Use of data from the Health Survey for England in obesity policy making and monitoring

The socioeconomic gradient in overweight and obesity among Colombian adult and pediatric populations: A scoping review

Background: The imminent increase in overweight and obesity prevalence constitutes a pervasive concern for the adult and pediatric Colombian population. Nonetheless, the unequal distribution across distinct social groups limits the implementation of public health policies targeting these escalating rates. Aim: This study aimed to compile existing evidence regarding the prevalence of overweight and obesity in relation to the socioeconomic status (SES) of the Colombian population. Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews parameters in MEDLINE (PubMed), EMBASE, and LILACS databases for inclusion of investigations published up to January 2024. Results: Twenty-two cross-sectional studies were included. A higher prevalence of overweight and obesity was documented in adults with lower SES defined by social stratum and monetary income, while in particular for nonpregnant adult women, the prevalence of excess weight was higher in the medium-low socioeconomic stratum. In the pediatric population, higher SES defined by social stratum was directly related to an increased prevalence and risk of overweight and obesity. The ownership of household assets, however, was positively related to the risk of overweight in both adult and pediatric populations. Conclusion: The findings of this investigation disclose a socioeconomic gradient in overweight and obesity in Colombia that resembles the epidemiological distribution in high-income countries for adults, though similar to low-income countries for the pediatric population. Further intersectoral interventions aimed at the most vulnerable groups are imperative to mitigate the inequalities that condition their predisposition to overweight and obesity.

National Health Examination Surveys: an essential piece of the health planning puzzle

National health examination surveys (HESs) have been developed to provide important information that cannot be obtained from other sources. A HES combines information obtained by asking participants questions with biophysical measurements taken by trained field staff. They are observational studies with the highest external validity and make specific contributions to both population (public health) and individual health. Few countries have a track record of a regular wide-ranging HES, but these are the basis of many reports and scientific papers. Despite this, little evidence about HES usefulness and impact or the factors that influence HES effectiveness have been disseminated. This paper presents examples of HES contributions to society in both Europe and the Americas. We sought information by emailing a wide list of people involved in running or using national HESs across Europe and the Americas. We asked for examples of where examination data from their HES had been used in national or regional policymaking. We found multiple examples of HES data being used for agenda-setting, including by highlighting nutritional needs and identifying underdiagnosis and poor management of certain conditions. We also found many ways in which HES have been used to monitor the impact of policies and define population norms. HES data have also been used in policy formation and implementation. HES data are influential and powerful. There is need for global support, financing and networking to transfer capacities and innovation in both fieldwork and laboratory technology.

Is Obesity Policy in England Fit for Purpose? Analysis of Government Strategies and Policies, 1992-2020

Policy Points This analysis finds that government obesity policies in England have largely been proposed in a way that does not readily lead to implementation; that governments rarely commission evaluations of previous government strategies or learn from policy failures; that governments have tended to adopt less interventionist policy approaches; and that policies largely make high demands on individual agency, meaning they rely on individuals to make behavior changes rather than shaping external influences and are thus less likely to be effective or equitable. These findings may help explain why after 30 years of proposed government obesity policies, obesity prevalence and health inequities still have not been successfully reduced. If policymakers address the issues identified in this analysis, population obesity could be tackled more successfully, which has added urgency given the COVID-19 pandemic.

CONTEXT

In England, the majority of adults, and more than a quarter of children aged 2 to 15 years live with obesity or excess weight. From 1992 to 2020, even though the government published 14 obesity strategies in England, the prevalence of obesity has not been reduced. We aimed to determine whether such government strategies and policies have been fit for purpose regarding their strategic focus, nature, basis in theory and evidence, and implementation viability.

METHOD

We undertook a mixed-methods study, involving a document review and analysis of government strategies either wholly or partially dedicated to tackling obesity in England. We developed a theory-based analytical framework, using content analysis and applied thematic analysis (ATA) to code all policies. Our interpretation drew on quantitative findings and thematic analysis.

