Search

Background The Italian National Institute of Health (Istituto Superiore di Sanità, ISS) considers health inequalities (HI) an important area of activity. As the scientific and technical body of the Ministry of Health and the National Health Service, ISS may play a key role to reduce HI. In order to enable ISS in addressing the new and crucial HI challenge, a Research Positioning Exercise was designed and implemented. Methods The Exercise included: (i) workshop to strengthen the institutional interest in the field of HI; (ii) review and analysis of ISS publications (years 2000–2017) to identify HI research topics; (iii) survey among ISS researchers regarding main research challenges to address HI in the coming years; and (iv) analysis of input on research challenges from HI international experts. Results The results of this Exercise suggest that the following points should be included in the future ISS agenda planning: (i) themes which ISS should continue working on (e.g. migrants/vulnerable groups); (ii) themes to be improved: (a) relationship between social determinants and mechanism of HI generation and (b) relationship between risk factors exposure and social determinants; and (iii) new themes to be addressed: (a) mechanisms underlying the resilience observed in Italy; (b) new socioeconomic indicators for HI monitoring; and (c) evidence-based policies aimed at reducing HI. Conclusion Findings of this Exercise show that ISS researchers identified relevant areas, addressing inequalities in addressing the health. Because of ISS structural peculiarity that includes multidisciplinary expertise, the ISS could provide a significant contribution to HI research challenges and knowledge gaps.

Background The European Core Health Indicators (ECHI) list provides a 'snapshot' of European public health (including care). It is the result of consecutive EU-wide projects in response to a 1998 European Commission (EC) call to establish an indicator list as the core of the EU public health monitoring system. The current list contains 88 indicators, a large part of which have been implemented and used across the EU. Using ECHI to internationally compare public health aspects adds value to national health information. Currently, EC maintains a tool in which the indicators can be consulted. However, no formal governing entity exists. The aim of this study, under the Joint Action on Health Information (InfAct), is to explore the future of the policy guiding role of the ECHI list, the process of adapting and innovating the list and the role of current member state initiatives in this. Methods Relevant technical information, available via 'doc(umentation) sheets' dating from 2012, was subjected to an update process. Potential improvements in content (additions, deletions, and adjustments), overall balance and policy relevance were suggested by health information experts (via survey and expert meetings). This work will be expanded in the near future of InfAct. Results Peer-reviewed updates of the doc sheets included aligning with meta information from relevant data collecting bodies and reviving web links. A process to guide content changes to the list is in development, balancing sustainability and updates for public health policy. Online background ECHI information is disseminated via ECHI.eu. Conclusions Health information experts still consider the ECHI shortlist important for EU health policy, but it needs to be modernized and promoted. A formal structure is needed to ensure the highest value to EC and MS health policies. The future distributed research Infrastructure on population health (DIPoH) may host the shaping and governing the ECHI, in liaison with EC and MS.

Background The Institute for Health Sciences in Aragon developed a process-mining based algorithm deployed using a container solution to describe the Stroke Care Pathway reproducible in different Health Systems. Our aim is to apply the proposed solution to administrative data of an Italian region to explore interoperability in the case of the stroke care; the study is developed in the context of the Joint Action on Health Information 'InfAct' funded by the European Commission. Methods The target population included 1538055 residents in Marche Region who received National Health System (NHS) assistance in 2017. The collected information was sex, date of birth and death, residence from NHS Beneficiaries database; admission and discharge date/time, hospital code, admission type, discharge status, up to 6 diagnoses from Hospital Discharge database; admission date/time, urgent care facility code, discharge status, diagnosis from Emergency Care database. Patients without hospital/urgent care events were excluded from NHS Beneficiaries database. Care pathway traces and map with frequency information, timing across the pathway and timeline plots with time information were the outputs obtained. Results Data included 17752 patients, 10390 hospital, and 18329 urgent care events. Results were represented graphically, easy to read and spread: 500 episodes of stroke were detected, 66% of patients was hospitalised after emergency room (ER) admissions, 19% directly hospitalised and 10% discharged after ER admission. The most frequent access and exit points of the pathway were ER admission and hospital discharge. Conclusions The application of the stroke case to Italian data demonstrates feasibility and usefulness of interoperability in analysing health care administrative data for public health purposes. A European health information system is crucial to build capacity between researchers across Europe and improve health data on Health Monitoring and Health System Performance Assessment. Key messages Sharing a process-mining methodology deployed using a container solution is a useful strategy to describe care pathways and ensures results’ reliability across European Health Systems. Developing and testing tools to encourage interoperability between researchers across Europe is essential for public health policymaker in Europe.

