Dare to Compare! Benchmarking Dutch health with the European Community Health Indicators (ECHI) How does public health in the Netherlands compare to public health in other European Union (EU) countries? Are we among the top five or lagging behind? Does the picture change when focusing on specific subjects? This report compares the Netherlands to EU countries along a set of more than eighty European health indicators on, for example, disease, lifestyle and prevention. This is the first time that the indicators that make up the so-called ECHI (European Community Health Indicator) shortlist are used for benchmarking Dutch public health. This shortlist has been adopted by the EU to assist health policy makers in identifying common challenges, priorities and opportunities, and to learn from other countries’ experiences. The systematic benchmark approach also provides a detailed view on the actual availability, comparability and quality of data sets, both within the Netherlands and throughout the EU. It becomes apparent that EU-funded projects and Eurostat activities increasingly contribute to better data quality and more valid comparisons, but much work is still to be done. Dare to Compare! Given the ambition of the Dutch Ministry of Health, Welfare and Sport to get the Netherlands back into the top five of the healthiest European countries, a benchmark is a good exercise to identify possibilities for improvement and issues that require policy attention. This report was commissioned by the Ministry of Health, Welfare and Sport. Harbers MM | Van der Wilk EA | Kramers PGN | Kuunders MMAP | Verschuuren M | Eliyahu H | Achterberg PW Dare to Compare! RIVM Benchmarking Dutch health with the National Institute for Public Health and the Environment European Community Health Indicators (ECHI) Centre for Public Health Forecasting PO Box 1 3720 BA Bilthoven The Netherlands www.rivm.nl/ With respect to the front cover: In English the idiom ‘comparing apples and oranges’ is commonly used to indicate that some items have not been validly compared. In some languages fruit other than apples and oranges can (or rather cannot) be compared. For example, apples and pears are compared in Danish, Dutch, German, Spanish, Swedish, Czech, Roma- nian, Slovene and Luxembourgish. Comparing health items between 27 European countries sometimes resembles com- paring apples and oranges (or apples and pears). Different languages, cultures and health systems indeed complicate comparisons and, apart from the international comparisons in this report, the question is raised whether data are actually available and technically comparable. However, exercises like these are very informative and valuable and we are convinced that the combined efforts of EU-funded projects, Eurostat, OECD, WHO and individual Member States have largely contributed (and will continue to do so) to increased data quality and more valid comparisons. Dare to Compare! Benchmarking Dutch health with the European Community Health Indicators (ECHI) M.M. Harbers E.A. van der Wilk P.G.N. Kramers M.M.A.P. Kuunders M. Verschuuren H. Eliyahu P.W. Achterberg Centre for Public Health Forecasting National Institute for Public Health and the Enviroment PO Box 1, 3720 BA Bilthoven, The Netherlands Tel.: +31-30-2749111; Fax: +31-30-2742971 A publication by The National Institute for Public Health and the Environment PO Box 1 3720 BA Bilthoven The Netherlands All rights reserved © 2008, National Institute for Public Health and the Environment, Bilthoven, The Netherlands Bohn Stafleu Van Loghum, Houten Het Spoor 2 3994 AK Houten The Netherlands Citation Harbers MM, Wilk EA van der, Kramers PGN, Kuunders MMAP, Verschuuren M, Eliyahu H, Achter- berg PW. Dare to Compare! Benchmarking Dutch health with the European Community Health Indicators (ECHI). RIVM report number 270051011. Houten: Bohn Stafleu Van Loghum, 2008. The greatest care has been devoted to the accuracy of this publication. Nevertheless, the editors, authors and the publisher accept no liability for incorrectness or incompleteness of the informa- tion contained herein. They would welcome any suggestions concerning improvements to the information contained herein. All rights reserved. No part of this publication may be reproduced, stored in an automated data- base or made public in any form or by any means whatsoever, whether electronic, mechanical, using photocopies, recordings or any other means, without the prior written permission of the National Institute for Public Health and the Environment and that of the publisher. Inasmuch as the production of copies of this publication is permitted on the basis of article 16b, 1912 Copy- right Act in conjunction with the Decree of 20 June 1974, Bulletin of Acts, Orders and Decrees 351, as amended by the Decree of 23 August 1985, Bulletin of Acts, Orders and Decrees 471, and article 17, 1912 Copyright Act, the appropriate statutory fees should be paid to the Stichting Reprorecht (Publishing Rights Organization), PO Box 882, 1180 AW Amstelveen, The Netherlands. Those wishing to incorporate parts of this