FINDINGS

We identified and analyzed 14 government strategies published from 1992 to 2020 containing 689 wide-ranging policies. Policies were largely proposed in a way that would be unlikely to lead to implementation; the majority were not interventionist and made high demands on individual agency, meaning that they relied on individuals to make behavior changes rather than shaping external influences, and are thus less likely to be effective or to reduce health inequalities.

CONCLUSIONS

The government obesity strategies' failure to reduce the prevalence of obesity in England for almost 30 years may be due to weaknesses in the policies' design, leading to a lack of effectiveness, but they may also be due to failures of implementation and evaluation. These failures appear to have led to insufficient or no policy learning and governments proposing similar or identical policies repeatedly over many years. Governments should learn from their earlier policy failures. They should prioritize policies that make minimal demands on individuals and have the potential for population-wide reach so as to maximize their potential for equitable impacts. Policies should be proposed in ways that readily lead to implementation and evaluation.

Utilisation of evidence from Thailand's National Health Examination Survey in policy development: finding the weakest link

BACKGROUND

Health surveillance and survey data are helpful in evidence-informed policy decisions. This study is part of an evaluation of the National Health Examination Survey (NHES) programme in Thailand. This paper focuses on the obstacles in the translation of survey information into policies at a national level.

METHODS

In-depth interviews with relevant individuals and representatives of institutes were carried out for the data collection. A total of 26 focal informants included executives and staff of NHES funders, government health agencies, civil society organisations, health experts, NHES programme managers and researchers in the survey network.

RESULTS

Utilisation of NHES data in policy-making is limited for many reasons. Despite the potential users' positive views on the technical integrity of experts and practitioners involved in the NHES, the strength of employing health examinations in the data collection is not well recognised. Meanwhile, alternative health surveillance platforms that offer similar information on a shorter timescale are preferable in policy monitoring and evaluation. In sum, the lack of governance of Thailand's health surveillance system is identified as a key element hindering the translation of health surveys, including the NHES, into policies.

CONCLUSION

Despite an adequate capacity to conduct population health surveys, the lack of governance structure and function has resulted in a fragmented health monitoring system. Large and small survey projects are conducted and funded by different institutes without common policy direction and alignment mechanisms for prioritising survey topics, collective planning and capacity-building programmes for survey practitioners and users. Lessons drawn from Thailand's NHES can be helpful for policy-makers in other low- and middle-income countries, as effective governance for evidence generation and utilisation is necessary in all contexts, regardless of income level and available resources.

From monitoring to action: utilising health survey data in national policy development and implementation in Finland

Background

Health interview and examination surveys provide valuable information for policy, practice and research purposes. Appropriate use of high-quality, representative and timely population data can indirectly help the citizens to live healthier and longer lives. The aim of this study was to review how health survey data have supported health policy making, health research and everyday health care in Finland.

Methods

Data were collected by focused interviews with ten Finnish senior experts from the Ministry of Social Affairs and Health, political parties, National Institute for Health and Welfare, universities, and health associations.

Results

Most interviewees agreed that health surveys have positively affected the health of the population over the past 50 years - through health strategies, care guidelines, legislation, research, prevention programs, risk calculators, and healthier products on the market. There is also a need for further development: the latest research results should be provided in a nutshell for politicians, and effective tools should be developed more for health care professionals’ use. The coverage of health information on children, adolescents, oldest old, disabled persons, migrants and ethnic minorities should be improved.

Conclusions

Sound health policy and its successful implementation require extensive national cooperation and new communication strategies between policy makers, researchers, health care professionals, health service providers - and citizens. The future health information system in Finland should better cover all population groups. To obtain more comprehensive health information, the possibilities for register linkages should be secured and register data should be further evaluated and developed to serve health monitoring purposes.