Background The WHO Global Action Plan for the Prevention of Non-Communicable Disease (WHO-NCD) recommends to halt the rise of obesity by 2025. Obesity is largely preventable. This preliminary analysis aims to assess mean level of BMI and prevalence of obesity in the Italian general adult population using the data collected within the CUORE Project to investigate if Italy can meet the WHO-NCD target. Methods Within the health examination survey conducted in 2018-2019, mean level of BMI and prevalence of obesity (BMI > =30 kg/m2) and overweight (25 Results In this preliminary analysis, mean level of BMI was 26.8 kg/m2 (95% C.I. 26.5-27.1) in men and 25.9 kg/m2 (25.6-26.3) in women. Prevalence of obesity was 19% (16-22) in men and 22% (19-25) in women; prevalence of overweight was 45% (41-48) in men and 28% (25-31) in women. Obesity resulted significantly higher in persons with lower educational level (primary or middle school) vs those with higher education: 26% (20-31) vs 16% (13-19) in men and 33% (27-38) vs 17% (14-20) in women. Both in men and women prevalence of obesity was significantly higher in the Southern regions. Conclusions Preliminary data show that more than half of Italian adults are overweight/obese. However, in comparison to BMI measured in the CUORE Project 10 years earlier, the prevalence of people at normal weight is increasing, moving in the direction of the WHO-NCDs obesity target. Preventive actions at community level should be more incisive in the population at low socio-economic level. Key messages Mean BMI and prevalence of obesity in the Italian general adult population are still high. If confirmed, in the last ten years an increase of normal weight prevalence in the Italian general adult population seems to be occurred.

The European framework of health information (HI) consists - besides the supra-national framework - of national frameworks of health infrastructures. It is therefore essential to strengthening capacities to provide HI and carry out research in countries. Nowadays, one can experience lack of coordination, communication and cooperation between stakeholders in a country, leading to overlap or duplication of research and field-work. InfAct proposes a tool to overcome a majority of these difficulties by encouraging MSs to establish national nodes (NN) as a national focal point for DIPoH. A NN is a building block of DIPoH often coordinated by a national institution or governmental unit that functions as a NN and brings together relevant national stakeholders in an organised way. Researchers from public health institutes and research groups constitute the NN to share expertise and updated knowledge on HI with each other. Currently, there are some active NN in the EU, with differences in scope, scale and initial purpose, due to different organisation of HI systems in countries. Such heterogeneity can also be found in national eHealth strategies. Diverse organizational arrangements exist which has proven to influence collaborative activities. At the same time new needs are arising, such as to better bridge the digital HI between research and health care, so that our health care systems can faster contribute to integrated data driven insights. This also relates to the debate on the Health Data Space, which creation is stated in the mission letter to the new European Commissioner for Health. For example, the eHealth Network has been discussing policy documents targeted at national level policy with regard to the organization of National eHealth Networks. In this pitch presentation, an overview of different practices will be presented with proposals for future work in this area, including the role of NN in DIPoH and proposals for their sustainability. Panelists: H Van Oyen Epidemiology and Public Health, Sciensano, Brussels, Belgium Department of Public Health, Ghent University, Ghent, Belgium Contact: herman.vanoyen@sciensano.be S Montante Brussels Liaison Office, National Institute of Health of Italy (ISS), Brussels, Belgium Contact: sabrina.montante@iss.it E Bacry Health Data Hub, Santś publique France, Paris, France E Bernal-Delgado Health Services and Policy Research Group, Institute for Health Sciences in Aragon, Zaragoza, Spain Contact: ebernal.iacs@aragon.es C Sousa Pinto Advanced Analytics and Intelligence, Shared Services In Ministry Of Health, Lisbon, Portugal Contact: catiasousapinto@gmail.com