publication in anthologies, readers and other compila- tions (article 16, 1912 Copyright Act) should contact the publisher. RIVM report number: 270051011 ISBN: 9789031361854 NUR: 860 4 dare to compare! PREFACE PrEfaCE Since the Amsterdam Treaty (1997), the public health agenda of the European Union (EU) has gradually gained importance. This has become apparent from the successive Programmes of Community Action in the field of Health, from 1998 onwards, and recently in the European Commission’s Health Strategy (2007). In practice, it has resul- ted in the operation of many Europe-wide networks in health and public health. It also resulted in a much enhanced activity of Eurostat and other international organizations on data collection in the field of health. Finally, it has stimulated the formulation of various indicator sets to enable comparisons of health across the Member States. One of these sets is the so-called ECHI (European Community Health Indicators) shortlist, covering the entire public health area. This list was adopted by the European Commis- sion as a priority list for harmonizing public health and health care data among EU countries. Simultaneously, policy makers at the national level have become increasingly inter- ested in assessing their own country’s position among the other EU Member States. For the Dutch situation, this has become apparent, for instance, from the prominent place of international comparisons in the national health reports (Public Health Sta- tus and Forecasts Reports). International comparisons have also put the unfavourable developments in female life expectancy and perinatal mortality on the Dutch political agenda. Since 2006, the Dutch Health Care Performance report has placed emphasis on international comparisons wherever possible. In 2006, the Dutch Minister of Health, Welfare and Sport (VWS) has announced the ambition to bring the Netherlands back into the top five for health, within the EU. At the same time, we see that many European countries face similar public health chal- lenges, for example: an increasing number of people with overweight, adverse health behaviours concentrating in young people, unnecessary health differences between population subgroups, chronic conditions and quality of life in the elderly, substantial mental health problems, insufficient application of coordinated preventive efforts. This is another reason to use the instrument of international comparison, or benchmarking: not only for assessing the situation, but also for the Member States to learn from each other’s experiences. The latter was the subject of the recent study ‘Learning from our neighbours’, comparing countries’ policies on a range of public health issues. This is why the Ministry of Health, Welfare and Sport has asked RIVM to update the picture of Dutch public health against other EU Member States, and to base this on the ECHI indicator shortlist. The picture that arises from the international comparisons in this report is quite diverse. For some issues, the Netherlands ranges among the top five within the EU, but for a few others, we are among the bottom ones. Such diversity is not unexpected, rather it points at the need to further investigate underlying pat- terns: why are we doing well on some issues, and what can we learn for policy action on the ones that lag behind? For this, we need subsequent steps to follow up on the 5 preface dare to compare! straightforward indicator benchmarking done in this study. Another thing shown by this diverse picture is that the practice of ranking countries by just one composite index for ‘health’ or ‘public health’, as has been done in the past, only generates a very simplistic view of the actual situation and of policy opportunities. Behind all this, the question is raised whether for all the ECHI indicators, data are actually available and really comparable, i.e. based on similar mechanisms of data col- lection. The results of the study show that the Netherlands is doing relatively well on this point. Throughout the EU, Member States are making progress, but we still have a long way to go. The ECHIM (ECHI Monitoring) project and Joint Action, as EU initi- atives under the EU Health Programme, have been, and hopefully will continue to be instrumental in keeping these developments going. For the Netherlands, we are ready to take interest in complementing these EU activities by arranging adequate guidance, coordination and central ownership concerning the regular collection of the required data. This report is primarily aimed at the Dutch policy maker and public health professio- nal, as it is a direct comparison of many of the currently prevailing issues. At the same time it is also of prime interest at the EU level, because it is an exercise on the feasibility of using the Europe-wide ECHI shortlist for health monitoring in a specific country. I hope that the report will further stimulate our European orientation. This includes our awareness of how we can learn from our neighbours and our readiness to serve as an inspiring example within the EU.