What is ECHI?
The European Core (formerly: Community) Health Indicators (ECHI) initiative started in 1998 as a project responding to the European Commission (EC)’s call to establish a shortlist of public health indicators which would serve as the core of a European public health monitoring system. The first version of the ECHI shortlist was approved by the EC and the EU Member States (MS) in 2005. In 2008, the EC and the EU MS began putting the indicators into practice.
The current shortlist contains 88 indicators – 94 when taking into account that some indicators rely on two types of data sources – grouped into five main chapters (see below) and mapped to 17 (non-exclusive) policy areas. Currently, 67 out of 94 indicators have been put in to practice (implemented), 14 indicators are nearly ready (work-in-progress) and 13 are not yet ready (under development).
The ECHI work has been coordinated through a series of five EC funded projects: ECHI-I, ECHI-II, ECHIM, JA ECHIM and under the BRIDGE Health project. The work will be continued under the Joint Action on Health Information (effective as of 2018).
The ECHI Indicators derive their data from a variety of sources, including the EU's statistical office (Eurostat), the World Health Organisation’s European ‘Health for all’ database (HFA-DB), the Health Statistics database of the Organisation for Economic Co-operation and Development (OECD) and several topic-specific databases.
ECHI project documentation
Overview of reports from the 4 projects and 1 project work package (wp) on the development and maintenance of the ECHI so far
|Project||Period||First author and year of final report|
|ECHI-I||1998-2001||Design for a set of European Community Health Indicators||ECHI working group, 2002 (pdf)|
|ECHI-II||2002-2004||Public Health indicators for the European Union: Context, selection, definition||Kramers, 2005 (pdf)|
|ECHIM||2005-2008||European Health Indicators: Development and initial implementation||Kilpeläinen, 2008 (pdf)|
|Joint Action for ECHIM||2009-2011||
Implementation of European Health Indicators- first years
|ECHI indicator development and documentation||Part II, Verschuuren, 2012 (pdf)|
|ECHIM Pilot Data Collection, Analyses and Dissemination||Part III, Thelen, 2012 (pdf)|
|BRIDGE Health (wp 4)||2015-2017||Part I: Update of ECHI Indicators (RKI)||Part I (Fehr), 2017 (pdf)|
|Part II: ECHI content evaluation and update on ECHI information repository (RIVM)||Part II (Tijhuis), 2017 (pdf)|
The results of the BRIDGE Health project have also been described in Archives of Public Health: European Core Health Indicators - status and perspectives (pdf; 2018).
These projects formulated recommendations for the future advancement of ECHI. In addition, during the JA ECHIM, an ECHI transition network was established, which delivered a proposal (pdf) on how to maintain a health indicator system for the EU after the JA ECHIM.
The ECHI meta-data is preserved in the so-called ‘documentation sheets’. Their latest official version is available collectively in Part II of the JA ECHIM (Verschuuren et al., 2012; pdf) or separately per indicator under the indicator topics.
The European Commission Directorate of Health and Food Safety DG SANTE also provides ECHI web information here.
In 2013 the Public Health Evaluation and Impact assessment consortium (PHEIAC), under the lead of the Economisti Associati based in Bologna, Italy and commissioned by the EC.
ECHI data tool
The European Commission Directorate of Health and Food Safety DG SANTE established a graphic tool and an interactive application to present relevant and comparable information on health at European level, the ECHI data tool.
ECHI uptake in national health databases
ECHI used for benchmarking
- Dare to compare (pdf; The Netherlands, 2008)
- La Santé en France et en Europe: convergence et contrastes (pdf; France, 2012)
- Health at a glance: Europe (pdf; OECD/EC, 2018)
ECHI uptake in health policy
To support MS in their evidence-based decision making and highlight potential for mutual learning and EU added value, it has established the 'State of Health in the EU cycle'; this two year cycle includes four deliverables:
- The biennial Health at a Glance: Europe report, partly on ECHI indicators;
- Individual country health profiles for each Member State;
- A Commission paper to accompany the country health profiles;
- Voluntary exchanges that Member States can request to discuss best practices and other findings from the State of Health in the EU.
European Health Information landscape, collaboration and stakeholders
ECHI relies on close collaboration with the EU Member States, the European Commission (including Eurostat), WHO Regional Office for Europe, and OECD. The three large organisations have their own health information systems and operate by different mandates. The following links provide access to health information they collect:
The added value of collaboration has long been recognised and has led to initiatives such as joint data collections.
EU health information system
The EU has supported the establishment of an EU-wide monitoring system and the use of ECHI, through i.a. (funding of) strategic reports, legislation and its website. European Commission DG Health and Food Safety provides relevant information here.
- Council conclusions on the "Reflection process on modern, responsive and sustainable health systems"
- Cost/benefit analysis of a sustainable EU Health Information System, Economisti Associati
- The BRIDGE Health project has produced a paper on a an integrated and sustainable EU health information system as well as a concept paper and a policy paper on the development of a future ERIC to support the realisation of a sustainable health system
- Decision No 1400/97/EC called for a programme of Community action on health monitoring, which aimed for the establishment of a Community health monitoring system
- Regulation No 1338/2008 established a framework for Community statistics on public health and health and safety at work, which requires MS to produce statistical "data for structural indicators, sustainable development indicators and European Community Health Indicators (ECHI), as well as for the other sets of indicators which it is necessary to develop for the purpose of monitoring Community actions in the fields of public health and health and safety at work"
- Regulation No 2015/359 lays down lays down rules for the development and production of European statistics in the area of healthcare expenditure and financing, one of the subjects for statistics on healthcare listed in Annex II to Regulation (EC) No 1338/2008; This concerns the data, metadata, reference periods, intervals and time limits for the data provision to be supplied. This does not mean the ECHI process has legal status, but it does mean that MS are obliged to produce some of the statistical data that are needed to calculate the indicators.
Two projects that have not lost their relevance, but unfortunately no longer have working websites due to limited, project-based funding, are:
- The International Compendium of Health Indicators (ICHI) aimed to allow for an easy comparison of the indicator definitions used by international organisations. It developed into a web-based application (MS Access) containing health indicators used by WHO-Europe, OECD and Eurostat and following the ECHI hierarchical grouping of indicators. The project ended in 2005.
- The ICHI database was the basis for the European Union Public Health Information System (EUPHIX). EUPHIX aimed to provide policy relevant health information, data and knowledge for policy makers, public health experts and educated lay people in the European Union (EU).
These projects show the importance of a sustainable governance structure for EU health information and its websites.
In the future, an EU-wide ECHI information web space will be developed, as part of a new health information infrastructure maintained by EU/EFTA countries. The URL "www.ECHI.eu" will function as a point of entry to this future web space.
Further developments are expected under the Joint Action on Health Information (InfAct, 2018-2021, https://www.inf-act.eu/), working towards the sustainable EU health information infrastructure. In the meantime, please have a look around this site for a collection of ECHI background information (repository) and the individual indicators. Or visit the ECHI data tool maintained by the European Commission.