Background Differential exposure to lifestyle factors may mediate the association between education and cardiovascular disease (CVD). However, differential susceptibility (the effect of exposure to the same “dose” of risk factors differs across groups) may also elevate CVD risk but the causal pathways remain unclear. Allostatic Load (AL) is a marker of cumulative biological burden resulting from mal-adaptation to chronic stressors. We aimed to examine the role of differential exposure and susceptibility to AL and other factors in coronary heart disease (CHD) educational gradients in Europe. Methods 51,328 35-74-year-old participants originally free of CVD from 21 European cohorts in the BiomarCaRE consortium were identified and followed for a median of 10 years to their first CHD event. We defined an AL score as the sum of z-scores of 8 markers from the cardiovascular, metabolic, and inflammatory systems. To investigate the mediating role of AL (and smoking, alcohol and BMI) on educational differences in CHD incidence we applied marginal structural models and three-way decomposition on gender-specific additive hazards models. Results AL was a significant mediator of the association between educational status and CHD. The highest proportion mediated was observed in women, with 28% (95%CI 20% to 44%) attributable to differential exposure and 8% (95%CI 0% to 16%) to differential susceptibility. In men, AL mediated 16% of the increased CHD risk in the less educated, with 2% (95%CI 0%-6%) attributable to differential susceptibility. The effects of smoking, alcohol and BMI were relatively small for men and women, with a limited role of differential susceptibility. Conclusions While we found evidence of differential susceptibility to AL on CHD, effects were modest and the mediating effect of AL (and other lifestyle factors) was predominately via differential exposure. Controlling disproportionate exposure to AL may help reduce CHD morbidity among those with lower education. Key messages Educational inequalities in coronary heart disease in Europe were predominantly driven by differential exposure rather than susceptibility to allostatic load and other lifestyle factors. Controlling disproportionate exposure to AL may help reduce coronary heart disease morbidity among those with lower education.

Background Italian National Prevention Plan 2005-08 included 10-year cardiovascular risk assessment (10-CR) for the general population aged 35-69 years using the CUORE Project risk score. GPs were encouraged to perform 10-CR and send data to the Cardiovascular Risk Observatory (CRO). Aim To show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population. Methods Data were collected using the cuore.exe software, freely downloadable by GPs from the CUORE Project website (www.cuore.iss.it). The CRO provides a web-platform to compare data on 10-CR and risk factors at regional/national level. For persons examined at least twice, variations in risk factors from baseline to follow-up and 95% confidence intervals (C.I.) were calculated using methods for matched pair samples. Results Up to February 2019, about 3,500 GPs downloaded cuore.exe; about 300,000 CR assessments on about 140,000 persons were sent to CRO. Mean CR was 3.1% in women (W), 8.5% in men (M); 28% of M, 64% of W were at low risk (CR Conclusions Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. Individual risk score is a useful tool for GPs to assess CR and promote primary prevention focusing on the adoption of healthy lifestyles. Data can be used to support health policy decision process. Key messages The cuore.exe software, freely downloadable from the CUORE Project website-www.cuore.iss.it, allows GPs to assess the CUORE Project risk score, to collect and to send data to the CVD Risk Observatory. 10 year Cardiovascular Risk assessment in the general adult population can be an effective first step to implement preventive actions in primary care.