Disparities, variations, inequalities or inequities: whatever you call them, we need data to monitor them

Health inequalities are a problem in high, middle and low income countries. Most are unfair ('inequities') and could be minimised but primarily through policies outside the health service.In the US, the Center for Diseases Control has used high quality, nationally-available data to monitor conditions and determinants of health among different groups (by sex, disability, race, ethnicity, and language) to motivate action to reduce inequalities. In the UK, the 10 top level 'health' indicators in London at the turn of the millennium included unemployment, education, housing quality, crime, air pollution, road travel injuries, as well as traditional health measures. Most of these affect mental and physical health through social determinants or adverse environmental exposures. Current inequalities monitoring in England includes a Local Basket of Inequalities Indicators focusing on a wide range of determinants of health as well as traditional health metrics.Israel, like the US, has above average socio-economic inequalities but has universal healthcare. Health inequalities in Israel occur within different Jewish groups and by income, education, ethnicity, and religion, with disadvantages often clustering. Current monitoring in Israel focuses on health outcomes and 'midstream' healthcare-related provision. I agree with Abu-Saad and her colleagues that including monitoring of social determinants of health is crucial to identify and tackle health inequalities in Israel.National, 'upstream', interventions are the most effective ways to reduce inequalities and improve the population's health. High-level political support is crucial for this. While a 'Health in all Policies' approach combined with political will to 'leave no one behind' can lead to great improvements, regular monitoring is essential, to: identify the inequities; plan appropriate and effective, targeted interventions; implement and evaluate them; and change them where needed. All of this requires adequate and timely data on health and its determinants, including information about undiagnosed and poorly controlled disease, obtained from the general population not just those attending for healthcare, analysed for each population sub-group at risk of experiencing inequalities.This is a commentary on https://doi.org/10.1186/s13584-018-0208-1.

Normalization of Plus Size and the Danger of Unseen Overweight and Obesity in England

OBJECTIVE

This study aimed to investigate trends and sociodemographic factors underlying weight misperception in adults with overweight and obesity in England.

METHODS

This study used descriptive and logistic regression analyses based on a pooled nationally representative cross-sectional survey, Health Survey for England, for the years 1997, 1998, 2002, 2014, and 2015 of individuals with BMI ≥ 25 (n = 23,459). The main outcomes were (1) weight misperception and (2) weight-loss attempts as well as the associations with demographic and socioeconomic characteristics and health status.

RESULTS

The proportion of individuals with overweight and obesity misperceiving their weight status increased over time between 1997 and 2015 (37% to 40% in men; 17% to 19% in women). There were socioeconomic disparities in the misperception of weight status, with lower-educated individuals from poorer-income households and members of minority ethnic groups being more likely to underestimate their weight. Those underestimating their overweight and obesity status were 85% less likely to try to lose weight compared with people who accurately identified their weight status.

CONCLUSIONS

The upward trend in underassessment of overweight and obesity status in England is possibly a result of the normalization of overweight and obesity. Obesity prevention programs need to consider differential sociodemographic characteristics associated with underassessment of weight status.

European health examination surveys - a tool for collecting objective information about the health of the population

Background

Representative and reliable data on health and health determinants of the population and population sub-groups are needed for evidence-informed policy making; planning and evaluation of prevention programmes; and research. Health examination surveys (HESs) including questionnaires, objective health measurements and analysis of biological samples, provide information on many health indicators that are available not at all or less reliably or completely through administrative registers or health interview surveys.

Methods

Standardized cross-sectional HESs were already conducted in the 1980’s and 1990’s, in the framework of the WHO MONICA Project. The methodology was developed and finally, in 2010–2012, a European Health Examination Survey (EHES) Pilot Project was conducted. During this pilot phase, an EHES Coordinating Centre (EHES CC, formerly EHES Reference Centre) was established. Standardized protocols, guidelines and quality control procedures were prepared and tested in 12 countries which conducted pilot surveys, demonstrating the feasibility of standardized HES data collection in the European Union (EU).

Currently, the EHES CC operates at the National Institute for Health and Welfare (THL), Finland. Its activities include maintaining and developing the standardized protocols, guidelines and training programme; maintaining the EHES network; providing professional support for countries planning and organizing their national HESs; external quality assessment for surveys organized in the EU Member States; and development of a centralized database and joint reporting system for HES data.

