assured the database integrity in order to compare and aggregate the indicators.
● Population Health Index applied to 269 NUTS 2 and 540 municipalities within 10 Metropolitan Areas The application of the PHI to the EU regions and selected metropolitan areas provided an evidence-based analysis of the present inequalities in several sub-indices, namely in: ○ 2 components Health Determinants and Health Outcomes; ○ 10 areas of concern I) Economic Conditions, Social Protection and Security, II) Education, III) Demographic Change, IV) Lifestyle and Health Behaviours, V) Physical Environment, VI) Built Environment, VII) Road Safety, VIII) Healthcare Resources and Expenditure and IX) Healthcare Performance and X) Health Outcomes; ○ 17 dimensions; ○ 39 indicators.

● The integration of researchers, stakeholders, policymakers and citizens should be further improved and promoted by the European Commission. Continued and enhanced multi and interdisciplinary approaches are essential in supporting the measurement of health inequalities and inequities and for informing policymaking.
● The Population Health Index is to be seen as a tool for more evidence-based policymaking. Its findings offer opportunities to maximize the potential of the European Structural and Investment Funds (ESIF) in order to reduce inequalities and stand to be a starting point for policy dialogue at national and regional levels. In addition, it could be a valuable resource for policy monitoring and evaluation.
● The design of population health measures should reflect the views of stakeholders and experts along with scientific evidence and reliable data. With the involvement of local panels (e.g. stakeholders, policymakers, citizens) and accounting for the specific local context, the PHI model could be transferable to other geographies, in particular to support the definition of policy priorities and axes of intervention to promote health.
● There is an urgent need for data collection at meaningful scales for analysing population health, that is, at regional and local level. There is a lack of data at regional level on several indicators considered relevant to appraise population health, namely those associated with physical environment, healthcare performance and lifestyle and health behaviours.
● Opportunities for a more standardized, harmonized and concerted data collection in the EU Member States in a widely agreed set of indicators of population health should be promoted and implemented. High quality data is fundamental to understand the health variations and, most importantly, to address them.
● Finally, the monitoring of the PHI may be ensured at a high EU level through the hosting of its WEBGIS in existing or planned infrastructures of health information. The incorporation of the Population Health Index findings in an open access web platform (WEBGIS) enabling the visualization, analysis and comparison of population health across countries, regions and selected metropolitan areas, is a cornerstone in bringing not only the policymakers but also citizens on board of the multidimensional understanding of geographical inequalities in health.

1. Santana P, Costa C, Freitas Â, Stefanik I, et al. Atlas of Population Health in European Union Regions. Coimbra, Portugal: Imprensa da Universidade de Coimbra; 2017. doi:10.14195/978-989-26-1463-2.
2. Kindig D, Stoddart G. What Is Population Health? Am J Public Health. 2003;93(3):380383. doi:10.2105/AJPH.93.3.380.
3. European Commission Website. Call for proposals: Horizon 2020- PHC-31-2014 – Foresight for health policy development and regulation. Published 2014. Accessed March 6, 2017.

PREPARED BY Prepared by: Paula Santana 1, Ângela Freitas 1, Cláudia Costa 1, Iwa Stefanik 1,Pedro Lopes Ferreira1, Carlota Quintal1
1 University of Coimbra (UC)

Page last modified on 21 dec 17 13:49