Background The WHO Global Action Plan for the Prevention of Non-Communicable Disease (WHO-NCD) recommends a 25% relative reduction in the prevalence of raised blood pressure (RBP) by 2025. Prevalence of RBP and mean blood pressure in the Italian general adult population measured in the 2018 CUORE Project-Health Examination Survey are presented to investigate if Italy can reach this target. Methods Within the health examination survey conducted in 2018-2019, representative random samples of resident population, aged 35-74 years, stratified by age and sex (822 men and 869 women) were examined in 8 Italian Regions from the Northern, Central and Southern Italy. Blood pressure was measured by automated oscillometric device using standardized procedures and methods; mean level of two measurements are here considered. RBP is defined as systolic and/or diastolic blood pressure equal or greater than 140/90 mmHg or being under specific drug treatment. The survey is funded by the Italian Ministry of Health-CCM. Results Preliminary analysis shows that prevalence of RBP is 43% (95% C.I. 40-47) in men and 32% (29-36) in women. Prevalence of persons with raised blood pressure and not receiving pharmacological treatment is 19% (15-22) in men and 9% (5-12) in women. In men and women prevalence of raised blood pressure is significantly higher in the Southern Regions. Mean value of systolic blood pressure is 131 mmHg (130-132) in men and 122 mmHg (121-123) in women. Mean value of diastolic blood pressure is 77 mmHg (76-78) in men and 73 mmHg (72-74) in women. Conclusions Preliminary data underline that RBP is commonly observed in the Italian adult population. However, in comparison to data measured within the CUORE Project 10 years earlier, prevalence of RBP and mean blood pressure are declining, facilitating the meeting of WHO-NCDs target. Key messages Raised blood pressure is commonly observed in the Italian general adult population. If confirmed, in the last ten years prevalence of raised blood pressure and mean blood pressure are declining in the Italian general adult population.

Background Health information systems both at the national and international level play a key role in ensuring that timely and reliable evidence is used for operational and strategic decision making inside and outside the health sector. The availability of data generated from different sources is increasing with the possibility to link these data sources together. However, more efficient data generation processes are required to use data collected for different purposes initially, as well as advanced statistical techniques to generate comparable and timely health information. The main objective is to explore the innovative use of health information for better public health policy across the Member States. Methods As part of InfAct, we have conducted as survey among EU-MS to describe the innovative use of data sources. We are collecting inspiring examples on the innovative use of health information based on national or European data networks involved with health policy-making at national, regional or local level. We are further developing generic methods to estimate health indicators using machine learning techniques and mathematical modelling. Results These approaches will generate a roadmap on the innovative use of health information across Member States, enlarge the existing list of health indicators estimated from linked data and/or advanced statistical techniques, inform on the implications of these indicators in health policy with inspiring examples from Member States, and provide methodological guidelines for using linked data and advanced statistics to estimate health indicators, and composite outcome measures. Conclusions This work will highlight the gaps in the innovative use of data sources, and improve the comparability of health indicators and the capacity of EU-Member states to apply innovation for increased relevance and timeliness of health information for public health policy-making.

Issue Health literacy (HL) is recognized as a determinant, mediator or moderator of health and of use and results of health care services Inadequate HL is associated with patient disengagement, inappropriateness of care, increased health care costs, and higher mortality rates. Description of the problem Few previous studies suggested that inadequate HL is a prevailing problem in Italy. As compared with the European Countries, Italy has peculiar characteristics of socio-demographic determinants of HL levels, which constitute a challenge for policy making. In so far HL has not been considered as a strategic priority for the Italian National Health Service. The Italian National Institute of Health and Ministry of Health are promoting a national program on HL by adhering to the WHO action network on measuring population and organizational health literacy (M-POHL). Main aim of the program is to propose policies that could enable all citizens to share the benefits of improved HL. A national population survey, coordinated at European level, has been planned in each participating country in 2019. Preliminary results We are setting up the survey using the questionnaire with 47 specific questions about HL and 32 about lifestyles and demographic characteristics. Updated results of this survey will be analysed in order to define a strategic line for the implementation of actions for the improvement of HL in the next National Prevention Plan. Furthermore, the national survey will be scheduled and repeated to monitor results. Lesson State Policies can be implemented at individual, community, organization or system level. Italy is at the beginning of its experience in this field. A national steering committee of experts has also been appointed to support HL policy initiatives. The comparison with existing policies in other countries within the M-POHL action will be another asset to develop HL policies and related activities to benefit citizens, patients and communities.