Results

An increasing number of EU Member States are conducting national HESs, demonstrating a strong need for such surveys as part of the national health monitoring systems. Standardization of the data collection is essential to ensure that HES data are comparable across countries and over time. The work of the EHES CC helps to ensure the quality and comparability of HES data across the EU.

Conclusions

HES data have been used for health monitoring and identifying public health problems; to develop health and prevention programmes; to support health policies and preparation of health-related legislation and regulations; and to develop clinical treatment guidelines and population reference values. HESs have also been utilized to prepare health measurement tools and diagnostic methods; in training and research and to increase health awareness among population.

The difficult conversation: a qualitative evaluation of the 'Eat Well Move More' family weight management service

OBJECTIVE

The Eat Well Move More (EWMM) family and child weight management service is a 12-week intervention integrating healthy eating and physical activity education and activities for families and children aged 4-16. EWMM service providers identified low uptake 12 months prior to the evaluation. The aims of this study were to describe referral practices and pathways into the service to identify potential reasons for low referral and uptake rates.

RESULTS

We conducted interviews and focus groups with general practitioners (GPs) (n = 4), school nurses, and nursing assistants (n = 12). Data were analysed using thematic analysis. School nurses highlighted three main barriers to making a referral: parent engagement, child autonomy, and concerns over the National Child Measurement Programme letter. GPs highlighted that addressing obesity among children is a 'difficult conversation' with several complex issues related to and sustaining that difficulty. In conclusion, referral into weight management services in the community may persistently lag if a larger and more complex tangle of barriers lie at the point of school nurse and GP decision-making. The national prevalence of, and factors associated with this hesitation to discuss weight management issues with parents and children remains largely unknown.

Impaired maternal hemodynamics in morbidly obese women: a case-control study

OBJECTIVE

Maternal obesity is associated with significant pregnancy complications and is a risk factor for the development of hypertensive disorders of pregnancy as well as other adverse outcomes. There are few data regarding the hemodynamic aberrations observed in maternal obesity. The aim of this study was to investigate maternal hemodynamics in morbidly obese women.

METHODS

This was a prospective, case-control study of morbidly obese women (body mass index (BMI) ≥ 40 kg/m² ) and controls (BMI 20-29.9 kg/m² ). The control population was matched for maternal age and gestational age. BMI was calculated based on maternal height and weight at the time of recruitment to the study, which occurred on the same day as the hemodynamic assessment. Pregnant women in the second or third trimester of pregnancy were included. Women who were found to be hypertensive at any time were excluded from the study. A USCOM-1A® device was used to assess hemodynamic parameters (heart rate, stroke volume (SV), cardiac output and systemic vascular resistance (SVR)). The parameters were corrected for body surface area (BSA) to provide the SV index (SVI), cardiac index (CI) and SVR index (SVRI). Mann-Whitney U-test was used to compare the medians of the hemodynamic variables between the two groups.

RESULTS

In total, 23 morbidly obese women and 327 controls were included in the analysis. There was no difference in maternal (P = 0.506) or gestational (P = 0.693) age at recruitment between the groups. Mean arterial pressure was higher both at pregnancy booking (90 vs 80 mmHg, P < 0.001) and study recruitment (91 vs 85 mmHg, P < 0.001) in the obese group compared with the controls. Heart rate was higher in the obese group (P = 0.003), but there was no difference in SV (P = 0.271), cardiac output (P = 0.238) or SVR (P = 0.635). Following correction of these parameters for BSA, compared with the control group, SVI (34 vs 45 mL/m² , P < 0.001) and CI (2.96 vs 3.64 L/min/m² , P < 0.001) were significantly reduced in the obese group, whereas SVRI was significantly higher (2354 vs 1840 dynes × s/cm⁵ , P < 0.001).

