Annex 1: Inventory of indicators from surveys and registries

This theoretical model provides a comprehensive way to consider current health promotion
practice. We therefore consider it as a useful framework for our analysis of indicators
regarding social inequalities and health. In order not to be too reductionism or restrictive,
however, we will use it in a flexible manner. The way this model is used in this study and how
the indicators are operationalised, is described in the next paragraph.
Literature Search
The aim of the literature search was to find out to what extent the various health indicators that
are described in the Nutbeam model, as linked to socio-economic variables, are currently
being collected by information systems in the member states of the EU 2 , in the accession
countries 3 and on a pan-European level. To that effect, various information sources were
consulted, including information from Ministries of Health and Social Affairs and from National
Institutes for Statistics, reports and other information from National Institutes for Public Health
or Health Promotion, review studies from the European Working Group on Socio-economic
Inequalities in Health, and references from studies in international literature. The latter were
identified by means of the Health-Promis database of the Health Promotion Information Centre
at the Health Development Agency (HDA), using the following key words: “socio-economic
status OR inequality”, “health OR mortality OR morbidity”, “cohort studies”, “NOT United
States”, “NOT Canada”. Furthermore, use was made of the Sources and Methods part of the
OECD 4 Health Data, and of the European Health and Safety Database (HASTE) of the
European Foundation for the Improvement of Living and Working Conditions.
The following criteria were used for inclusion of data in the study.
a) The monitoring systems considered for the study include health surveys, surveys of living
conditions, population censuses, labour force surveys, household surveys, youth surveys,
mortality and birth statistics and cancer registries. These information systems were included
when they were representative for the population under consideration, and intended to monitor
trends either on a national level or on a regional level, if this region is responsible for health
promotion and/or for the collection of data regarding the health status of its population and if it
is an administrative areas of at least 1 million people. The latter criterion is also used in the
Health Behaviour of School-aged Children study. Local or small-scaled studies were therefore
excluded from this review. For example, the study on ‘Bridging the East-West Health Gap’ was
not taken into account because its data are based on smaller areas, and the Barcelona Health
Interview Survey is excluded because it only covers this city. Furthermore, to be considered
for the study the monitoring systems had to be in use and/or intended to be continued in the
future, have started in 1994 or later, and be available to the scientific community. Commercial
marketing surveys are not taken into account.
b) The health indicators considered for the study were defined according to the Nutbeam
model described above. However, not all the indicators of this model were considered:
indicators on the most proximal level of the model, describing health promotion actions, were
not included. Although such indicators would provide valuable information, the population
exposure to health promotion interventions is not systematically monitored in any of the
European countries. With regard to morbidity, indicators were included which measure
perceived general health, mental health and dental health, as well as information deriving from
cancer registries. In contrast, registries of specific or rare diseases were excluded from the
study, as were studies on specific patient groups, since these by definition represent a smallscaled
population that is not representative for the (sub) national population. For example, the
2
Austria, Belgium (Flanders and Wallonia), Denmark (+Greenland), Finland, France, Germany, Greece, Ireland,
Italy, Luxembourg, the Netherlands, Portugal, Spain (also Catalonia and the Basque country), Sweden and the
United Kingdom (England, Scotland, Wales and Northern Ireland)
3
Czech Republic, Estonia, Hungary and Slovenia
4
Organisation for Economic Cooperation and Development
Report on the role of Health Promotion in Tackling Inequalities in Health
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