Background Obesity is a risk factor for the majority of non-communicable diseases-NCDs. In the Italian country profile, the NCD Risk Factor Collaboration estimated the 2010 obesity prevalence at 19.0% (95% confidence interval - C.I. 15.7-22.7) in women aged 18 years and over and 18.5% (95% C.I. 15.1-22.0) in men, with a very low probability (2-9%) of halting the increase of obesity by 2025 (WHO global obesity target). This preliminary analysis aims to assess 20 years trend of BMI and obesity in the Italian general adult population using the data collected within the CUORE Project. Methods Mean of BMI and prevalence of obesity (BMI > =30 kg/m2) in random samples of resident population in 6 Italian Regions, aged 35-74 years, stratified by age and sex, were assessed in an on-going survey started in 2018 (men 612; women 649), and compared to those assessed in the same Regions in 1998-2002 (men 1933, women 1926) and in 2008-2012 (men 1306; women 1318). Weight and height were measured using standardized methodologies. Surveys were partly funded by the Italian Ministry of Health-CCM and approved by the National Institute of Health ethical committee. Results In men, mean values of BMI resulted 26.6 kg/m2 (95% C.I. 26.4-26.8) in 1998 survey, 27.5 (27.2-27.7) in 2008 and 26.5 (26.1-26.8) in 2018; prevalence of obesity was 16.8% (95% C.I. 15.1-18.4) in 1998, 23.5% (21.2-25.8) in 2008 and 17.3% (14.4-20.4) in 2018. In women mean values of BMI were 26.1 kg/m2 (95% C.I.: 25.9-26.4) in 1998, 26.4 (26.1-26.7) in 2008 and 25.5 (25.1-25.9) in 2018; prevalence of obesity was 20.7% (95% C.I.: 18.9-22.5), 21.9% (19.7-24.2) and 19.0% (15.9-22.0) respectively. Conclusions Preliminary data of first 6 Regions (out of 10 to be examined in the on-going survey) suggest that mean BMI and prevalence of obesity in Italian adult population are still very high; if confirmed, in the last ten years a reduction seems to be occurred increasing the probability of meeting the WHO obesity target by 2025. Key messages Mean BMI and prevalence of obesity in Italian adult population are still high. If confirmed, in the last ten years a reduction of mean BMI and prevalence of obesity in Italian adult population seems to be occurred.

Issue The WHO Global Action Plan for the Prevention of NCDs recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan (NPP) 2014-2019, with the collaboration of the Interdisciplinary Working group for Salt Reduction in Italy (GIRCSI). Description of the problem According to the “Gaining Health” Programme, agreements between the MoH and the associations of artisan bakers and food industry companies were signed since 2009 to reduce the salt content in bread and in other food products. The reduction of excessive salt intake is one of the main objective of the NPP 2014-2019 pursued by the Regions through initiatives as local inter-sectors agreements and information activities for the population and training for food sector operators. The Italian Institute of Health conducts national surveys to estimate habitual salt intake in the general adult population by collecting 24h urine. Baseline assessment was in 2008-2012 from random samples of persons aged 35-79 years, resident in all 20 Regions. A new survey is ongoing (2018-2019) involving persons aged 35-74 years, resident in 10 Regions. Surveys are funded by the MoH-CCM; urinary sodium excretion is effected by a central lab at Federico II University of Naples, subjected to strict quality controls. Results The baseline survey showed a mean sodium excretion of 10.6 g/24h (95% confidence interval 10.5-10.8) in 1963 men and 8.2g/24h (8.1-8.4) in 1894 women. Results of the ongoing survey are expected in the coming months. Lessons In Italy preventive actions of salt reduction supported by the MoH have been implemented. Estimation of salt intake in diet by 24h/urine is included. Results of baseline and on-going surveys will allow to estimate the possibility of meeting the WHO salt reduction target by 2025. Key messages In Italy inter-sectors preventive actions of salt reduction are implemented. Results of the baseline and on-going surveys will allow to estimate in Italy the possibility of meeting the WHO salt reduction target by 2025.