CONCLUSIONS

The findings of our study suggest that cardiac function is significantly altered in morbidly obese pregnant women. In order to make appropriate comparisons between individuals, it is imperative that hemodynamic parameters are indexed for BSA, as is standard practice in pediatric cardiology. The novel finding of reduced CI in morbidly obese pregnant women may explain the predisposition to pre-eclampsia and other adverse outcomes in this population and warrants further investigation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Alcohol and depression: Evidence from the 2014 health survey for England

BACKGROUND

A relatively large body of literature examines the association between depression and alcohol consumption, with evidence suggesting a bidirectional causal relationship. However, the endogeneity arising from this reverse causation has not been addressed in the literature.

METHODS

Using data on 5828 respondents from the Health Survey for England (HSE), this study revisits the relationship between alcohol and depression and addresses the endogenous nature of this relationship. We use information on self-assessed depression, and control for endogeneity using the Lewbel two-staged least square (2SLS) estimation technique.

RESULTS

We find that drinking alcohol promotes depression, and this is consistent across several measures of drinking behaviour including the amount of alcohol consumed, consumption intensity, alcohol dependence and risk of dependence.

CONCLUSION

While drinking may be generally accepted and in the case of England, part of the culture, this has costs in terms of both physical and mental health that ought not to be ignored. While public policy has predominantly focused on the physical aspects of excessive alcohol consumption it is possible that these policies will also have a direct positive spillover in terms of the mental health costs, through the impact of lower alcohol consumption on quality of life and wellbeing.

Comparison of Health Examination Survey Methods in Brazil, Chile, Colombia, Mexico, England, Scotland, and the United States

Comparability of population surveys across countries is key to appraising trends in population health. Achieving this requires deep understanding of the methods used in these surveys to examine the extent to which the measurements are comparable. In this study, we obtained detailed protocols of 8 nationally representative surveys from 2007-2013 from Brazil, Chile, Colombia, Mexico, the United Kingdom (England and Scotland), and the United States-countries that that differ in economic and inequity indicators. Data were collected on sampling frame, sample selection procedures, recruitment, data collection methods, content of interview and examination modules, and measurement protocols. We also assessed their adherence to the World Health Organization's "STEPwise Approach to Surveillance" framework for population health surveys. The surveys, which included half a million participants, were highly comparable on sampling methodology, survey questions, and anthropometric measurements. Heterogeneity was found for physical activity questionnaires and biological samples collection. The common age range included by the surveys was adults aged 18-64 years. The methods used in these surveys were similar enough to enable comparative analyses of the data across the 7 countries. This comparability is crucial in assessing and comparing national and subgroup population health, and to assisting the transfer of research and policy knowledge across countries.

Framing obesity in UK policy from the Blair years, 1997-2015: the persistence of individualistic approaches despite overwhelming evidence of societal and economic factors, and the need for collective responsibility

Since 1997, and despite several political changes, obesity policy in the UK has overwhelmingly framed obesity as a problem of individual responsibility. Reports, policies and interventions have emphasized that it is the responsibility of individual consumers to make personal changes to reduce obesity. The Foresight Report 'Tackling Obesities: Future Choices' (2007) attempted to reframe obesity as a complex problem that required multiple sites of intervention well beyond the range of personal responsibility. This framing formed the basis for policy and coincided with increasing acknowledgement of the complex nature of obesity in obesity research. Yet policy and interventions developed following Foresight, such as the Change4Life social marketing campaign, targeted individual consumer behaviour. With the Conservative-Liberal Democrat government of 2011, intervention shifted to corporate and individual responsibility, making corporations voluntarily responsible for motivating individual consumers to change. This article examines shifts in the framing of obesity from a problem of individual responsibility, towards collective responsibility, and back to the individual in UK government reports, policies and interventions between 1997 and 2015. We show that UK obesity policies reflect the landscape of policymakers, advisors, political pressures and values, as much as, if not more than, the landscape of evidence. The view that the individual should be the central site for obesity prevention and intervention has remained central to the political framing of population-level obesity, despite strong evidence contrary to this. Power dynamics in obesity governance processes have remained unchallenged by the UK government, and individualistic framing of obesity policy continues to offer the path of least resistance.

