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Introduction

The European Union has launched a Programme of Community Action on Health Monitoring, with its objective to contribute to the establishment of a Community health monitoring system which makes it possible to:

measure health status, trends and determinants throughout the Community;
facilitate the planning, monitoring and evaluation of Community programmes and action; and
provide Member States with appropriate health information to make comparisons and support their national health policies.

The objective of the actions in the first stage (Pillar A) of the programme is to establish comparable Community health indicators by means of a critical review of existing health data and indicators, by developing methodologies for obtaining comparable health data and common indicators, and by developing appropriate methods for the collection of the progressively comparable health data needed for these indicators.

The European Health Risk Monitoring (EHRM) Project was established to contribute to the Programme of Community Action on Health Monitoring by planning indicators and measures for co-ordinated standardized national population risk factor surveys. Such surveys would gather information on major chronic disease risk factors, related behaviours and determinants, in order to serve and evaluate disease prevention and health promotion efforts in the countries and at European level. The major chronic diseases concerned are cardiovascular diseases, chronic obstructive pulmonary disease, cancers and diabetes. Mental health, accidents and environmental and occupational diseases are also major public health problems, but are outside the scope of this Project. Furthermore, nutrition and physical activity will not be considered because they are being dealt with by other projects of the Health Monitoring Programme. These projects are European Food Consumption Survey Methods (EFCOSUM) and European Physical Activity Surveillance System (EUPASS). There is also a separate project for more comprehensive health interview and health examination surveys (HIS/HES), with which the EHRM project was in contact to avoid overlap.

Part I of this document gives a list of recommended population indicators for chronic disease risk factors. These indicators are divided into two categories: primary and secondary. Primary indicators should be included in every future survey to give basic information about the risk factors. Secondary indicators provide useful additional information about the risk factors and should be included in future surveys whenever feasible.

Part II deals with issues related to organizing the risk factor surveys on the national level. The definition of the target population, selection of sampling frame, procedures for sample selection, procedures for attaining a high response rate, general guidelines for organizing the survey measurements and the order of measurements are considered in this section.

Part III contains a protocol and operational guidelines for the individual measurements. Detailed instructions for the questionnaires to be used and for conducting the measurements needed for the indicators listed in Part I are given. Also, the important issues to be taken into account during the training of the measurers and interviewers, and quality control for each measurement/questionnaire items during and after the survey are considered. This part ends with a discussion about data management.

Collaboration between countries in standardizing survey methods, quality control and reporting will be crucial for the comparability of the results of the surveys between countries. Part IV makes recommendations for organizing such international collaboration.

This document is largely based on findings and conclusions of the Review of surveys for risk factors of major chronic diseases and comparability of the results (http://www.ktl.fi/publications/ehrm/product1/title.htm), which is another document prepared by the EHRM project.