Background Health Literacy-HL is an important determinant to improve and maintain health and quality of life during life course. HL implies people’s knowledge, motivation, competencies to access, understand, appraise, apply information to make judgements and decisions in everyday life concerning healthcare, disease prevention, health promotion. Thanks to Ministry of Health funds, Italy joined the WHO Action Network on Measuring Population and Organizational Health Literacy-M-POHL for collecting comparable data on HL in order to measure and promote citizens’ HL among MS. Objective: The HLS-EU-Q16 questionnaire was administered to a sample of adult population during the Health Examination Survey-HES of the CUORE Project started in 2018, to verify and evaluate the feasibility of the HL survey. Methods One hundred people aged 35-74 years, resident in Reggio Calabria (South of Italy), were interviewed (face-to-face) following consecutive access to the HES. According to the HLS-EU-Q16 sum score, three levels of HL were defined: inadequate, problematic, and sufficient. HL mean score and standard deviation-SD were elaborated together with prevalence of the three HL levels. Socio-demographics conditions, lifestyles, risk factors were measured during the HES. Results HL mean score of 98 completed questionnaires (47 men, 51 women) was 13.0 (SD = 3.5), with no sex difference; prevalence of persons with inadequate HL was 11.2%, problematic 26.5%, sufficient 62.3%. Sufficient HL level presents the highest prevalence (72%) of high educational level. Smoking habit decreases as HL level increases. Conclusions The HLS-EU-Q16 questionnaire represents a standardised tool applicable in the general population. Preliminary results from the Italian pilot of the HLS-EU-Q16 suggest that the survey is feasible within the HES of the CUORE Project, with the opportunity to link HL data with HES measured data. More than one third of interviewed adult population have inadequate/problematic HL.

Background Identification of high risk individuals is one of the main goals of the primary prevention of cardiovascular disease (CVD) and constitutes the basis for implementing actions aiming at reducing modifiable risk factors at individual level through changing life styles or drug interventions. The most appropriate method for identifying high risk individuals is the absolute risk assessment, a probability indicator of incidence, predictable on the basis of risk factors levels. Objectives The CUORE project score of the National Institute of Health-ISS is adopted in Italy; since 2007 ISS has implemented a national training course for General Practitioners-GPs with the aim of supporting and facilitating the use of CVD risk assessment in clinical practice as a preventive action in the general population. Results The training course is based on five sequential packages linked to educational credits: packages 1-2 facilitate the adoption of standardised methodologies for the assessment of CVD risk score; in package 3 patients are invited by GPs to assess the risk score; packages 4-5 evaluate and discuss data collected with GPs and stakeholders. A cascade training was implemented: ISS personnel provided training to local GPs who in turn provided the same training to other GPs. Two manuals for the training course were published. Since 2007 about 4,300 GPs were trained; about 320,000 10-year CVD risk assessments were performed in 260,000 men and women aged 35-69 years. Feedback was provided to all GPs participating to the 4th-5th packages of the training courses. Conclusions Implementation of the training course for the use of CVD risk assessment in the population represents a primary preventive action according to the recommendation of the EU Guideline on CVD prevention. The collected data may play an important role in the identification of strengths and weaknesses of preventive actions and represents the first step to improve good clinical practices standards.