Weight status misperceptions among UK adults: the use of self-reported vs. measured BMI

Background

It has been suggested that a significant proportion of overweight and obese individuals underestimate their weight status and think of themselves as being a healthier weight status than they are. The present study examines the prevalence of weight status misperceptions in a recent sample of UK adults, and tests whether the use of self-reported BMI biases estimation of weight status misperceptions.

Methods

Data came from UK adults who took part in the 2013 Health Survey for England. We examined the proportion of overweight vs. normal weight (categorised using self-reported vs. measured BMI) males and females who perceived their weight as being ‘about right’, as well as how common this perception was among individuals whose waist circumference (WC) placed them at increased risk of ill health.

Results

A large proportion of overweight (according to measured BMI) women (31 %) and men (55 %) perceived their weight as being ‘about right’ and over half of participants with a WC that placed them at increased risk of future ill health believed their weight was ‘about right’. The use of self-reported (vs. measured) BMI resulted in underestimation of the proportion of overweight individuals who identified their weight as ‘about right’ and overestimation of the number of normal weight individuals believing their weight was ‘too heavy’.

Conclusions

A large proportion of UK adults who are overweight misperceive their weight status. The use of self-reported BMI data is likely to produce biased estimates of weight status misperceptions. The use of objectively measured BMI is preferable as it will provide more accurate estimates of weight misperception.

The attitudes of student nurses towards obese patients: A questionnaire study exploring the association between perceived causal factors and advice giving

BACKGROUND

Nurses acting in primary care roles are central in addressing obesity as a public health priority. Nurses with a lower Body Mass Index have been shown to have negative attitudes towards obesity. Additionally, where the patient is perceived as being responsible for their excess weight, a negative attitude may also be held. The extent to which negative attitudes may influence the advice provided by nurses to obese patients is unknown.

OBJECTIVES

The present paper sought to examine whether the level of advice offered to obese patients by student nurses is associated with (i) the perceived causal factors of obesity, (ii) attitudes towards obesity and (iii) body mass index of the nurse.

METHOD

Participants were 92 student nurses from a university in the Midlands, UK. Participants received one of four patient vignettes; three were affected by obesity, with reference to either a behavioural, social, or medical cause; and the fourth was normal weight. Student nurses elected advice they would offer from five staged options (from no active involvement in advising the patient, through to discussing dietary advice). Attitudes towards obesity and social desirability were measured using validated questionnaires.

RESULTS

No association was found between the level of advice offered and either the causal factor of obesity, the student nurses' attitude towards obesity, or the nurses' Body Mass Index. Most students endorsed the highest level of advice-a patient centred discussion.

CONCLUSION

Findings show that advice giving by student nurses was not associated with perceived cause of obesity, or attitude, but is in line with the current Nursing and Midwifery Council (2015) recommendations. That is, most students endorsed a patient centred discussion. This suggests that professional training guidelines for the non-judgemental treatment of obese patients are not only being recognised, but implemented.

Sample selection, recruitment and participation rates in health examination surveys in Europe--experience from seven national surveys

Background

Health examination surveys (HESs), carried out in Europe since the 1950’s, provide valuable information about the general population’s health for health monitoring, policy making, and research. Survey participation rates, important for representativeness, have been falling. International comparisons are hampered by differing exclusion criteria and definitions for non-response.

Method

Information was collected about seven national HESs in Europe conducted in 2007–2012. These surveys can be classified into household and individual-based surveys, depending on the sampling frames used. Participation rates of randomly selected adult samples were calculated for four survey modules using standardised definitions and compared by sex, age-group, geographical areas within countries, and over time, where possible.