Background Data collection methods, metadata-reporting standards and usage of data for health monitoring (HM) and health system performance assessment (HSPA) are not uniform in Europe. Moreover, the evidence produced by research are not always available, comparable or usable for research purposes and policy making. The aim is to summarize health data collection methods, quality assessment, availability and accessibility procedures covering different data sources for HM and HSPA across EU countries. Methods The study is conducted through a multidimensional approach, which includes: i) a review of institutional websites (OECD, Eurostat, WHO-Europe); ii) a review of EU research networks; and iii) a multi-national survey addressing epidemiologists, health data managers and researchers that have played leading roles in EU projects. Currently, the survey instrument is being piloted. A qualitative data analysis to describe and compare the identified data sources for HM and HSPA will be performed. Results As part of the work within the Joint Action ‘Information for Action’ (InfAct), the study will generate knowledge on standardized health data collections and related metadata, used methods and procedures for HM and HSPA in EU. It will also facilitate the identification of national or sub-national health data collected through standardized procedures but not included in international databases or research networks. Conclusions The lack of infrastructures for health data sharing in EU limits data usage and comparability within and between countries. This study, as part of InfAct, will facilitate the assessment of health inequalities across EU countries in terms of quality, availability, accessibility and comparability of health data and information. It will also facilitate sharing and dissemination of standardized and comparable health data collections, which are essential for research and evidence-based policy-making.

Background Italy has a long tradition of cardiovascular surveys. Due to the decline in the participation rates, in the OEC/HES new exams such as bone densitometry were added; more attention was put to select and train the fieldwork staff; possibility to change the appointment was offered. Methods The OEC/HES was conducted in May 2008-July 2012; 220 men and women aged 35-79 years per 1.5 million persons were randomly selected for a …

Background Health reporting should deliver up-to-date data and information on the population's health status, its determinants and on national (or regional) healthcare services. Establishing an information or discussion base for health policy is an important objective ('data for action'), but health reporting also addresses other target groups like scientists, the media or the general public. Depending on the needs and competencies of the respective target groups, requirements for health reporting formats will differ. At the same time, heterogeneity of health reporting practices in Member States causes, next to occasional language barriers, difficulties in facilitating access to EU-comparable information. To allow for alignment and identification of good practices, our study aims to provide a comprehensive overview of the health reporting formats in the EU. Methods A web-based desk research of health reporting formats and their target groups was conducted among EU Member States and associated InfAct partner countries. Good practice examples were identified on the basis of quality criteria derived from 'Good Practice in Health Reporting' for Germany and the Eva PHR (Evaluation of National and Regional Public Health Reports) project. Based on the findings of the desk research, a guidance document for health reports will be drafted in close cooperation with InfAct partner countries. Results The guidance should accommodate the heterogeneity of reporting practices at EU level while defining desirable and feasible good practice standards. Although the focus is on public health reports, recommendations for other formats of health reporting will also be included. It will facilitate the preparation, dissemination and access to EU-comparable and high-quality health information. Conclusions The guidance is expected to be a useful tool for making health information adequately available to the targeted groups while reducing inequalities in health reporting across the EU.

Background Prioritization of Health information (HI) involves the establishment of methodological standards, and the development of political momentum to reliably track health status and health determinants. This is important in order to strengthen the evidence base for public health policies and facilitate effective delivery of healthcare services. In support of the establishment of a sustainable EU-wide Health information system, this consortium explores how HI is prioritized in EU and associated countries. Methods The Robert Koch Institute is conducting an online Policy Delphi survey among InfAct project partners, stakeholders from EU-Member States and associated countries. The Delphi methodology allows for rankings and priority-setting among a group of experts. The Policy Delphi facilitates the analysis of the impact and acceptability of a proposed policy option. The survey targets experts in national public health institutes and agencies, ministries of health and research. Participants are invited to provide information regarding their national HI prioritization processes, and to rank prioritization strategies and criteria, according to their degree of “desirability”, “feasibility”, “importance” and “confidence”. Results The Delphi survey will compile and assess processes and methods used to prioritize health information at national level in the EU and associated countries. The expected outcome is a list of good-practices in health information development and prioritization within countries, which could be further integrated to a health information prioritization strategy at the European level. Conclusions Prioritizing health information ensures that the right data is collected, is used to support ongoing public health policy action, and to capture emerging public health issues. This overview of prioritization strategies and methods aims to promote evidence-based public health by structuring exchanges about national HI prioritization in Europe.