Results

All surveys covered residents not just citizens; three countries excluded those in institutions. In two surveys, physical examinations and blood sample collection were conducted at the participants’ home; the others occurred at examination clinics. Recruitment processes varied considerably between surveys. Monetary incentives were used in four surveys. Initial participation rates aged 35–64 were 45 % in the Netherlands (phase II), 54 % in Germany (new and previous participants combined), 55 % in Italy, and 65 % in Finland. In Ireland, England and Scotland, household participation rates were 66 %, 66 % and 63 % respectively. Participation rates were generally higher in women and increased with age. Almost all participants attending an examination centre agreed to all modules but surveys conducted in the participants’ home had falling responses to each stage. Participation rates in most primate cities were substantially lower than the national average. Age-standardized response rates to blood pressure measurement among those aged 35–64 in Finland, Germany and England fell by 0.7-1.5 percentage points p.a. between 1998–2002 and 2010–2012. Longer trends in some countries show a more marked fall.

Conclusions

The coverage of the general population in these seven national HESs was good, based on the sampling frames used and the sample sizes. Pre-notification and reminders were used effectively in those with highest participation rates. Participation rates varied by age, sex, geographical area, and survey design. They have fallen in most countries; the Netherlands data shows that they can be maintained at higher levels but at much higher cost.

A review of the use of health examination data from the Health Survey for England in government policy development and implementation

Background

Information is needed at all stages of the policy making process. The Health Survey for England (HSE) is an annual cross-sectional health examination survey of the non-institutionalised general population in England. It was originally set up to inform national policy making and monitoring by the Department of Health. This paper examines how the nurse collected physical and biological measurement data from the HSE have been essential or useful for identification of a health issue amenable to policy intervention; initiation, development or implementation of a strategy; choice and monitoring of targets; or assessment and evaluation of policies.

Methods

Specific examples of use of HSE data were identified through interviews with senior members of staff at the Department of Health and the Health and Social Care Information Centre. Policy documents mentioned by interviewees were retrieved for review, and reference lists of associated policy documents checked. Systematic searches of Chief Medical Officer Reports, Government ‘Command Papers’, and clinical guidance documents were also undertaken.

Results

HSE examination data have been used at all stages of the policy making process. Data have been used to identify an issue amenable to policy-intervention (e.g. quantifying prevalence of undiagnosed chronic kidney disease), in strategy development (in models to inform chronic respiratory disease policy), for target setting and monitoring (the 1992 blood pressure target) and in evaluation of health policy (the effect of the smoking ban on second hand smoke exposure).

Conclusions

A health examination survey is a useful part of a national health information system.

Under-estimation of obesity, hypertension and high cholesterol by self-reported data: comparison of self-reported information and objective measures from health examination surveys

BACKGROUND

Non-communicable diseases (NCDs) cause 63% of deaths worldwide. The leading NCD risk factor is raised blood pressure, contributing to 13% of deaths. A large proportion of NCDs are preventable by modifying risk factor levels. Effective prevention programmes and health policy decisions need to be evidence based. Currently, self-reported information in general populations or data from patients receiving healthcare provides the best available information on the prevalence of obesity, hypertension, diabetes, etc. in most countries.

METHODS

In the European Health Examination Survey Pilot Project, 12 countries conducted a pilot survey among the working-age population. Information was collected using standardized questionnaires, physical measurement and blood sampling protocols. This allowed comparison of self-reported and measured data on prevalence of overweight, obesity, hypertension, high blood cholesterol and diabetes.

RESULTS

Self-reported data under-estimated population means and prevalence for health indicators assessed. The self-reported data provided prevalence of obesity four percentage points lower for both men and women. For hypertension, the self-reported prevalence was 10 percentage points lower, only in men. For elevated total cholesterol, the difference was 50 percentage point among men and 44 percentage points among women. For diabetes, again only in men, the self-reported prevalence was 1 percentage point lower than measured. With self-reported data only, almost 70% of population at risk of elevated total cholesterol is missed compared with data from objective measurements.

CONCLUSIONS

Health indicators based on measurements in the general population include undiagnosed cases, therefore providing more accurate surveillance data than reliance on self-reported or healthcare-based information only.